A nurse case manager is hired by the insurance company

Know your rights when it comes to nurse case managers in a worker’s compensation case. Nurse case managers are hired by worker’s compensation insurance companies and routinely attend actual doctor visits with the injured worker. Most workers—who are unfamiliar with a worker’s compensation injury and process—simply accept the insurance company nurse’s presence. These nurses generally pitch their services as easier navigation of medical care for the worker and facilitating communication with the insurance company. While many nurse case managers are helpful for workers not familiar with medical treatment and providers, not all have the worker’s best interests at heart.

An injured worker always should remember who pays the check. A nurse case manager is hired by the insurance company. The insurance company wants to avoid payment of claims. Thus, there is an incentive for a nurse case manager to push an early return to work or to question the severity of a doctor’s limitations. Over the years, I have heard from countless clients who tell me about how an aggressive nurse case manager was pushing for a premature return to work while the client was still recovering from an injury. My clients also have seen nurse case managers argue with the treating doctor about<!–more–> “loosening” restrictions or about lessening the percentage of disability. These stories are not an indictment of nurse case managers as a whole, but injured workers must be aware of the proverbial “wolf in sheep’s clothing.”

More importantly, injured workers need to know their rights. There is no Wisconsin legal authority for an insurance nurse case manager to have contact with an injured worker at all—especially at their doctor’s visits. Most clients are shocked when they understand this information. Also, anything a worker tells the nurse case manager can be shared with the worker’s compensation insurance adjuster. Even if the nurse acts as their best friend, potentially confidential information will be passed to the insurance company, with negative consequences on a worker’s claim and medical care.

I generally tell my clients that if they believe the nurse case manager is helpful, they can maintain communication. However, if the worker (as a responsible adult) can manage their own medical care, my advice is to politely tell the nurse case manager to have no further contact. Consultation with an experienced worker’s compensation attorney can help navigate any issues with nurse case managers.