- The role of the Nurse Case Manager is to monitor your care and report back to the insurance adjuster
- Insist on a private examination with your doctor
- Never let the Nurse Case Manager change your treating doctor
- Let the doctor’s office know that if your treatment or recovery is being discussed, you would like to be present
When you have been injured at work and you are dealing with a Virginia Workers Compensation Claim and getting medical care from a workers comp doctor, the insurance company may assign a Nurse Case Manager (NCM) to follow your care. This is not always a good thing as the NCM has a lot of pull with the insurance company. If you have been assigned a Nurse Case Manager, there are several things you need to know on how to navigate this process.
What You Need to Know if a Nurse Case Manager is Assigned to Your Virginia Injury Claim
There are, of course, some good Nurse Case Manager’s out there who truly care about your recovery and level of care. However, there are several NCM’s out there who understand that they are being paid by the insurance company and so they can often air on the side of saving money for the insurance company by trying to deter expensive care or pressuring a doctor to return you to work too soon.
How to Handle the NCM’s Presence at your Doctor’s Appointment
Always insist upon a private examination by your doctor outside the presence of the nurse case manager. You have the right to a private examination with your physician. This will give you an opportunity to discuss your medical issues privately with your doctor. If the nurse case manager walks into the room, you simply ask the doctor if there could be some privacy during your examination.
The second part of this is to try to avoid having the nurse case manager talking privately with your physician by staying present until the end of the appointment. If the nurse case manager asks to speak to the doctor privately, you ask to join in that conversation.
YOU NEED TO KNOW WHAT IS GOING ON IN ORDER TO AVOID THESE DIRTY TRICKS!
Dirty Trick #1 – The SNEAKY Work Release
I’ve had injured workers call me in the past and tell me that they left their doctor’s appointment with an off-work note, only to get a call from their employer the next day stating that they were fired for not reporting to work! SAY WHAT??!!.
Come to find out, when the injured worker left his doctor’s appointment, the NCM got the doctor to “adjust” the work restrictions, gave it to the employer, and “forgot” to inform him that he had been released for light-duty work!. Not only is this madness but this is an extremely dangerous position to be in.
Dirty Trick #2 – Switching Your Treating Doctor
I’ve also had injured workers tell me about situations of “doctor shopping”. When the insurance adjuster does not like the opinion of your doctor (usually regarding your work abilities or need for expensive testing or treatment) or when the NCM knows the doctor you picked is “pro-patient”, they can sometimes try to tip the scales in their favor by switching your treating doctor.
Here’s how it works – The nurse case manager says the doctor you picked is not available for a month or more and you could see another particular doctor this week. There is a reason why one doctor is booked and the other is not. Why would anyone go to a doctor who has no patients?
My suggestion is to set the appointment for next month and tell the receptionist to call you if there are any cancellations so you could come in immediately
Unfortunately, there are a few doctors to whom the insurance companies always send injured workers for second opinions, or treatment, or Independent Medical Examinations when they want an opinion that the worker is able to return to work without restrictions or with very little restrictions.
Contact a Lawyer
If you feel you have a Nurse Case Manager who is working against you, you are likely going to need help. Contact my office today! 804-755-7755
About the Author: Michele Lewane
The Injured Workers Law Firm is a Richmond, Virginia based firm solely focused on serving clients with workers' compensation claims in Virginia. If you have questions about your benefits or if you would like more information on the Virginia workers’ compensation system, order our book, “The Ultimate Guide to Workers’ Compensation in Virginia” , or call our office today (804) 755-7755.