Nurse case managers are registered nurses that coordinate all aspects, services, and resources of a particular patient’s care. They make sure that everything is running smoothly, and their services are utilized both inside and outside actual medical facilities. They work to make sure that a patient has everything he or she needs for treatment and the healing process, and they work with everyone involved with the case, from families to doctors. In worker’s compensation cases, nurse case managers can be vitally important because they can reduce the duration of the case and help you get back on your feet, as well as provide information to insurance companies. However, be aware that nurse case managers can sometimes have a conflict of interest. In this article, we will discuss the role NCMs play in worker’s comp cases, as well as how to protect your own interests and when to seek legal counsel.
When NCMs are used
NCMs are used for most workers’ comp cases. Unless the injury is catastrophic or extremely severe, a nurse, not a doctor, will be the case manager. Depending on your insurer (or third party administrator), the NCM may be provided to you, or the NCM’s services may be outsourced to a company that specializes in worker’s comp cases.
The role of the NCM
The nurse case manager is in charge of facilitating communication between all parties involved in the injured person’s case. The NCM manages the distribution of medical resources to the patient, and provides updates and detailed information about the injured party to the insurance company, employers, and others. In some worker’s comp cases, a nurse might take control of the patient’s medical treatment to make sure that he or she is being optimally positioned for recovery. If an NCM is working in the field, he or she may make home or workplace visits to assess the care that the person is receiving and to discuss any provisions that may need to be made in the event of the worker’s return. The NCM essentially deems the condition of an employee’s health in order to grant the approval of workers compensation.
A conflict of interest
There is an inherent conflict of interest with an NCM because he or she works for the insurance company. While almost all nurses are hardworking and ethical individuals, know that an NCM in a worker’s comp case reports to the insurance company and is supposed to serve their needs as well. And, as anyone who has ever faced off against an insurance company knows, the needs of the insurance company rarely correspond to those of the person who is injured and asking for money. If your workers compensation has not been granted due to a conflict of interest, then it is essential to contact a legal professional.
Protecting your interests
It can be intimidating knowing that the nurse case manager isn’t immediately on your side. In many states, the NCM can request to be in the room with you when you are being examined and treated by the doctor for your injuries. However, you can also refuse to allow them into the examination room if you decide to for your own privacy (this is definitely something to consider if you feel that your NCM is not acting in a way that is conducive to your health).
Seeking legal counsel
Seek legal counsel if you feel that the insurance company is wielding their NCM in a way that prevents you from obtaining the healthcare and monetary compensation you need. There is a conflict of interest, and it is all-too-easy to forget that not everyone is out to expedite your treatment and cut costs to you personally (not just to the insurance company).
Obtain a personal injury lawyer if you feel that your case is being inappropriately handled by those involved. The Leo Trial Group assists in the mishandling of workers compensation cases. Contact attorney Charles Leo for legal advice if your case has not been appropriately resolved. You deserve compensation for your injuries and a path to a recovery.