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What Is A Nurse Case Manager?

Lynn Taylor

doctorWhen you’ve suffered an injury at work, you may receive notice that a nurse case manager has been assigned to your case. Below are a few quick answers to common questions employees have regarding what nurse case managers are and what their purpose is in regards to your workers’ compensation claim.

What is a nurse case manager?

A nurse case manager (or NCM for short) is a nurse hired by the workers’ compensation insurance carrier to be involved with the employee’s care and treatment related to the work injury. Typically, nurse case managers will discuss the employee’s care and treatment with the employee and his or her treating physician, coordinate the scheduling of appointments, and draft reports summarizing the medical care and treatment, which are then sent to the workers’ compensation carrier.

Will the NCM attend every appointment I go to?

Generally, no. Nurse case managers typically only appear for appointments that you have with your treating physician, when decisions about your care and treatment would be made. For example, if you are participating in a course of physical therapy, the NCM would not appear for each of these appointments. Additionally, nurse case managers also may participate telephonically, so they do not actually appear in person at the employee’s appointments.

Does the nurse case manager provide me with medical treatment?

No. Although the NCM is a nurse, the NCM will not be rendering any actual care or treatment to you.

Does the nurse case manager get to decide what kind of treatment I receive?

No, the NCM should not be making decision regarding your medical care and treatment. The medical care you received should be decided by you and your treating physician, and the nurse case manager should not be interfering with these decisions.

Do I have any choice about whether a nurse case manager can participate in my care and treatment?

Yes. If you do not wish to have a nurse case manager involved with your case, you can decline to authorize the NCM’s participation in your treatment.

Will my doctor discuss my case with the nurse case manager, even if I don’t want one involved?

No, your treating physicians should not be discussing your medical care with anyone, including an NCM, unless you have authorized them to do so.

Should I allow the NCM to participate in my treatment?

There is no definitive yes-or-no answer to that question. Some nurse case managers are helpful in assisting the injured employee to get the treatment they need, while others obstruct treatment and push for the employee to return to work before the employee’s doctor recommends. There are also some requirements that can be put in place if an employee elects to allow the NCM’s participation, such as requiring that all reports authored by the NCM be sent to the employee’s attorney as well. You and your attorney should discuss the issue to make the best decision for your individual case.

If a nurse case manager has been assigned to your case, you should discuss the pros and cons of allowing the NCM’s participation with an experienced workers’ compensation attorney. Call the lawyers at Woodruff Johnson & Evans at (866) 400-4450 to discuss your workers’ compensation claim and whether allowing a nurse case manager to participate in your claim is the right decision for you.

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