What exactly is a nurse case manager (NCM)? In Ohio’s workers’ compensation system, case managers are registered nurses who are supposed to play a supportive role and help coordinate the care that an injured worker receives from the company’s workers’ compensation insurer.
In theory, that means that they’re supposed to be neutral parties who focus on specific tasks that can speed up your treatment. Those can include:
— Coordinating the communication between you, your doctors, the insurance company and your employer.
— Helping you obtain all the necessary authorizations for treatment.
— Explaining to avoid delays in your treatment or care.
— Making sure that accurate records are kept about your treatment, surgeries, prescriptions, rehabilitation, overall medical progress and any future prognosis.
In reality, many NCMs are overly sensitive to the desires of the company’s insurer to get workers off the compensation rolls and either back to work or settled out. They aret not supposed to function like an insurance adjuster or investigator and dig around in your life. However, NCMs rely on insurers for their livelihood, which may factor into how they actually treat you. Keep the following things in mind:
— Your NCM should not speak to your physician about you unless you or your attorney are present. If that happens, let your attorney know immediately.
— You have the right to be examined by your physician privately and to discuss your treatment options without the NCM present. Don’t agree to waive that right at any time.
— Everything you say or do can end up in the NCM’s report to the insurance company. Watch what you say and don’t confide anything to the NCM that you don’t want the insurer to know.
— You should receive copies of all your NCM’s correspondence with the insurance company and your treatment providers. If you find out that you aren’t (usually through one of your physicians), let your attorney know.
The reality is that some NCMs are genuine professionals who are dedicated to making life easier for injured employees. Others forget what their role is really supposed to be.
If you’re having trouble with a nurse case manager, don’t let it derail your workers’ compensation claim. For more information on how our company can help protect your rights and benefits, please visit our webpage.