Nurse Case Managers

NURSE CASE MANAGERS

by Chad Snow, Attorney and Managing Partner

One of the insurance company’s best tools in reducing their costs (and your benefits) is by hiring a “Nurse Case Manager” to work on your case.  These are usually R.N.’s who try to act like they are your advocate, but are really just an agent of the insurance company.  They will arrange for you to see doctors who are usually extremely insurance-oriented, schedule your appointments, and then attend the appointment with the injured worker.   At the appointment, they can then pressure the doctor into limiting the amount of medical care that the injured worker receives and into releasing him or her to work as soon as possible – even if the injured worker doesn't feel ready to return.  Generally, our firm does not allow nurse case managers on our files.  One of the benefits of having a Workers Compensation Attorney is that any agent of the insurance company (NCM’s) is not allowed to have contact with you as it violates the attorney-client privilege.  In some special cases we do allow them to work with our clients and they can be very helpful.  For example, in catastrophic injury cases where the injured worker is unable to make appointments or follow up on their own medical care or in cases where multiple specialists are involved.  I don’t mean to sound overly negative about nurse case managers, and there are some that are very conscientious and great at what they do – but we’ve had too many bad experiences with them over the years to not be at least a little skeptical.  If you have questions about a Nurse Case Manager in your case, you should contact one of our attorneys to see if it is hurting your case.  

Nurse Case Managers and Workers Comp Cases

Many of our clients come to us with nurse case managers assigned to their cases by the insurance carrier.  While many of these are nice people, and while they may act like they are your best friend and just there to help you, they are not.  They are hired by the insurance carrier to minimize costs on your claim.  This is usually unfortunately accomplished by pressuring your doctor into providing a minimal amount of treatment or releasing you to work earlier than they should or with less work restrictions than they should. 

You may call me cynical, but this is borne out by years of experience dealing with nurse case managers in Arizona Workers (Workmens) Compensation claims.  I have sent Spanish speaking clients with tape recorders to appointments to record what the nurse case manager is interpreting to the doctor and on some occasions the NCM tells the doctor the exact opposite of what my client said!  There are exceptions, but I have unfortunately found them to be few. 

While the insurance carrier has a right to monitor your claim and get information from the treating doctor, they do not have the right to violate your physian - patient privilege or unduly pressure the doctor.  One of the benefits of having an attorney on your claim is that the nurse case manager cannot have contact with you and is usually removed from the case.  If you have questions about nurse case managers, you should immediately contact an attorney who practices in Arizona Workers Compensation Claims. 

Snow, Carpio, and Weekley are Workers Compensation Attorneys with offices in Phoenix and Tucson.  They can be reached at (602) 532-0700 or (520) 647-9000.