Nurse case managers are part of the workers’ comp process, hired by L&I or your employer. They might seem helpful at first, claiming to be the bridge between you, your doctor, and the insurance. But don’t be fooled. Their main goal isn’t to speed up your recovery. Their main goal is to speed up your case. So they often push doctors to end your care and benefits early. You and your claim will benefit if you know your rights regarding these nurse case managers.
There are Two Types of Nurse Case Managers
Both types are introduced to your case with the same line: “They’re here to help manage workers’ compensation claims and your treatment to ensure everything goes smoothly.” Their real job is to keep health care costs down for the insurer or your employer, This means less medical care and possibly less time loss for you.
Depending on your employer’s insurance, you might have to deal with one of two types of nurse case managers:
- L&I Nurse Case Managers: These nurses work directly for the Department of Labor and Industries (L&I). The state assigns them to your case. L&I generally does this to assist with complicated and severe medical situations. Most of these nurse case managers are good people. There is a good chance they may help you.
- Self-Insured Employer Nurse Case Managers: Nurse case managers hired by self-insured companies are there to spy on you, come between you and your doctor, report back to the employer, and “assist with the closure of your claim.
The Reality of Nurse Case Managers
Despite their title, nurse case managers focus more on the financial side of your claim than your health. They often work to limit your treatment and benefits.
If you think the nurse case manager is not working in your best interest, you’re probably right.
If there is a self-insured nurse case manager assigned to your case, watch out. Here’s why:
- Their main aim is to save money for L&I or your employer, not to ensure you get the best possible care.
- They may try to influence your doctor’s decisions, pushing for less treatment or declaring you ready to return to work before you truly are.
This is a conflict of interest and can lead to a significant impact on your recovery and benefits. Understanding this dynamic is key to protecting your interests. Learn the basics.
Who Are Nurse Case Managers and Claims Managers?
Nurse Case Managers are health workers paid by L&I or your employer. They want to attend your medical appointments. You can prevent this from happening because medical privacy is your right. They want to influence your doctor. They will ask for information about your condition, treatment, and prognosis. They are there to pass this info on to the claims manager. They will suggest things to the doctor that may not be in your best interests.
Claims Managers are paid employees of the organization that manages your claim. Nurse case managers sometimes think they are claims managers.
In state fund cases, claims managers and nurse case managers are paid by Labor & Industries. In self-insured cases, they are either in-house employees of your employer or they are agents of your employer via a service company.
These people have a lot of power over your claim.
They decide whether or not you get medical care, time loss payments, vocational training, and a settlement or a pension.
Most claims managers and nurse case managers are not there to help you. They are there to help your employer save money. The way the employer saves money is to not pay it to you.
So, If They Aren’t There to Help You, Can You Refuse a Nurse Case Manager Altogether?
Refusing to have a nurse case manager involved in your workers’ compensation case altogether can be challenging, primarily because their assignment is often a decision made by L&I or the self-insured employer managing your claims process.
However, you have rights and options to limit their involvement, especially regarding your privacy and direct healthcare interactions.
You Have Rights When It Comes to Nurse Case Managers and Medical Appointments
As an injured employee, you have rights when it comes to dealing with nurse case managers. Knowing these rights can help you maintain control over your treatment and the information developed and shared about your case.
- You can say no to having a nurse case manager join you during medical appointments. This is your right to privacy. You need to feel comfortable and open with your doctor without feeling watched. Nurse case managers have no right to attend your medical exams or tell you what to do, but if you let them do it, then they will.
- Talking to your doctor. You can’t stop the nurse case manager from talking to your doctor outside of appointments, you can tell your doctor you prefer they not discuss your case with the nurse case manager. Your doctor does not have to talk to a nurse case manager, but if you let them do it, they probably will.
How an Injured Worker Can Handle Nurse Case Manager Interferences
It’s your medical treatment and your claim. Make your preferences clear from the start to prevent unwanted interference and ensure your care is matter between you and your healthcare provider.
If a nurse case manager is assigned to your case, here are steps you can take:
- Communicate Your Wishes: Politely inform the nurse case manager that you prefer they do not attend your medical appointments. You can do this directly or through your lawyer.
- Inform Your Doctor: Inform your doctor that you do not want the nurse case manager’s involvement in your care. You can request that your doctor not share detailed information with them or that they limit their involvement.
- Document your request for privacy and limited involvement from the nurse case manager in your medical records.
- Advocate Through Legal Representation: Lawyers specializing in workers’ compensation can help advocate for your interests, including communicating your preferences about the nurse case manager’s role and involvement. They can also ensure that your rights are protected and that the nurse case manager’s involvement does not negatively impact your claim or care.
- Contact the Insurance Company or Self-Insured Employer: You or your representative can express concerns directly to the entity managing your claim, outlining why you believe the nurse case manager’s involvement is unnecessary or detrimental to your recovery. This may not lead to the removal of the nurse case manager, but it can result in limitations on their role.
Many Medical Providers Feel Pressured by Nurse Case Managers, Even Though They Might Not Show It
This pressure can lead to changes in your care plan that aren’t in your best interest. Remember:
- No Obligation: Doctors aren’t required to follow suggestions from nurse case managers. Your health comes first. Your doctor, not the nurse claims manager, is the person in charge of your medical care.
- Your Advocacy: If you feel a nurse case manager is compromising your care, it’s time to seek legal help. Lawyers can advocate for your rights, protecting your treatment and benefits.
Understanding how nurse case managers influence your treatment helps you to be proactive about your rights and preferences.
Can a Nurse Case Manager Make Decisions About My Medical Care?
No, they cannot make decisions about your care. Their role is advisory only. You and especially your healthcare provider have the final say on your treatment.
However, nurse case managers often tell claims managers what to do, and this can seriously affect your claim. Claims managers will make decisions about your health care.
What if My Treating Physician Agrees with the Nurse Case Manager?
If you’re concerned about your doctor’s decisions, discussing that directly with your doctor is important. If you still feel your care is being compromised, seek legal advice to protect your interests. Don’t wait until it’s too late.
Can Refusing a Nurse Case Manager Hurt My Claim?
Refusing a nurse case manager’s attendance at your appointments should not negatively impact your claim. It’s your right to privacy and control over your medical care.
How L&I Attorneys Can Help With Workers’ Compensation Claims Involving a Nurse Case Manager
Good workers’ comp and L&I attorneys understand the challenges you face with nurse case managers. They will help you navigate these waters and ensure your rights are protected, with your recovery being the top priority. Here’s how attorneys can assist:
- Advocacy: They stand up for you, making sure nurse case managers do not overstep their boundaries. The goal is to keep the focus on your health and recovery.
- Communication: They can communicate with your healthcare providers on your behalf, clarifying your wishes about nurse case manager involvement.
- Guidance: They provide expert advice on dealing with nurse case managers, and medical complications, helping you to make informed decisions about your care and claim.
Workers compensation lawyers are specialists, committed to advocating for injured employees. If you’re feeling pressured by a nurse case manager or worried about your treatment and benefits, workers compensation lawyers are available to help.
Don’t Let Nurse Care Managers Poison Your Workers’ Comp Case
Nurse case managers play a nasty role in the workers’ comp process. While they may present themselves as helpful intermediaries, their primary goal aligns with the insurance company, not your recovery. Remember, you have the right to refuse their presence at medical appointments and request your doctor limit their involvement in your case.
If you’re facing challenges with nurse case managers, get legal help. Our priority is protecting the rights of injured workers and ensuring you receive the care and benefits you deserve. Contact our workers’ compensation lawyers today for a free consultation.
