When You’re Assigned a Workers’ Comp Nurse Case Manager

If your workers’ compensation claim is approved, your employer’s insurance company may assign you a nurse case manager. A workers’ comp nurse case manager is a healthcare professional who manages a patient’s long-term care, serving as liaison between medical providers and the insurance company. A nurse case manager can help ensure injured workers receive all the care they need, but it is worth remembering that part of their job is to minimize costs for the insurance company.

What Does a Workers’ Comp Nurse Case Manager Do?

The typical duties of a nurse case manager can vary, depending on the patient’s needs and the instructions of the insurance company. A good nurse case manager will assist in coordinating a path to full recovery from your work injury. A bad nurse case manager will try to dictate what treatment you receive—or don’t receive—on behalf of the insurance company’s interests. Typical duties may include the following:

• Create a return-to-work plan for the injured employee
• Schedule medical appointments and follow up on them
• Communicate status of the employee’s recovery to the insurance company
• Provide required paperwork to approve insurance for treatments and medication
• Arrange transportation for appointments
• Coordinate with healthcare professionals to ensure patient’s specific needs are met

Your Rights When Working with a Workers’ Comp Nurse Case Manager

Section G of Utah Admin. Code R612-300-2 – Obtaining Medical Care for Injured Workers goes over the injured worker’s right to privacy (note the “agent of the payor” includes nurse case managers):

No agent of the payor may be present during an injured worker’s medical care without the consent of the injured worker. However, if the payor’s agent is excluded from a medical visit, the physician and the injured worker shall meet with the agent at the conclusion of the visit or at some other reasonable time so as to communicate regarding medical care and return-to-work issues.

When you meet with a healthcare professional for an exam, checkup, treatment, or surgery, you have the right to decline a nurse case manager’s presence. This way you and the doctor can decide on treatment, medication, and work restrictions without outside influence. The nurse case manager may speak to your doctor after the conclusion of your appointment, and you may wish to stick around to ensure the message they receive is accurate. They will be reporting back any useful information to the insurance company they work for.

Careful Communication

Here are a few tips to keep in mind when speaking with your nurse case manager:

• Don’t agree to any changes to your recovery plan before consulting with your doctor.
• Don’t downplay your injury or illness, or try to guess how soon you will get better.
• Don’t talk about issues unrelated to your current injury or illness (such as pre-existing conditions).
• Don’t let yourself get pressured into saying you’re ready to return to work before you’ve made a full recovery.
• Don’t agree to change your doctor at the nurse case manager’s insistence.

Your Doctor, Your Nurse Case Manager, and Your Workers’ Compensation Attorney

Remember, it is your doctor who should be recommending a course of treatment for your recovery—not the nurse case manager. If you feel your nurse case manager is making decisions that are not in your best interest, go over your concerns with them. If they are unwilling to cooperate, try speaking with the claims manager of your employer’s insurance company. Or get in contact with a workers’ compensation lawyer (such as a Rose Legal attorney), who can help protect your rights and keep the nurse case manager from damaging your claim.