In nearly all of the workers’ compensation cases that our office handles, a nurse case manager is assigned to the injured employee’s claim. The nurse case manager usually wants to accompany the injured employee to his/her doctors’ appointments. Our clients often ask us if the nurse case manager has to go to the doctor appointments. The short answer is: NO.
Most of our client’s ask this questions, because it never seems to be an option for them. In other words, the injured employee is lead to believe that if the workers’ compensation insurance company is paying disability benefits, then the case manager has to go to his/her appointments and talk directly with the injured employee’s doctors. Our clients tell us that the nurse case manager explains that they are acting in their best interest and will help get them the best treatment. In some situations, this may be true. A lot of times, however, we have seen just the opposite. Injured employees need to understand that the case managers work for the insurance company and have insurance company’s interest in mind. The case manager wants to have your doctor release you to work so that the insurance company can stop paying you (or pay you less money each week).
For example, in a worker’s comp case we are handling now, our client, who was injured on the job and out of work collecting total disability benefits, had a nurse case manager go with her to her doctor’s appointments (against our advice). Our client told us that initially the nurse case manager was so nice and very helpful. Our client later explained that things changed quickly. At the most recent appointment the case manager pressed and manipulated the doctor into putting in his medical records that our client could do something, like answering phones or sedentary desk work. The problem is, our client’s employer doesn’t offer desk work. Based on this, the insurance company immediately filed to modify the disability benefits from total to partial disability. This means that our client may get less money every week, but hasn’t fully recovered from her injury and is still unable to work.
The doctor-patient relationship is confidential. You do not have to allow the insurance company’s nurse case manager into your doctor's visit. These confidential visits allow you to privately tell the doctor your concerns and focus on how to best recover from your injury. The nurse case managers are agents of the insurance company and want to shift your doctor’s advice and comments in the insurance company's favor.