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Q
Do I need to see a nurse case manager in my workers’ compensation case?

A

When you are receiving workers’ compensation benefits, you will need to work with your employer’s workers’ compensation insurance company as well as your doctor and other medical care providers regarding your medical care. The insurance adjuster could have a nurse case manager contact you to assist in managing your treatment. Here, we discuss the role of nurse case managers in workers’ compensation cases in New Jersey and whether you should consult with one in your case.

What Is the Role of a Nurse Case Manager in a Workers’ Compensation Case?

A nurse case manager is often a registered nurse who is hired by the insurance company in part to help you manage your medical care. He or she may also be looking for ways to minimize your medical treatment and reduce costs for the workers’ compensation insurance company. A nurse case manager also often reports back to the insurance adjuster. Because of this, you need to be careful when dealing with him or her. A nurse case manager’s duties can include:

  • Helping you obtain the medical care you need and identifying and resolving problems with your care
  • Acting as a liaison between you and your doctor, your employer, and the insurance company
  • Providing information to the insurance adjuster as to your doctor’s appointments and treatment

There are generally two types of nurse case managers. One type of case manager will help manage your care through telephone calls to find out about your treatment and how it is helping you. She may also call your doctor about a report sent to her that she has a question about. You do not need to be as wary of this type of nurse case manager because she does not want to interfere in your workers’ compensation claim, and she may help you manage your care.

The second type of nurse case manager may be more actively involved in your case—sometimes in ways that you may be uncomfortable with. She may want to meet with you, pop in on doctor’s appointments, and try to consult with your doctor when you are not present. These types of actions should be red flags that her involvement is not focused on your health and interests, and you should consult with an experienced workers’ compensation attorney on what to do.

Do You Have to Work With a Nurse Case Manager?

You are not required to meet with or cooperate with a nurse case manager in New Jersey. However, you want to consult with an attorney before making a decision not to work with this person and for advice on how to inform him of your decision. In some cases, a nurse case manager could be helpful to you, such as in these situations:

  • You suffered a very traumatic injury
  • You need multiple surgeries as part of your medical treatment
  • You have become severely disabled
  • You have been placed in a hospital or nursing home while you recover from your injuries

Tips for Dealing With a Nurse Case Manager

If you are working with a nurse case manager, you need to be careful not to take actions that result in disputes in your workers’ compensation claim or that violate your rights in regards to your health and medical treatment. Follow these guideline in dealing with a nurse case manager:

  • Do not let the nurse case manager come into the examining room when you are meeting with your doctor.
  • Do not authorize the nurse case manager to talk to your doctor when you are not present.
  • Do not let the nurse case manager change your doctor without your consent.
  • Do not provide the nurse case manager with personal information that is unnecessary to her assistance in managing your medical care.
  • Meet with the nurse case manager at her office or a neutral location. You do not have to allow her to come to your home.

Do you have questions about working with a nurse case manager while you are receiving workers’ compensation benefits? Do you have other questions regarding your rights under New Jersey workers’ comp laws? Call my office to schedule a free, no-obligation consultation to get your questions answered and learn how I can help you obtain the benefits that you deserve. Your best shot at asuccess is teaming up with an experienced workers' compensation attorney.

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