Should I work with the workers’ comp nurse case manager?

Workers Compensation - March 4, 2023

The attorneys with Horwitz, Horwitz & Associates get this question a lot when representing clients in workers’ compensation cases. Many of our clients are annoyed, and even intimidated when they realize there’s a workers’ comp nurse case manager speaking with their doctor. However, many don’t realize they have control over the situation.

What is a workers’ comp nurse case manager?

When an employee suffers a workplace injury and files a workers’ comp claim, the insurance company will likely want to bring in a workers’ comp nurse case manager.

The case manager is a medical professional who works for the insurance company and, in an effort to save their employer – the insurance company – money, they try to insert themselves in your treatment, pushing to be present at your appointments and communicate with your doctors.

They don’t work for you, they work for insurance

The problem most people have with a workers’ comp nurse case manager is that they try to discuss their care with the doctors and medical providers, even without the patient present.

Nurse case managers are often intrusive, going so far as to suggest cheaper methods of treatment. They’ll tell a doctor whether or not the insurance company will cover those methods, and tell the medical team whether or not the insurer believes a course of treatment is appropriate or necessary.

Factors to consider before working with a nurse case manager

If a workers’ comp nurse case manager has been assigned to your case, remember that you have control. The manager doesn’t have the right to be present at your appointments and definitely doesn’t have the right to interfere with your treatment. You have the right to request that person be removed from your case at any time.

Here are some of the factors to consider when making your decision regarding whether you want to work with the case manager.

• The severity of your injury or illness – The nurse case manager might try to downplay how badly you’re injured. They may also act as sort of a “spy” for the insurance company, employing tactics to appear to be on your side. The nurse case manager might try to convince the doctor that you’re actually doing much better than you’re letting on and that you should be released to go back to work earlier than you should.
• The complexity of your medical treatment – Insurance companies are going to do everything they can to pay as little as possible for your case. The workers’ comp nurse case manager may try to pressure the doctor into offering a less costly course of treatment that might not be as effective.
• Your personal preferences and comfort level – Lots of injured workers don’t want the nurse case manager present during their appointments and don’t want them talking to their doctor behind their back.

Remember, the case manager works for the insurance company, not for you. While there are many managers who genuinely care about injured workers, the vast majority are going to place the insurer’s interests over the patient’s.

You’ll need to have an attorney working on your behalf to make sure there are clear rules regarding how that manager will act, such as when they can and cannot be present, and whether or not they can talk to your doctor without you or your attorney present for the conversation. This can help ensure that your rights are protected, not the insurance company’s pockets.

Horwitz, Horwitz & Associates is here to protect your rights

Our law firm has decades of experience dealing with workers’ comp nurse care managers. Let us put that experience to work for you. Call our skilled Chicago workers compensation attorneys at (800) 985-1819 for a free case review.