I have been helping injured workers since 1997. I have seen a lot of crazy scenarios come up, but can still be surprised every now and then. I had this happen recently when it came to the behavior of a nurse case manager and their involvement in the medical care of an injured worker.
What made this case so unusual is the injured worker reached out not because the nurse case manager was interfering, but because they did not show up to the doctor’s appointment like they said they would. And then they wrote a report that the injured worker got. In the report it said that they DID attend the doctor’s appointment. The injured worker contacted us because they were upset that the nurse case manager lied.
Now I have received hundreds of calls over the years (if not thousands) of people upset with nurse case managers. For those who do not know, that is a worker assigned by the insurance company to monitor your medical care. They are allowed to ask for medical records and bills related to your work injury. There are lot of things that they should not do, but often do, including:
- Try to schedule your appointments for you. They often do this based on their schedule, not what is best for you.
- Tell you what medical care you can and can not have. This is not in any way up to them.
- Go into the doctor’s appointment with you.
- Talk to your doctor without your presence or permission.
They do these things at the request of the insurance company to try and interfere with your care. Other than getting copies of your medical records and bills, none of these things should happen. If they do, it can result in your work comp benefits being terminated or delayed.
Usually the calls we get are from injured workers upset with the interference. This recent caller was upset because the nurse case manager was not involved enough and certainly not as much as she said she was. I let them know that he likely dodged a bullet and that it is not a problem at all. I do have worries that she would end up lying in her reports in a way that could hurt him, but that does not seem to have happened yet. The good news is that we got involved before any major problems occurred.
And so while this was a first for me, the end result is the same. Beware the nurse case manager and their role in your case. They have a job to do and that job is not to look out for you or your best interests.