Nurse Case Managers

159996-20131021This article explains the role of the Nurse Case Manager, and what you should do when working with one in order to keep your case moving along successfully. 

Read this over if a Nurse Case Manager has been appointed in your Maryland workers’ compensation case. If you have any questions after reading this information, call me to discuss it.

What Is A Nurse Case Manager & Why Do I Need One?

In Maryland, the Nurse Case Manager is usually appointed by, and paid for by, the workers’ compensation insurance company. However, this does NOT mean they are against you, or spying on you. They are independent third parties and they are bound by some ethical rules preventing them from only doing what the insurance company wants.

They are there to make sure you get good medical care. In the days before Nurse Case Managers, some people would simply forget to follow up with their doctors, or they would get stuck for a long time with a bad doctor, and their health would deteriorate. This is not only bad for you and your health. It is bad for the workers’ compensation insurance company too. They have to pay you more the longer you are out sick. They want you to make a full recovery as fast as possible – not because they like you – they just want to save money. But it so happens than in this one area (quick recovery) your goals are aligned perfectly.

The Nurse Case Manager is supposed to make all this work smoothly. They are usually appointed when there is some unusual issue in your medical situation, or if they expect a longer recovery time. They usually work by telephone, but they may sometimes go to your doctor’s appointment with you. See below for more on that.

A Nurse Case Manager can be a tremendous asset to your workers’ compensation claim if you have a good one who cares and is willing to speak up when something needs to be addressed. I am not a medical professional. The insurance adjuster is not a medical professional. You do not want us making medical decisions for you. The Nurse is a medical professional and can be very helpful in coordinating and providing outstanding medical care.

The Workers’ Compensation Commission loves Nurse Case Managers, and they will expect you to cooperate with her. If you do not, the insurer may cut off your benefits, and the Workers’ Compensation Commission probably won’t have much sympathy for your opinion about the nurse.

This doesn’t mean the nurse is your friend. The nurse is going to report what you tell her and everyone is going to know about it. I get a copy of those reports, and they go straight to the insurance adjuster. So be careful of what you say to her. Don’t say anything misleading, or hold anything back. Just be smart and be aware that anything you say is going to end up in that report.

Rules for Working with a Nurse Case Manager

The Nurse Case Manager will strictly be managing medical aspects of your workers’ compensation case. Do not talk to them about benefits, or your legal case, or other non-medical aspects of the case.

The Nurse may sometimes attend the doctor’s appointment with you. However, they should NOT attend the actual examination. That is a violation of doctor-patient confidentiality. They must wait in the lobby and try to talk to the doctor afterwards. If they talk to your doctor, you should be present for that and you should report to me what is said.

You do have to cooperate and talk to the Nurse Case Manager. If you ever feel uneasy about her, or think something isn’t right, call me immediately.

Conclusion

A good Nurse Case Manager can be a real asset to your recovery. Go into this with a positive attitude and you may be surprised at how much she can help you. Just stay on guard and realize that anything you say will absolutely be reported to all parties.

Again, call me if you have any questions about anything in this article, or anything about your case.

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About Tucker Clagett

Tucker has one of the largest Personal Injury and Workers’ Compensation practices in Southern Maryland. He is an experienced litigator, winning jury trials in courts around the state, and successfully litigating appeals in Maryland’s Appellate Courts. Tucker is very active in the community and loves to serve through various community groups and non-profit agencies, some of which he created. He is on the Board of Directors of Living Water of Charles County, which puts water and septic into homes of families with out. Tucker is also a member of the Mason Springs Conservancy, which purchased an environmentally sensitive piece of land along the Mattawoman Creek to protect it from pollution while leaving it open to local fisherman who have been fishing there for decades. Tucker is a member of the Maryland Association for Justice. He served as Law Clerk to the Honorable Richard H. Sothoron on the Prince George’s County Circuit Court.