Nurse Case Managers: Are They The Workers' Compensation Claimant's Friend Or Foe?
A nurse case manager (NCM) is sometimes assigned to an injured worker in order to help the worker schedule (and keep) his or her doctor's appointments or physical therapy, make the arrangements for any hospital testing, surgeries, or post-surgical care, and get any necessary medical aids or prescriptions.
On the surface, that sounds like such a wonderful thing it's hard to understand why everyone wouldn't be delighted to have an NCM assigned to their case. However, there are some downsides to having an NCM involved as well -- and not every injured worker welcomes their intrusion. Here are the pros and cons so you can understand the potential problem.
Nurse Case Managers Are Supposed To Be Independent Parties -- But Might Not Be
The NCM is assigned to you by the insurance company -- however, he or she is theoretically an independent party who is supposed to advocate for you if there's a problem at the doctor's office and facilitate communication between you and medical professionals.
However, a lot of people feel that NCMs are very conscious of the insurers' goals -- which is to either get you back to work or close out your case somehow. Because of that, not every NCM may have the patient's needs at heart. They may be looking at the bottom line -- if treatment is stalled, instead of advocating a more aggressive procedure, they may try to push the doctor into saying that nothing more can be done so that the case can be closed.
Nurse Case Managers Have A Lot Of Access To Your LIfe -- And That's Bad
The NCM also has pretty open access to your life -- and that isn't necessarily good. He or she may try to actively interfere with your care or draw judgments about the truthfulness of your claim and attempt to manipulate your doctor into believing that you are lying in order to get out of work.
In addition, the NCM may want to come into your home in order to help you set up medical equipment or examine any dressings on your wounds. At that point, he or she has the unfettered ability to essentially snoop into your life and can draw judgments about what he or she sees. For example, if you claim a back injury is keeping you stuck on the couch all day but your bathroom is on the second floor, she may question how you manage the trips up and down the steps. If you have empty beer cans in your recycling bin, she may question if you're drinking on the job.
If you have an NCM that doesn't seem to have your interests at heart, talk to your attorney immediately -- a good NCM can be truly helpful but a bad one can destroy your right to compensation. For more information, contact a local lawyer like Gerald Lutkenhaus.
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