So you get hurt at work and not long after, you get a cheery letter from a “nurse case manager” or “case manager” or “rehab consultant,” happily telling you she will be accompanying you to all your doctor appointments, just to help you out with care. But she doesn’t work for the doctor, and she can’t prescribe any treatment.
Who is this person, and what does she do?
The intended purpose of nurse case managers is simple, but they can complicate your case. Nurse case managers:
Maybe you already caught the potential complication: all nurse case managers work for the insurance company. So you’ve got to be careful, and you’ve got to know your rights, especially if the nurse case manager turns out to be a bad apple who’s out to close your case cheaply. Mind you, many nurse case managers are genuinely concerned for your health and can really help you get good care.
So here’s the good, bad, and ugly on nurse case managers—plus a review of your most important rights.
If you’ve got questions about nurse case managers or how South Carolina workers’ comp “works,” don’t suffer in silence. Get your questions answered in a free*, no pressure strategy session with a Spartanburg, SC workers’ comp attorney. Call toll free at (864) 582-0416 or fill out a Get Help Now form.
Legally, the nurse case manager’s primary concern is supposed to be your recovery and return to work. For you, they are supposed to facilitate, coordinate, and manage your care. That means they should, most importantly:
All this is good, but there’s some potential bad, too.
Here’s the main thing: you’ve got to remember they work for the insurance company, which profits by limiting your treatment and settling cheaply in the end. That’s really bad only if you’ve been assigned a nurse case manager bent on helping the insurance company instead of you.
Many folks get uncomfortable over the fact nurse case managers can learn a lot about you without your consent. That includes:
When a nurse case manager abuses these privileges, it leads to…
Rarely, we get a nurse case manager who’s just an advocate for the insurance company. Warning signs include:
If that’s the case, you need an experienced workers’ compensation attorney immediately to help protect you. Because you’ve basically got an insurance executive tagging along at your medical visits, looking to shortchange you—medically and financially.
But you’ve still got rights, and they are important. You need to know them.
The most vital right is that you can choose to be examined in private by the doctor. If so, the nurse case manager can’t come in for that.
We’ve found that in most cases, that’s the best way to do it. Even if you’ve got an injury that’s not embarrassing, like a broken arm, it’s just easier on you—and maybe even the doctor—to do the exam without an audience. Doctor visits are not a spectator sport.
Plus being alone with the doctor makes it easier on lots of folks to share their symptoms freely. If you injury isn’t embarrassing, sometimes the effects of it can be. No tough factory worker wants to admit their shoulder keeps them from picking up a grocery bag. Having those conversations are hard enough when it’s just with a doctor you feel is on your side. Doing it with a nurse case manager there can just make some people clam up, leaving out important symptoms that can make a real difference in the doctor’s diagnosis, treatment—and the outcome of their case.
So it’s better to do it in private, because if you don’t paint the doctor an honest and thorough picture of what you’re going through, it can lead to inaccurate medical conclusions that can wreck your case.
Your second most important right: You have the right to be present when the doctor and nurse case manager discuss your case. Listen carefully. If anything’s missed or misstated, pipe up! This is your case, and your body, and you’ve got to help the doctor help you.
Workers’ compensation is designed to help workers, but many find it complicated, confusing, and even a little intimidating. Don’t just let your case happen to you. Take a little control back!
One of the unspoken benefits of having an experienced workers’ comp lawyer on your side is that you’ve got a guide to help you through the system—a guide who knows it just as well as everyone who’s against you on the other side. The nurse case manager’s got the insurance company’s back, just like the adjuster, so you need a professional who’s got yours.
If you’ve got any other questions, feel free to start a live chat from our website, where you’ll get your questions answered by a skilled workers’ compensation attorney or feel free to schedule a free strategy session with us by calling our office at (864) 582-0416. You can also download our book The Hurt Worker’s Toolkit to get valuable information to help you.
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