Brian Clymer, Attorney at Law

Nurse case managers -- whose side are they on? Not the injured worker's in most cases

We often see that when an injured worker's case begins to get complicated the insurance carrier typically contracts with a third-party company to assign a nurse case manager ("NCM") to the claim. The NCM says he or she is there to "help" you with the medical aspects of your claim, to schedule medical appointments, and to meet with your doctors. In reality, you should assume that the NCM is working for the insurance carrier.

Keep this assumption in mind before you agree to let the NCM speak to your doctors when you are not present. Additionally, you do not have to let the NCM in the exam room while the doctor is examining or treating you for your industrial injury. 

If you have already given permission for the NCM to speak with your doctor outside your present, you can rescind the authorization in writing. Be sure to give copies rescinding authorization to the NCM, the claims adjuster, and your doctor, so your treating doctor will not speak with the NCM unless you are present. Remember, however, the carrier is allowed copies of the doctor's medical notes about the appointment.

Recovering from an industrial injury is stressful. If this is the first time you have been injured on the job, the workers' compensation system can be intimidating as well, leading to feelings of vulnerability. Nurse case managers proclaim they are here to help you, but keep in mind the following:

  1. The law does not describe the role for a NCM in a workers' compensation case.
  2. Insist on being present with the NCM talks with your doctor.
  3. There is no legal requirement that the NCM be present or in the exam room during examination and treatment with your doctor.

If you have questions about the role your NCM is playing or about your workers' compensation claim, call our office at (520) 323-1234 to schedule an initial interviw.

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