If you are injured at work and have won a workers’ compensation claim award, the insurance company may assign a nurse case manager (NCM) to your case. A nurse case manager is a healthcare professional that works for the insurance company to oversee your medical care as you work to recover following your on-the-job accident. While they do want to help you get back to gainful employment, their motive behind this sentiment is because getting you back to work saves the insurance company money. You want to get back to work as well, so while the end goals are the same, the motivations are different, and you need to be very mindful of this when working with an NCM during your recovery.
What Does A Nurse Case Manager Do?
As we touched on a little bit in the introduction, a nurse case manager oversees an injured worker’s recovery program to make sure they are progressing as expected. They want to make sure that you are receiving the right type of treatment, but again this is because they don’t want the insurance company racking up any unnecessary expenses. Always remember who is paying them and what their ultimate motives are. We’ve worked with some incredible case managers and some incredibly awful ones, and we tell clients to keep their guard up because these NCMs are getting paid by the insurance company. A seemingly innocuous comment here or an offhand remark there can end up tanking your injury claim, so remember where their interests lie.
It’s also important to note that you are not legally required to speak to the nurse case manager assigned to your case. They may want to hear information from you, but you are not required to provide statements to them. You also have some rights when it comes to your nurse case manager and their access to your health information. You can request to be present whenever your NCM wishes to talk with your doctor about treatment. You can also request privacy if the NCM wants to sit in on a check-up or appointment. This allows you more control over what information the NCM has in regards to your health and your care.
What Not To Say To An Nurse Case Manager
You want to choose your words carefully when talking with a nurse case manager, because similar to giving a statement to police, anything you say can be used against you. Because of this, here are some things you should never do when talking with your nurse case manager:
Don’t Downplay Your Injuries – We understand that you may want to come off as tough or unbothered by your injuries, but that’s not how the NCM will take that statement. Instead, they’ll see you as making great progress, and they may push to end treatment sooner than it should. Be very honest about your health and your symptoms as they pertain to your work injury when talking with an NCM.
Don’t Lie – Getting caught in a lie can cause major problems for your case, so don’t embellish or lie when talking with the NCM. If the truth eventually comes out, it could lead to the termination of your injury benefits. Don’t lie or guess if you are searching for an answer to a question. Remember that “I’m not sure” is a completely appropriate answer.
Don’t Overshare – Be clear and concise when talking about your injuries or your treatment. Oversharing will give the insurance company more opportunities to use your words against you, so be direct and stay on topic.
Don’t Agree To Changes To Medical Care – Don’t agree to changes to your current medical plan suggested by your nurse case manager without consulting with your attorney or treating physician. They may be trying to get you to switch to a provider with a history of favorable recommendations for the insurance company, or they may try to push you through your rehab program too quickly. Remember why they are making medical recommendations, and only agree to changes if you, your lawyer and your treating healthcare professional feel that it is in the best interests of your health.
Again, many nurse case managers are wonderful people, but always remember that they have a vested interest in protecting the insurance company’s bottom line. They may work with you, but they are not on your side. Your allies are your doctor and your workers’ compensation attorney, so lean on these professionals as you work your way back from injury.
For more information, or for assistance navigating your workers’ compensation claim, reach out to Dean and the team at Hey Workers today at (844) 439-9675.
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