If you’re dealing with a workers’ compensation claim, you could meet with a liaison that will do the mediating for you, and the insurance company. This typically comes in form of a nurse case manager. This person is typically a registered nurse who will be there every step of the way with you. But, you’re likely not familiar with their role and might feel unsure about their involvement in your personal business. Understanding their role is important to you, so we’re here to help…

Nurse Case Managers: Understanding Your Claim Liaison’s Role

What roles do a nurse case manager play in my claim?

Nurse case managers essentially serve as an unbiased third party who is familiar with the medical world, as well as that of your comp claim insurance. This liaison serves as a middle man for your doctor, the insurance company, and you. They serve as a knowledgeable third party who’s there for every step of your medical journey.

Are they representatives of the insurance company?

Not always. A nurse case manager is typically independent of the insurance company. However, they can be either third-party, a hospital employee, or an independent contractor. While they are working with the insurance company, it is only in reference to the patient and the medical treatment. They are not patient advocates, negotiators, or investigators. They are merely serving as a reporter of your condition, treatment, and progress for the insurance company.

So, do insurance companies hire them?

Yes, an insurance company will typically hire a nurse case manager to facilitate the treatment and report back on it. They will typically have a background in occupational health, home health, or medical management. When hired by an insurance company, their intended role will be to ensure efficiency when it comes to claims and medical treatment.

Nurse case managers work in two ways

A nurse case manager works in many different ways. They serve as a reporter, like we said. But, they are also quite useful to the patient. They do much of the leg work for you. Think about it— they keep track of your medical record, of doctor’s orders, and of prescribed medications. By having a medical liaison, you might be able to better focus on getting better— rather than providing documentation.