Do I Have to Talk to My Nurse Case Manager in Georgia?
You’ve suffered an injury at work, and you get a call from a friendly nurse case manager. That should be a good thing, right? Wrong!
As helpful as they claim to be, nurse case managers are really interfering with your workers’ comp claim – and not to your benefit.
They are paid representatives of workers’ comp insurance companies, which means they are helping the insurance company rather than the injured employee.
Nurse case managers show up when someone is injured at work because they have been hired by the insurance company in hopes the nurse case managers will save them money. That’s the cold, hard truth.
I know that seems harsh, especially because the vast majority of times, nurses are on Team Patient. Usually, nurses are lifesavers and heroes.
But at some point, certain nurses find themselves working for insurance companies and their role shift from Team Patient to Team Insurance Company.
Let me explain in more detail.
What Is the Role of a Nurse Case Manager?
The role of a nurse case manager is to help claims adjusters manage the medical care of injured workers.
As part of this strategy, nurse case managers act as a liaison between the patient, the medical team, and the insurance company.
Since they communicate directly with the insurance company (and are paid by the insurance company), it can open the door to a whole world of problems for the patient.
The Nurse Case Manager Is Not Your Advocate
According to RegisteredNursing.org, one of the main roles of nurse case managers is to “work with insurance companies to help patients receive the most cost-effective care available.”
Typically, when an insurance company hires a nurse case manager, it is because they want to save money, hence their role of finding the “most cost-effective care available.”
This means they are looking to save money for the insurance company, not looking out for you.
Nurse case managers help insurance companies save money by cutting costs, such as pressuring doctors to send employees back to work as soon as possible with as little medical treatment as possible.
And they intentionally try to find dirt on a patient to help the insurance company get out of paying injured employees what they deserve.
Why Workers’ Comp Insurance Companies Love Nurse Case Managers
Again, sorry to be harsh, but a nurse case manager is not your friend. No matter how friendly the person seems.
Their role is to save insurance companies money. It is the whole reason why they are hired by insurance companies.
According to Business Insurance, “Although they are an added expense, nurse case managers can significantly reduce the duration and cost of workers’ compensation claims by guiding injured employees’ medical treatment and return-to-work efforts. […] Nurse case managers have shaved an average of $6,100 off medical and indemnity costs for the workers’ comp claims on which they were involved, producing a return on investment of 8-to-1.”
This is a direct quote from an article geared to an audience of insurance companies and business owners encouraging them to see the cost benefits of nurse case managers.
In addition, a study by Liberty Mutual Insurance also encourages buyers and brokers of workers’ comp to utilize nurse case managers. Their study found, “The results answer the claim profession’s long-standing question about how much impact nurses have on workers compensation claims. In fact, those claims that involved a nurse had:
- 18 percent lower future medical costs
- 26 percent lower overall claim costs
- 15 percent faster claim resolution.”
They use these numbers to convince people to hire nurse case managers. Why? Because it LOWERS COSTS!
Quality of care isn’t a factor. Money is.
The Problem with a Nurse Case Manager Managing Appointments
Nurse case managers often want to help manage appointments.
Sure, it sounds helpful.
The problem is that this puts the nurse case manager in the driver’s seat, and they control when you go to appointments and when you reschedule or cancel.
They may reschedule or delay doctor’s appointments or physical therapy on behalf of the insurance company.
For example, the insurance company may want a little more time to find “proof” you don’t need treatment. If they can hold off on treatment, this gives them time to catch you making a mistake.
Additionally, since the nurse case manager is in constant contact with the insurance company, the insurance company is aware of your schedule. They can then send a private investigator to follow you.
[Related Read: Is My Workers’ Comp Insurance Company Spying on Me?]
The Problem with a Nurse Case Manager Choosing Doctors
Yes, you’ve got a lot on your mind, and choosing a doctor is one more thing to add to your list.
However, choosing your own doctor is one of the most important decisions you can make when it comes to workers’ compensation claims in Georgia.
Under Georgia workers’ compensation law, employers are supposed to post a list of physicians for you to choose from.
You are the one who gets to choose which of the doctors from the approved list treats you.
This is important because your employer may push you to go to a doctor they know is more likely to say you aren’t hurt “too bad” and can return to work tomorrow when it is clear you really shouldn’t.
In the same way, a nurse case manager will go with the most employer-friendly and insurance-friendly doctor rather than the doctor best equipped to treat you.
The Problem with a Nurse Case Manager Attending Your Doctor Appointments
Imagine attending an important job interview and having someone sit in on the interview just looking for ways to tell the boss not to hire you.
That’s similar to what happens when you allow a nurse case manager to attend your doctor’s appointments or be in the examination room.
Again, they will claim they are there to advocate for you.
But they are there to tell the insurance company what they found out so the insurance company won’t give you what you deserve.
Let’s say your doctor asks you to describe your pain and you say something benign like, “Well, I’m sure I’ll be okay.” The nurse case manager will turn around and tell the insurance company what you said, and they will argue you don’t deserve benefits because “you’ll be okay.”
Ultimately, do not allow a nurse case manager to enter the examination room with you at your doctor appointments. This is your right!
Unless your claim has been deemed catastrophic, you can opt not to have any communication or dealings with the nurse case manager and can request that the nurse case manager be excluded from the examination room.
At DeMedeiros Injury Law, we handle communications with nurse case managers and always instruct them that they are forbidden from communicating with our clients and are also forbidden from entering into the examination room with our clients.
The Problem with a Nurse Case Manager Requesting Access to Medical Records
A very common tactic nurse case managers use is getting injured workers to sign blank medical authorizations.
The injured worker mistakenly believes this is necessary to get the ball rolling for workers’ comp benefits.
However, they are far more interested in the medical authorization so they can get access to all your medical records – even those before your workplace injury.
This is because they hope they can find something in a past medical record, such as a pre-existing condition, that they can use to deny your workers’ comp claim.
Allow a Workers’ Comp Attorney to Deal with the Nurse Case Manager
If we haven’t made it clear, you should not speak to a nurse case manager or allow one to be present for examinations.
But, they are relentless. It’s their job to get the dirt on you.
That’s why it is wise to hire a qualified workers’ compensation attorney. We understand how nurse case managers work and what they are after, so we can protect you from their intrusive behavior.