The role of the nurse case manager is as an agent for the insurance company, not a medical provider. She is not attending your appointments to help you get better, but rather for the insurance company that wants to cut off your medical care and benefits. In claims involving non-catastrophic injuries, your employer or insurer may decide to use a medical case manager to provide medical case management services. As these services are paid for by the employer or insurer, the nurse case manager is working for them.
Can I refuse a nurse case manager?
I’m often asked this question after I’ve asked a workers’ compensation adjuster or defense counsel to cease sending a nurse case manager to medical appointments with my client. Why do I do this? Because she is not trying to help you get better. I release nurse case managers from my clients’ cases because they have lied about my clients to their treating doctors, tried to manipulate the medical care delivered by the authorized treating physician, and have consistently shown zero interest in helping my client recover from his/her injuries.
Here’s an example:
Consider the note below, sent by a workers’ comp RN case manager to the authorized treating physician on an accepted workers’ compensation claim:
The nurse case manager’s name is Kim Williams. If you can’t make out the language, she’s telling the patient’s doctor that the patient is “doing everything she can to not have to work” after her surgery. This is a lie. Ms. Williams goes on to beg the doctor “NOT [to] take her out of work” and then explains that despite the fact that she has been “removed from her case” she is “working the file on the backside.” I hope you find this appalling, as I do.
In this case, we have a woman with a legitimate, accepted workers’ compensation injury. She’s had surgery and is supposed to be recovering. But the field nurse case manager assigned her case wants her to stop getting treated and be sent back to work. This is so that the insurance company can save the money it would otherwise have to pay in benefits while the patient recovers from her surgery. I hope Ms. Williams loses her nursing license over this and that the insurance adjuster (if he/she is “in on it”) does as well.
Does the nurse from workers comp have to come to my doctors appointments?
If you’ve been hurt at work and the insurance adjuster has assigned a nurse case manager to accompany you to your medical appointments, know that in Georgia you do NOT have to allow this. Consent for allowing the nurse case manager to attend your doctors appointments with you must be in writing. You can also withdraw your consent. And, you should be informed in writing that consent can be refused.
Unfortunately, in Georgia, you do have to allow a nurse case manager to meet with your doctor. The nurse case manager has to give your attorney 10 days notice before any meetings with your medical provider. Consent and notice need to be in writing.
Get help from our Workers’ Comp Lawyers
You may think your workers’ comp nurse case manager, insurance adjuster, and human resources person are looking out for you, but at some point you will realize they aren’t. They’ll decide you’ve been injured too long and will work to manipulate your medical care and medical providers in order to get them to release you from care and say your injury is no longer from work. There are myriad ways in which this can happen. If you have a workplace injury in Georgia, I strongly encourage consulting (for free!) with my office to see how we can help be your advocate during your recovery from a workplace accident.
Editor’s Note: This post was originally published in August 2014 and has been updated for accuracy and comprehensiveness.