Lawyer explains your legal rights when a workers’ comp nurse case manager has been assigned to the claim.
Many of the injured employees who contact our office want to know about the workers’ comp nurse case manager. Who is this person showing up at medical appointments? Is it necessary to give them a signed medical authorization? Should they be allowed into the examination room? Are they allowed to speak with the doctor alone?
Injured employees are entitled to medical treatment and lost wages regardless of fault. It is no secret that insurance companies want to save money on these claims. This is especially true if benefits have been paid for an extended period. A workers’ comp nurse case manager can help them save money.
What is the purpose of a workers’ comp nurse case manager?
A workers’ comp nurse case manager is the insurance carrier’s eyes and ears on the ground. They attend medical appointments and help coordinate care. Our experience shows that some cross the line and become advocates for the insurance carrier by manipulating work restrictions or interfere with medical care.
An injured employee need not cooperate with the workers’ comp nurse case manager. Rules to follow include not allowing them into the examination room until after the physical examination is completed. It is also a good idea to make sure they not permitted to speak with the doctor alone.
Here are some guidelines published by the State of Michigan regarding medical case management. Use the following as a workers’ comp nurse case manager checklist to make sure legal rights are not being abused. We recommend contacting an experienced workers’ comp lawyer if problems occur.
What To Do:
Adhere to all state licensure requirements.
Coordinate activities of medical professionals, community agents, funding sources, client and family for the goal of achieving maximum functional outcomes.
Facilitate inpatient, outpatient, and home services as well as medical evaluations and environmental modifications as needed.
Assist in securing funding for medical equipment, supplies, medications and services in a cost-effective manner.
Provide information to the client to help facilitate timely and appropriate treatment.
Guide client to self-directed care, self-advocacy and decision-making to the degree possible.
Maintain a professional rapport and open communication with all members of the team so that the care plan can be discussed objectively, problems identified and adjustments made as needed.
Make adjustments in the care plan to promote better outcomes, if the plan is static or regressive.
Coordinate the care plan with an established critical pathway to determine variances.
Support the stability of the client and family environment.
Be inclusive of all parties involved in the medical recovery process, especially the injured employee and his/her family. The client should be an active participant in the development of the care plan, and/or the legal guardian when necessary.
Include goals and timeframes when creating the care plan, and allow for updates as needed.
Educate the involved parties on suggested treatment options to allow informed decision-making.
Once a treatment plan is chosen, ensure that the client is following that plan.
Validate the funding for case management services prior to proceeding.
Verify the needs of all parties to ensure successful return-to-work, especially the employer.
Provide client advocacy and support at all times, and provide input and guidance on treatment services…BE A LIAISON BETWEEN PARTIES.
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 participants 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.
What Not To Do:
Give legal advice at any time, including the signing or witnessing of legal documents.
Question the physician or employee or make determinations regarding issues of claim compensability or work relatedness.
Initiate cost services prior to obtaining carrier authorization.
Schedule Independent Medical Examination (IME) appointments.
Change or reschedule the client’s medical appointments without first discussing the need for change with the client.
Withhold information crucial to the return-to-work process.
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.
Provide legal direction to the claims adjuster or engage in claim investigation and/or adversarial activities.
Have questions about your workers’ comp nurse case manager? Call now, our attorneys can help!
If you suffered an injury on the job and you have questions you workers’ comp nurse case manager, call now to speak with an experienced attorney, or fill out our contact form for a free consultation. There is absolutely no cost or obligation. We’re here for you.
Our attorneys have been exclusively helping injured workers in Michigan for more than 40 years. Our attorneys can help you better understand work injury laws and what happens after someone has been hurt on the job. To see what our own clients have to say about the caring, compassion, and communication they received from us, you can read in their own words about their experience here on our testimonials page from clients we have helped.
Michigan Workers Comp Lawyers never charges a fee to evaluate a potential case. Our law firm has represented injured and disabled workers exclusively for more than 35 years. Call (844) 201-9497 for a free consultation today.
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