Nurse Case Manager: Friend or Foe?

Michigan workers comp lawyer explains the purpose of the nurse case manager and what to do if you are being treated poorly.

Insurance companies go to great lengths to save money on workers comp claims.  This is especially true when benefits are being paid voluntarily and there is no dispute.  Insurance companies will use nurse case managers to influence your medical treatment with the hope of reducing costs.

A nurse case manager is supposed to help coordinate medical care so that you can recover from your injury.  Like everything else, there are some good nurse case managers and some bad.

It is important to make sure that any nurse case manager has your best interest at heart and is not just out to save the insurance company money. You should always follow the recommendations of your doctor and don’t let the nurse case manager interfere with your medical treatment.

Medical Case Management Do’s and Don’ts

The State of Michigan has outlined some guidelines regarding nurse case managers that you should know about:

DO:
 
-Be inclusive of all parties involved in the medical recovery process, especially the injured employee and their family.
-Include goals and timeframes when creating the care plan, and allow for updates as needed.
-Determine if treatment is appropriate.
-Determine if funding for case management services is secured before proceeding.
-Determine what is needed for successful return to work, especially from employer’s perspective.
-Provide client advocacy and support at all times, and provide input and guidance on treatment services…BE A LIAISON BETWEEN PARTIES.
-Use valid disability duration guidelines, and use them as GUIDELINES.
-Educate all parties, especially employer, whenever possible on the positive and cost-effective aspects of return to work programs and processes.
-Always obtain and maintain appropriate releases of information prior to beginning case management services.
-Understand that there are many players in the case management process, but that your main client should always be the injured employee.
-Always identify clearly your role as a case manager to the employee at the start of the relationship.
 
DO NOT:
 
-Give legal advice at any time.
-Schedule IME appointments.
-Change employee’s doctor appointments just to fit YOUR schedule.
-Withhold information crucial to RTW success.
-Perpetuate disability by failing to address doctor recommendations, health concerns, or return-to-work issues in a timely fashion.
-Become personally and/or emotionally attached to the client.
-Assume that you have an absolute right to attend all doctors’ appointments despite client wishes against it.
-Interfere with due process between employee and employer.
-Initiate cost services prior to obtaining carrier authorization.
-Provide legal direction to the claims adjuster, or engage in claims investigative or adversarial activities.

Get help from an experienced workers comp lawyer

If a nurse case manager is interfering with your medical care or treating you badly, we can help. You have the right to privacy in the examination room and to know what is being said behind your back.

We will stand up to the insurance company so that you don’t have to fight alone.  To speak with one of our workers comp attorneys, call (855) 221-COMP for a free consultation. There is no fee unless workers comp benefits are recovered for you.

Alex Berman is the founder of the law firm. He’s been representing injured and disabled workers exclusively for more than 30 years.  Alex has helped countless people obtain workers compensation benefits and never charges a fee to review a case.

Related information:

Video: Injured at work? Advice from a Michigan workers comp lawyer

FAQs about workers compensation to help protect you

Photo courtesy of Creative Commons, by David Goehring.

05/01/2011
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