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How To Deal With A Nurse Case Manager

Nurse Case Manager

Adjusters like to assign nurse case managers on workers’ compensation claims.  Insurance companies will tell you that a nurse case manager is assigned to your case to help you get the treatment you need faster.  There are one or two out there that might do that, but almost all of them work against you, not for you.

Nurse case managers are good at pressuring your doctor to order a less expensive test instead of the right test, or to use the insurance company referral doctor instead of the one your doctor wants to use.  They pressure your doctor to return you back to work before your doctor thinks you are ready.  And, they try to get you placed at maximum medical improvement and kicked to the curb before you cost too much.

You can’t get rid of nurse case managers, but you can work to limit their effectiveness.  The first thing to do is pick a treating doctor that doesn’t give in to insurance companies – and never let the nurse case manager pick the doctor.  Next, tell your doctor that you have a right to a confidential exam and you do not want the nurse case manager present during your exam.  The doctor will kick them out.  Use that alone time with the doctor to ask any of your questions – don’t do that in the presence of the nurse case manager.

If the nurse case manager becomes a problem, be prepared for claim issues and denials.  Make a plan for what you will do if that happens.

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