If you’ve been hurt on the job in Massachusetts and your injuries prevent you from returning to work to earn your wages and you need medical treatment, chances are you’re dealing with your employer’s workers’ compensation insurance company – and possibly a nurse case manager.
As an experienced Framingham workers’ compensation attorney, I see this in a lot of cases. Many of our clients from Boston, Framingham, and Worcester areas ask me the same question:
“Do I have to let the nurse case manager come with me to my medical appointments?”
The answer is simple: No, you do not.
What Is a Nurse Case Manager in a Workers’ Compensation Case?
A nurse case manager (also referred to as NCM) is a medical professional that is hired by the workers' compensation insurance company and typically assigned to an injured worker’s claim. Their general role is to manage and coordinate your medical care and treatment. Typically, they follow your treatment, communicate with your doctors, and report updates to the insurer.
Many times, a nurse case manager wants to attend doctor’s appointments with an injured worker. This is where things get concerning.
Why You Should Be Wary of Letting a Nurse Case Manager Attend Your Doctor Visits
It’s important to understand who the nurse case manager really works for — and it’s not you. The nurse case managers work for the insurance company. Understandably, this raises concerns with injured workers and workers’ compensation attorneys in Massachusetts. Since they work for the insurance company, there is some element of allegiance to the insurer.
Sometimes, even though the nurses may appear friendly and supportive, they are not on your side. Their job is to monitor your medical treatment, report back to the insurance company, and often seem to try and persuade your treating doctor to clear you for work as soon as possible — even before you're fully recovered and ready to return.
Injured workers are often led to believe they must allow the nurse case manager into their appointments. Insurance companies may imply that it’s required, especially if they’re paying you weekly workers’ comp disability benefits. Your doctor-patient relationship is confidential. You are under no obligation to allow the nurse case manager into your examination room. In fact, keeping your appointments private helps ensure your doctor focuses solely on your health — not on appeasing the insurance company.
Thus, you have the right to privacy during your medical treatment, and you can absolutely say no to having a nurse case manager present.
Here’s some concerns about having a nurse case manager attend your doctor’s appointments:
- They work for the insurance company. Their goal is to help the insurer reduce the amount they pay – not to ensure your full recovery.
- They may influence your doctor. Some nurses have been known to pressure doctors into releasing patients for “light duty” or sedentary work — even if your employer doesn’t offer such positions.
- Your benefits could be at risk. If the nurse case manager convinces your doctor to say you can work in a limited capacity, the insurance company may try to reduce your weekly payments from total to partial disability.
In Fairness - Sometimes a Nurse Case Manager Can Be Helpful
To be candid, in some cases, a nurse case manager can be helpful to get injured workers the treatment they need or resolve any medical treatment disputes. It is really case and injury specific.
As a nurse assigned to an injured worker’s claim, the do have an obligation to the patient (i.e., you). There are cases where the nurses are helpful to an injured worker and offer assistance getting appropriate and necessary treatment. It all really depends on your case and the nurse assigned to your claim. As with all professionals, there are good ones, and then there are not so good ones.
Real Example from a Massachusetts Workers’ Comp Case
In one of our recent cases, a client from Marlborough, Massachusetts was receiving weekly temporary total disability benefits after he was hurt at work as a landscaper in Worcester, MA. Before he hired attorney Chuck Pappas, he allowed a nurse case manager to attend his doctor’s appointments. Our client explained that at first, the nurse was polite and helpful. But things changed quickly.
At a follow-up visit with his doctor, the nurse attended. He described how the nurse pushed the doctor to note that he could do sedentary tasks like answering phones – in other words “light-duty”. However, his employer didn’t have desk jobs or sedentary positions available. The major issue this created was, with this note from his doctor, the insurance company immediately filed a Complaint to reduce his weekly workers’ comp benefits. The insurance company used the doctor’s note releasing our client to light-duty as support for their Compliant, claiming he could return to work in a limited role — even though he was still recovering from his work injuries and there were no light-duty positions available.
Talk to a Trusted Framingham Workers’ Compensation Lawyer
If you're unsure about your rights or feel pressured by the insurance company to have a nurse case manager go to your doctor’s appointments, don’t face it alone. Attorney Chuck Pappas has a lot of experience dealing with nurse case managers and the workers’ compensation insurance companies.
Attorney Pappas works closely with his clients and together we can make a decision whether a nurse case manager would be helpful or pose a risk to your workers’ compensation claim.
A work accident isn't something most think about often until it happens to them. This is why injured workers typically have many questions and concerns after being seriously injured on the job. If you were hurt at work, you should have a good understanding of the workers’ compensation process and benefits available in Massachusetts. The experienced workers’ compensation lawyers at Mahaney & Pappas, LLP, are here to help you during this difficult time.