Warnken, LLC Attorneys at Law, Attorneys & Lawyers, Pikesville, MD

Nurse Case Managers: Friend or Foe to the Injured Worker?

A common question we get from clients is: Do I have to talk to the nurse case manager? Is the nurse case manager really there to help me?

First, what is a nurse case manager?

The nurse case manager role is actually defined in Maryland law.   “A nurse who is certified by the State Board of Nursing to provide case management services, including but not limited to interviewing, the worker for purpose of implementing and coordinating services with health care providers, and with the worker and the worker’s family. (COMAR: 14:09:07:01) A nurse case manager’s (NCM) job is to coordinate care of the patient, acting as a liaison between the patient and his medical providers, claims adjusters, and employer. This can mean providing “triage” immediately after an injury and can also mean ongoing work on the injured worker’s case. The case manager can also accompany patients on physicians’ visits, make home visits, and arrange modified work assignments with the employee’s supervisors.

While an injured employee should never speak directly to an insurance adjuster (the adjuster can use what the injured employee says against him), the employee can communicate directly with the NCM. It can be helpful to give the NCM updates about treatment and recovery. However, even if the case manager seems like an honest advocate, the injured employee should have the support of a lawyer. The lawyer can relay updates between the injured employee and his NCM if they employee does not feel comfortable talking to the NCM directly. Remember, case managers still work for insurance companies. Better safe than sorry.  If you no longer want to communicate with your nurse case manager, tell your workers’ comp lawyer.

The Nurse as the Patient Advocate

Nurses are taught, in nursing school, that they are the patient advocate. Nurses speak for the patient when the patient cannot speak for himself. Some nurse case managers put their patient above all else. Some nurse case managers realize the paycheck ultimately comes from the insurance company and act in their own self interest. Like any industry, it’s a mixed bag.

NCMs working for insurance companies must try to save their insurance company as much money as possible while organizing sufficient care for the injured employee. It’s not an easy job. It’s a very difficult job when you have a NCM with a strong conscious and a lot of pressure from the workers’ comp insurer.

Make Sure Your Nurse Case Manager is Looking Out for You

If a nurse case manager is not complying with the list below, seek advice of a workers’ comp lawyer immediately. If you’re suspicious, trust your gut.

  • A NCM shall consider the best interests of a disabled covered employee, whether or not they have legal representation in providing vocational rehabilitation services.
  • A NCM may not misrepresent his duties or responsibilities or the workers’ compensation process to disabled covered employees.
  • At the initial comprehensive assessment, a NCM shall advise the disabled covered employee that: (1) The NCM’s fees are paid by the employer/insurer; and (2) NCM is an independent professional and shall render an opinion based solely on the facts and evidence in the case.
  • A NCM shall exercise independent and professional judgment (not that of the NCM’s employer) when performing an assessment or developing a vocational rehabilitation plan.
  • A NCM shall notify all parties of any contact with or about the disabled covered employee, whether that contact was in person, in writing, or made electronically.
  • A NCM shall comply with: (1) The Commissioner’s orders and procedures; and (2) Standards of practice adopted by the Maryland Board of Nursing.

Byron, with Rebecca Smith, Baltimore Workers’ Compensation Lawyers