Customer Inquiry

While healing from a serious injury, the workers compensation insurance carrier may hire a nurse case manager to help. However, be aware that this person works for the insurance company.

Nurse Case Manager Role

Because most people think of nurses as being care givers, they think a nurse case manager is on their side. Certainly, most nurses are awesome caring individuals. And most clearly are just that. However, be aware that a nurse case manager works for the insurance company. Rather than take care of patients, they help coordinate treatment and procedures now. Although they are still there to help, their loyalty is to the company and not you. As a result, you must be careful about what you say to them. Furthermore, some NCM go beyond their role and try to direct medical care and treatment.

Private Medical Exam

Even though the workers comp insurance company is paying, you still have the right to private medical examinations. Consequently, you or your lawyer can demand the NCM stay outside during treatment. After the exam is over, the NCM can speak with the doctor. However, also keep in mind that whatever you say to the doctor and your medical records are not private. But you should be able to talk with the doctor outside the presence of the nurse case manager.

Improper NCM Actions

While helpful in coordinating care, some NCM will attempt to interfere with treatment. In fact, some will even try to tell doctors whether a procedure or test is really necessary. Also, they attempt to return a patient to light duty work too early. Because this is improper and outside of their role, we need to know about this behavior immediately. Rather the NCM should be replaced. If not, we will request a hearing before the SC Workers Compensation Commission. Since they are there to help, we want to work with them whenever we can. However, our main focus is always on you and getting you back on your feet.