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I have a workers’ compensation injury and am attending my doctor appointments. The doctor is examining me, prescribing medications, and physical therapy. There is a lady who is a nurse case manager at the doctor’s office. She is constantly asking about my appointments. She makes me feel uncomfortable and I feel that she is interfering with things. She also acts as if she is in charge of everything and seems to question the doctor. I understand that this lady reports to the insurance company. Does she have to be present at my doctor appointments? What is a nurse case manager and do I have any say in whether she is at my exams?
For the most part, it is the insurance company who assigns the nurse case manager to a workers’ compensation case. So, the nurse case manager works for the insurance company. The job description generally says they are to guide injured workers through the medical treatment process and get returned to work as quickly as possible. They are also supposed to communicate between all of the parties including the injured worker, the doctor, the employer and the insurance company. However, they are also supposed to follow the medical protocol that exists for providing treatment. In complicated cases a nurse case manager can be very helpful by coordinating exams, advocating for treatment with the adjuster, and following up with doctors to ensure reports are completed.
There are possible situations where they will take some questionable actions. This can sometimes be an individual who is getting too involved when they do not have to. For example there was an incident where a nurse case manager wrote a note to a doctor that she feels that this employee is “doing all he can to not return to work.” That is obviously something that is not supposed to happen as the nurse case manager now seems to be advocating for the insurance company and not helping the injured worker. If you encounter this, let the adjuster know immediately that you are encounter and request removal of the nurse case manager.
If you have questions about for your workers' compensation injury and want to talk to an attorney in Fresno, please call 559-408-7436 or fill out the form to the right.