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Who Is This Nurse Case Manager Assigned to My Case?

Burdine & Brown Oct. 18, 2019

A Nurse Case Manager could be an insurance representative or a telephone case manager. Their theoretical purpose is to help you, the injured person, to access quicker and better medical care so you can return to work faster. That is not always the case.

What actually happens is that the Nurse Case Manager that meets you in the company doctor's office has an agenda. It is most often to push the doctors to release you to work earlier than appropriately. In fact, the nurses many times try to take over the conversation with the doctor while you are sitting there on the examination table. The company doctors are trained to listen to the nurses rather that to you.

You then ask, how can they get away with this? The law changed a few years ago giving the NCM the right to talk to your doctor even if you are not present. No telling what the nurse says to the company doctor. (You do have the right to be present for those conversations if you push hard but rarely does the injured workers think to do this).

Again, in theory we are all hoping that the nurse assigned to your case has your interest as her/his number one priority. That is just such a rare thing. Who assigns the nurse to your case? Who pays the nurse for their services? Of course, it is the insurance company. Who assigns future work for the NCM? The insurance company is the lifeline for the future business of the NCM.

The best possible scenario is for your doctor to “just say no” to allowing the NCM to enter into his office, to enter into the exam room at any time. Most doctors are too weak of heart to take this positon. They want to “get along” rather than act in your best interest.

In the very few occasions when the NCM is helpful it is to push the adjuster for approval of the medical treatment proposed by your doctor. In those cases, the NCM is a welcomed partner but, of course, the NCM must have your interest as their number one priority. A rarity indeed.