So many injured workers mistakenly believe that their nurse case manager is their friend and looking out for them. This is wrong!
You should not work with nurse case managers from the insurance carrier, and you should certainly not speak to them or provide any information before reviewing things with your lawyer first. These nurses are essentially spies hired by the employer or insurer to interfere with your medical appointments and to put pressure on the doctor to release you back to work. You are an adult and do not need a nurse case manager to interfere in your case.
For help with your case, call Cardamone Law’s Certified Pennsylvania Workers’ Compensation Lawyers at (267) 651-7945 today.
What is the Role of a Nurse Case Manager in a Workers’ Compensation Case in Pennsylvania?
Nurses who work for the Workers’ Compensation insurance carrier are often described as case managers. Their purported role is to help you coordinate your care, keep an eye on your case, and track what’s happening with your claim. However, a lot of those things are not necessary if you have a lawyer and could be detrimental to your case.
Insurance companies like to give injured workers a point of contact who seems like they would be on their side. All the better if this person is a nurse who understands care needs, injuries, and treatment options. However, their job is not to help you get better, and it is certainly not to get you the benefits you need.
These nurses work for the insurance carrier, and they are constantly looking out for their employer, not you. They want to get information, and the insurance carrier wants to use it against you and cancel your benefits whenever possible.
While many of them are nice, hardworking people who are just doing their job, you have to always remember that they do not have the same interests as you. Your interest is to obtain all the benefits you deserve, given your medical condition. Their interest lies in getting you off of Workers’ Comp as soon as possible, without regard to how it affects your life.
Why Do Insurance Companies Use Nurse Case Managers?
Insurers love nurse case managers because they act almost like an investigator. The nurse case managers can obtain information from the injured worker and perhaps take it out of context, thereby prejudicing the doctor and/or adjustor.
Injured workers often feel intimidated and believe that the nurse case manager is a requirement. This is not true. You do not have to work with them, call them, answer their questions, or submit to anything they say.
Our lawyers can guide you through who you actually need to talk to, what information actually needs to be supplied, and when appointments with medical personnel are actually required. This is usually limited to your medical treatments – which the insurance company’s nurses are not providing – and independent medical exams/impairment rating evaluations – which are carried out by other medical staff the insurance carrier uses.
Having an experienced and Certified Pennsylvania Workman’s Comp Lawyer on your side is a way to maximize your benefits. Having a nurse case manager involved is a way to minimize your benefits. It’s true.
Should I Talk to the Insurance Adjusters?
Generally, you should avoid talking to the Workers’ Compensation carrier, their adjusters, their case managers, or any other staff without checking with your lawyer first. There may be times when talking to them is necessary, such as when coordinating transportation to an independent medical exam or impairment rating evaluation. Aside from this, most communications between the insurance carrier and you should go through your attorney.
Can My Attorney Help Coordinate My Case Instead?
Some of our roles as your lawyer involve…
- Collecting medical records and evidence, including depositions
- Processing them to present to the judge and insurance carrier
- Handling communications and settlement negotiations with the insurance carrier
- Advising you on next steps after denials, requests for medical information, and other communications from the insurance carrier
- Advising you as to what appointments, exams, and care are mandatory and which you can ignore
- Advising you on how to communicate with the insurance carrier, should the need arise (e.g., during depositions)
- Coordinating outside medical care and exams by other doctors to collect evidence.
There may be certain things you would communicate with the insurance carrier directly about, such as coordinating transportation if you need help getting to an medical exams/evaluations. Other than this, there is really nothing that the insurance carrier would do for you, and nothing that you would need help with from a case manager.
What Does a Case Manager Do vs. My Treating Physician?
A nurse case manager from the Workers’ Comp carrier is not your treating physician. Their job is not to get you better, examine you, diagnose you, or recommend treatment. Instead, they merely act as a go-between for you, your doctors, and the insurance carrier.
Your treating physicians or other care providers are instead the ones who will actually help you get better, treat your wounds, cast your broken bones, and provide you with physical therapy or medication to get better. There is no role for a case manager here.
Note that when you need to undergo an medical examination/evaluation that this doctor also is not your treating physician, and their goal is not to get you better either. Like a nurse case manager, their job is to obtain information on you and report it to the insurance carrier to try to get your case shut down. In many cases, we even need to seek outside assessments to counter the bad information that an independent medical exam or impairment rating evaluation doctor might come up with.
Call Our Pennsylvania Workers’ Compensation Lawyers Today
For help with your case, trust our Certified Pennsylvania Workers’ Compensation Specialists to have your back. Call Cardamone Law for a free case review at (267) 651-7945.
