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How to Deal with Your Nurse Case Manager Cautiously and Effectively?

By Michael Dominick posted Mar 25, 2014 6:18 AM


We associate care, treatment and affection with a nurse. And indeed that is what they symbolize. When a worker gets injured he is in need of all the above and would only be thankful to actually have a qualified medical professional by his side. But, the situation is not as rosy as it looks. A nurse case manager was initially introduced with a fair purpose. These were registered nurses whose job responsibilities included ensuring appropriate treatment of injured workers and coordinating the treatments, the doctor's appointments, the prescriptions, recommendations and medications of the doctor. What the nurse needed to ensure was that all the efforts are being put in the right direction for speedy and healthy recovery of the injured worker, so they can swiftly return to work. However, many times speedy recovery of the injured worker takes a backseat and the focus becomes minimum medical expenses to the insurer.

This leads to a lot of interference of the nurse in your medical treatment and may even give rise to malpractices and some unfair requirements placed of your doctor. Let us have a look at some of these common practices employed by your nurse case manager which are definitely not for your benefit.

Resistance in Choosing the Doctor of Your Choice

The first step you will know if the nurse case manager is sincerely devoted to your recovery or not is when she accepts or refuses your choice of doctor. If you see her making some excuse to not take you to the doctor of your choice and instead suggests or rather imposes one of her preference, smell the fish in the dealing and exercise your right to say no. But, if you somewhere feel that she is being genuinely concerned and referring you to somebody else for your own quick recovery, give it a second thought. On the other hand if you are convinced about your choice of doctor, do not let her push you to go to a doctor that you don't want to.

Accompanies you to all Your Medical Appointments

On the surface of it, your nurse accompanying you to your medical appointments may not seem like an unfair practice at all. However, if you feel uncomfortable with the nurse being around or see her being too pushy with the doctor or subtly influencing him to make recommendations and treatment options which will be more conducive to the insurance provider's pockets than your health, put your foot down.

Say you do not want her assistance or want her around when you are visiting the doctor as her presence is tyrannical and unhelpful. Nothing is more important than your health. Take assistance of your worker's compensation attorney to know your rights when you are an injured worker. Invoke them to stop her being a part of the case or accompanying you to the doctor's appointments.

Constantly Pressurizes the Doctor to Ease the Restrictions

Another very obvious cue you can observe to know your nurse case manager is not interested in helping you is when she persuades your doctor to ease the restrictions placed on you. She might ask your doctor to let you get back to manual labor and indulge in physical activity. Why would the nurse do that? Because, it would not just reduce the expenses on further physiotherapy classes, medical procedures etc. , but also deem you fit to join work back as soon as possible. Basically it is a technique to seek out the interests of the insurer.

Limits Medical and Diagnostic Tests

Another cue you need to be careful about your nurse case manager is when she starts considering a lot of your tests like MRI unnecessary and urges you and your doctor to not execute them. The reasons given could be anything from, "The injured worker is fine now." to "The tests will not be able to determine anything". Basically the underlying reason would either be that performing the tests are expensive and the insurer does not want to pay for it or the test results might indicate something that makes the situation more costly for the insurance company.


The claims adjustment process is a complex one and while responsibilities and actions of the nurse case manager can appear to be a reasonable way of dealing with the claims adjustment process, the problem arises when biased and unfair practices creep in. This is what gives rise to controversy and disputes. By yourself it is difficult to make these big sharks give you a fair settlement.

Have a worker's compensation lawyer who makes you aware of your rights and does not let the nurse case manager play fowl. Make sure you keep your lawyer informed at all times and seek his opinion before unwillingly agreeing to something put forth by the nurse case manager. It is important to understand that most nurse case managers' loyalties will be inclined towards the insurance company as ultimately that is where there salary is coming from and that is what their job demands. Hiring a lawyer is also important to get the best possible settlement that covers medical costs, wages lost and compensation for all the trouble, pain and anguish you have had to undergo. The lawyer's fees will be a small proportion of your settlement, but your settlement without your lawyer will be much lesser.




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