What You Need to Know if a Nurse Case Manager Has Been Hired for Your Worker's Compensation Case

Posted on: 30 May 2017


If you have filed a worker's compensation claim and have been assigned a nurse case manager, there are a few important things to understand. Nurse case managers are supposed to act as third parties or liaisons between you, the insurance company, and your medical team. However, nurse case managers who are paid by the insurance company may not act as an independent person. Here's what you need to do if you have been assigned a nurse case manager.

What nurse case managers do

Nurse case managers are hired by workers compensation insurance companies to quickly relay information between the insurance company and the medical team. Nurse case managers are not involved in making decisions regarding diagnosis, treatment, or prognosis, nor can they provide the insurance company or the medical team suggestions of any kind.

They can, however, facilitate your doctor's appointments, explain medical terminology to you, and obtain any necessary medical equipment and prescriptions for you. They can attend your doctor's appointments and other appointments but only with your permission. They can speak with your medical team but only after sending you advance notification, the time frame of which is based on your particular state's laws.

How HIPAA comes into play

As a patient, you may feel these duties impede your ability to keep your privacy. However, nurse case managers are legally required to adhere to Health Insurance Portability and Accountability Act (HIPAA) regulations. He or she is only able to discuss your medical condition with the insurance adjuster and your medical team and no one else without your written consent. They cannot discuss your medical condition with your boss unless you give the nurse case manager permission to do so.

When signing HIPAA consent forms, be absolutely certain that all of the information is filled in correctly. Do not sign any forms if there are empty spaces, especially where identifying information is to be given. If there are empty spaces, fill them in with "not applicable" so they cannot be filled in at a later date after you've signed the forms.

These consent forms should be made available to you whenever you ask. If you ask to see a consent form and are denied, immediately speak to your worker's compensation lawyer. He or she can demand these forms so you can see if any changes have been made or not. If you find that changes have been made, such as the addition of a name, fire the nurse case manager through your lawyer.

The importance of accuracy

For your best interest, it is crucial for you to be in all the meetings your nurse case manager has with your medical team. When you do, take copious notes. The information the nurse case manager gets from your medical team during these meetings is passed on to the insurance adjuster. They cannot, however, add their opinions or conclusions to the reports they give the insurance adjuster. A worker's compensation lawyer can obtain the reports for comparison against your notes from the meetings.

If you find any discrepancies, speak with your lawyer. The decisions made by insurance adjusters are based on the reports given to them by the nurse case manager's meetings with your medical team. A discrepancy could easily cause your worker's compensation to end and possibly put you back in the workforce before you are finished recovering. It's important to act quickly as things can change fast regarding the ending of your compensation and the beginning of your expectancy back to work.

If you feel your privacy has been violated by your nurse case manager, your nurse case manager does not act as a third party, or they do not provide accurate reports, speak with a lawyer from a firm like Gilbert, Blaszcyk & Milburn LLP.