Should I accept a nurse case manager’s assistance?

Growing numbers of Georgia employers are using nurse case managers to oversee injured workers’ medical care. However, Georgia law does not require case managers be used, and someone hurt at work is free to accept or refuse a case manager’s help, as he may prefer. If you’ve been hurt on the job, there are several important factors you’ll want to consider before deciding to accept a nurse case manager’s assistance.

About the Nurse Case Manager’s Role

A nurse case manager is typically hired by a workers’ compensation insurer to work with the injured worker, and to act as a liason between the doctors and the insurance company. In the majority of cases, a nurse case manager is a trained registered nurse with previous experience in the health care field.

Tasks a nurse case manager may perform include:

  • To perform “triage” immediately after an injury to schedule the necessary care and position the worker for a quick recovery.
     
  • To provide telephonic or field case management services.
     
  • To coordinate ongoing appointments with various care providers.
     
  • To obtain information needed to process the claim.
     
  • To answer questions from the injured worker.
     
  • To develop a plan to return the worker to his regular employment duties.
     
  • To make home visits to make sure an injured worker is following the doctor’s recommendations regarding his recovery.
     
  • To meet with the injured worker’s supervisor to perform on-site evaluations and recommend modifications necessary for a return to work.

Some employers and workers’ compensation insurers will automatically attempt to assign a nurse case manager to every injured worker. Others make decisions based on the severity of the injury or only assign a nurse case manager if the injured worker doesn’t appear to be making progress towards returning to work.

Potential Conflicts of Interest

As the nurse case manager is working for the insurance company, this can often result in a conflict of interest with respect to coordinating your medical care. Potential problems that may arise include:

  • She may advise you to stop treatment in order to save your employer money—even though you’re not yet fully recovered from your injuries.
     
  • She may direct you to a doctor who is known to release patients back to work before they’re ready to perform their normal job duties.
     
  • She may try to convince you to avoid seeking a second opinion, even though you may feel that the treating physician is not properly addressing your injury complaints.
     
  • She may try to convince your doctor to sign reports that say you’re exaggerating your injuries or trying to avoid going back to work.

To illustrate the cost-savings effect nurse case managers have for insurers, consider that a 2011 report from Boston-based Liberty Mutual Insurance Company found that nurse case managers reduced medical costs associated with workers' compensation claims by $6,100—producing a return on investment of eight-to-one.

Never forget that a “good” outcome will be defined differently by you and by your nurse case manager. Your nurse case manager’s priority is getting you back to work as soon as possible. Your priority is making sure you’ve recovered fully from your injuries and aren’t placing yourself at further risk. A nurse case manager's actions could also ultimately result in you receiving a smaller settlement on your claim than if you had not consented to that person's involvement in your case.

Consenting to Use Nurse Case Manager’s Services

Contrary to popular belief, in most cases, you’re not legally required to have a nurse case manager work on your claim. According to the State Board of Workers' Compensation, key points to remember regarding consent to use a nurse case manager include:

  • Consent of either you or your attorney is required for a nurse case manager to work with you on your claim.
     
  • Written consent is required for a nurse case manager to attend your medical appointments.
     
  • Your consent is not required for the nurse case manager to contact your physician for the purpose of assessing, planning, implementing, and evaluating options and services required for your treatment.
     
  • You have the right to withdraw previously given consent at any given time.

If you have questions about the nurse case manager’s role, or feel that your nurse case manager is damaging your workers’ compensation case, Rechtman & Spevak can help. Our attorneys are committed to helping Georgia residents receive fair and timely workers’ compensation settlements. Please contact us to schedule a free, no-obligation consultation.