What is a Nurse Case Manager?

What is a Nurse Case Manager?

The short answer:  a nurse paid by the insurance company who answers to the insurance company, not to you.

Many times, when you are injured at work, the workers’ compensation insurance company assigns a Nurse Case Manager to you to “help you” and it sometimes even seems like it’s a great thing, because this “nurse” will seemingly help you with obtaining medical appointments.  Many people are really fooled into thinking it’s a good and helpful thing.

What you should know, though, is that the “nurse” does not answer to you.  This is not a medical professional responsible for your well-being.  This is not a medical professional with any type of physician-patient relationship with you.

On the contrary, this is a medical expert who might help facilitate some of your medical care, but is actually really trying to minimize it.  Often, they are responsible for halting your medical care prematurely or putting pressure on your doctor to send you back to work prematurely.  They sometimes even talk with your doctor behind your back as well as your doctor’s staff.  The “nurse” is working for the insurance company to find reasons and ways to stop your medical care, or at a minimum, to reduce it.

I have had clients leave a medical appointment after having their doctor specifically tell them what they need, next, for medical care, and what their disability status should be in the meantime.  Then, seemingly out of nowhere, the medical care plan changes and is reduced, or the disability status changes, or even both.

What happened to make these harmful changes?  Answer:  the Nurse Case Manager.

The “nurse” you thought was helping you was busy communicating with your doctor and doctor’s staff, putting pressure on them behind your back.  And now, all of a sudden, you don’t get what your doctor already said to you that you need.

Should your doctor cave to such pressure?  No, of course not.  But it happens, and the common denominator I always see is the behind-the-scenes interference from your “nurse” who is really the insurance company’s expert working against you.

What are your rights?  You can tell you doctor that s/he and their office do NOT have permission to meet with the Nurse Case Manager without you present, or discuss your situation with the “nurse” unless you are present for the conversation.  That way, at least nothing will be behind your back.