The Problem With Workers’ Compensation Nurse Case Managers

When dealing with pain and injury, the last thing you want to do is make decisions. You may need to deal with doctors, hospitals, and workers’ comp insurance providers after an on-the-job accident.

Filing a workers’ compensation claim for the first time in California can be a bewildering process. In severe injury cases, a nurse case manager may contact you. The person claims he or she can help you with medical appointments, injury claim documentation, or go with you during doctor visits.

California’s Division of Workers’ Compensation has complicated rules, and each state has different laws. An NCM sounds like the perfect solution to relieve a perplexing load of rules and regulations after your injury.

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Can a nurse case manager help you?

The NCM relationship supposedly provides a “one-stop-shop” to smooth out all the road bumps in dealing with a workers’ compensation claim while you are off work.

Do not relax too soon. Moreover, do not give any information to the NCM. This person reports everything you say to the insurance company. Why? The main job of a nurse case manager is to rush you back to work and cut corners on your medical treatment. It is common for an NCM to attempt to push your doctor into clearing you for work even if you have not fully recovered from your injury.

An unethical NCM can try to get a doctor to prescribe cheaper medications or less-effective treatments to save the insurance company money. Their agenda is to get you back to work and keep the insurance company from paying for your injuries more than necessary as soon as possible. An NCM is often not your best friend. The insurance company pays that person. Do you see a potential conflict of interest here?

What rights does a nurse case manager have?

The NCM cannot prescribe treatment or medication for you or give you medical advice. NCMs know you are not at your best, physically or mentally, during an injury case. They can assume you do not know your legal rights. There are cases where NCMs illegally intervened to force people back to work too soon, causing them further injury. Find out your legal rights

In most states, NCMs cannot be in the room during your doctor appointments, so ask the person to remain outside. Do not discuss your treatment or anything your doctor says with an NCM. If you need to go to court, the NCM will tell the insurance company everything you said. Make sure you find an advocate you trust to protect your rights so you can be as healthy as possible when you return to work.