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Nurse Case Manager

Should I Agree to a Nurse Case Manager?

“The insurance company wants to assign a nurse case manager to my case.  Should I agree?”

This is a good and difficult question.

This is what the relevant section from the Workers’ Compensation Commission’s Professional Guide for Attorneys, Physicians and Other Health Care Practitioners Guidelines for Cooperation states:

C.        Role of Rehabilitation Nurses/Nurse Case Managers

Rehabilitation nurses and nurse case managers employed by the employer/respondent have, in general, played an important role in seeing to it that an injured worker receives appropriate medical treatment and returns to productivity as quickly as reasonably possible. These healthcare professionals must be sensitive, however, to the potential for a conflict of interest. There are many cases where disputes arise between the claimant and the insurer and the positions of the parties become adversarial. The rehabilitation nurse or nurse case manager must be sensitive to this at all times and refrain from engaging in any activity that could create a conflict of interest or otherwise leave him/her vulnerable to accusations of partisanship. The extent to which the rehabilitation nurse and nurse case manager may become actively involved in the medical treatment of a claimant, e.g., physical presence of the rehabilitation nurse at a physician’s examination of the claimant, lies within the discretion of the claimant and the treating physician after consultation with each other. The patient has the right to limit or reject the involvement of a rehabilitation nurse or nurse case manager. Where disputes arise, the Commissioner shall make the final decision

First, I do not feel there is any "adverse inference" if you decline a nurse case manager.  It is your right to decline, and there is no obligation to agree.

We typically advise our clients that the carrier is not doing it for the benefit of the injured worker, but for the carrier's.  The nurse case manager works for them, not for you.  Having said that, that does not mean their interests and yours are necessarily adverse.  If their objective is to get you back to work as soon as possible, usually, that is your objective too.  (Naturally, that does not mean before you are ready.)  I usually find that a nurse case manager facilitates my client getting medical treatment more quickly than if they were not involved.  Again, to the benefit of all.  And, more often than not, I find that a nurse case manager does have my client's medical treatment and interests in mind.  As an attorney, I do not participate in any meetings, whether telephonic or in-person, but naturally I have the right if I wished.

If, after fully advising our client, our client decides to utilize the nurse case manager, we put stipulations on their involvement.  They may meet with the physician, but only after our client has met with the attending physician themselves.  Their reports should be sent to us as well.  Neither the reports, nor the nurse case manager's observations could be used for the workers’ compensation case and any Form 36's, etc.  Finally, we advise our client that at any time they feel uncomfortable, they can terminate their involvement.

Ultimately, it is your decision.  We never authorize it unless our client agrees.  I do not think there is a right or wrong thing to do.  You have to do what you feel is best for you, and based on your own experiences.

Mark Leighton Personal Injury Workers' Compensation Attorney

<p>Mr. Leighton is the founding and current managing attorney of Leighton, Katz &amp; Drapeau. His practice consists primarily of representation of injured persons in both work and nonwork-related accidents. He is a Board Certified Workers’ Compensation Specialist and past Chair of the Workers’ Compensation Section of the Connecticut Bar Association. Mr. Leighton has represented both plaintiffs and defendants over the course of his career, having previously been an attorney for an insurance company defense firm as well as a claim representative. He also worked for the Attorney General’s Office in Massachusetts.</p>

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