If you are receiving worker's compensation you may have a nurse case manager assigned to your case. While there are generally clear guidelines for your nurse case manager, you may feel that he or she is a bit intrusive on your privacy. It's important to understand the role of your nurse case manager. That way, you may be able to determine if the actions he or she takes are appropriate or not. Here's what you need to know.
What Does a Nurse Case Manager Do?
A nurse case manager facilitates treatment by arranging appointments with various medical professionals and discusses your treatment with them. He or she may schedule appointments on your behalf to suit your schedule as well as their own. Another role of a nurse case manager (NCM) is to get you back on your feet again so you can return to work—all while containing the costs of your treatment. He or she reports back to the entity that hired them on a regular basis.
Who Does Your NCM Work For?
Your NCM works for the insurance company, your employer, or a 3rd party administrator if your employer is self-insured. This person acts as a liaison between you, your medical team, your employer, and the entity who hired them. However, he or she is not a non-biased party.
Does that Mean there Is a Conflict of Interest?
While it's true that your NCM likely does want to see you recover from your work-related injuries, his or her main role is not to expedite your recovery for your sake—but for the sake of the insurance company. Generally, a NCM may appear to be on your side, but in all honesty they are not. Since the costs of your treatment are covered by the insurance company, and one of the roles of your NCM is to contain those costs, it may mean a conflict in interest.
You may feel that your NCM is trying to move things along too quickly without allowing you time to recover. However, he or she cannot decide what your treatment will be or how long it will take. That is the job of your doctor.
Will Your Doctor Work with Your NCM?
Your NCM will be present at all your appointments, but this doesn't mean that he or she needs to be in the room with you during your examinations if you do not want them tagging along. After your exam, your NCM will talk with your doctor about the exam and to discuss treatment. It's a good idea to be there when these discussions take place. Your doctor will discuss your case with your NCM because, ultimately, it's their employer who is paying your medical bills. However, this doesn't mean that your doctor is required to agree with any recommendations or suggestions given by your NCM about your treatment.
Can a Lawyer Have Your NCM Dismissed?
If you are concerned about the way your NCM handles things, especially if you feel that your privacy is being invaded or your NCM tries to force changes to your compensation too early, inform your worker's compensation attorney. Your attorney may be able to get the NCM dismissed from your case. More than likely, however, the NCM will not be dismissed but will start to act more appropriately due to the fact that you have legal representation.
If you have a NCM assigned to you, it's a good idea to understand what their role is and who they work for. That way, you will know to keep a watchful eye on them while they embed themselves deeply into your medical issues involving your worker's compensation claim. If you feel your NCM is overstepping boundaries, hire a worker's compensation attorney, like those at Lovett Schefrin Harnett.