In New York, when an employee becomes injured or sick at work, there are many things going on all at once. The employee is gaining medical attention from their regular doctor or from an emergency room if the accident is serious and they need immediate medical attention. Also, the employer is being informed about the accident as the employee files a workers’ compensation claim with the employer’s insurance company.
While the employee is attending doctor’s visits, gaining medical treatment, and undergoing therapy, they may also have visits with a workers’ compensation nurse case manager. Learn more about what the nurse case manager does in these situations and how they might impact when an employee returns to work and the amount of compensation that the employee is entitled to for their workplace injury or accident.
What Is a Workers’ Compensation Nurse Case Manager?
A workers’ compensation nurse case manager is a registered nurse. They are hired by the workers’ compensation insurance company or by a self-insured employer to evaluate the medical needs of the injured worker. They may also work for a specialized treatment doctor who is providing medical care to the employee. For some extreme and catastrophic injuries that the employee may deal with due to a workplace accident, a doctor may take on the role of the workers’ compensation nurse case manager.
In New York, the workers’ compensation nurse case manager role is to help provide medical resources so the injured employee can obtain the right medical care for their conditions. The nurse case manager also serves as a liaison. They coordinate medical information that if provided to the injured worker, the workers’ compensation insurance company, the employer, and the doctors. The workers’ compensation nurse case manager helps the flow of medical information and treatment authorizations between the injured worker and the workers’ compensation insurance company.
Issues Experienced with Workers Compensation Nurse Case Managers in New York
For some workers’ compensation nurse case managers, their main function is to ensure that the injured worker gets the required medical treatment they need to prevent the injury or sickness from becoming worse. They also help to educate the employee about medical treatments and what the employers role is in helping the employee recover so the worker can return to their job.
Returning to Work Too Quickly
Unfortunately, due to the fact that many workers’ compensation nurse case managers work for the insurance company or the self-insured employer, the nurse case manager may feel obligated to get the worker back on the job as quickly as possible before it is medically recommended by the worker’s doctor.
This situation can cause the worker to sustain addition injuries or lead to the employee being back at work before it is time. By returning to work too early, the employee can receive lower workers’ compensation benefits toward their medical treatments in an effort to save the employer and the insurance company money.
Not Putting the Patient’s Medical Needs First
Another issue that many workers experience when having a workers’ compensation nurse case manager assigned to their claim is that the nurse case manager will direct the employee to work with certain doctors for their medical treatment. The nurse case manager may change the employee’s medical appointments to suit their schedule, or they may fail to address medical concerns or recommendations brought up by the doctor in an effort to get the employee back to work.
Influence on the Doctor’s Treatments
Lastly, a New York workers’ compensation nurse case manager may be aggressive in wanting to attend doctor’s visits and in wanting to be in the room during the medical examination. They may try to influence the doctor’s treatments toward the injured worker and limit treatments to lower compensation costs.
When A Nurse Case Manager Comes Calling…
Many New York State Workers’ Compensation insurers hire nurse case managers for the purpose of “coordinating medical care.” However, in most instances, the nurse case manager serves one roll: to save the insurance company money.
If a nurse case manager contacts you by telephone or shows up at your doctor appointment, it may be time to consult with an attorney.
At my firm, we almost never allow nurse case managers to contact our clients directly and we certainly do not consent to them appearing at our client’s doctor appointments.
Protecting Your Rights After a Workplace Accident
A workers’ compensation nurse case manager should act as an unbiased third party advocate who has the best interests of all the people involved in the workers’ compensation case, including the injured worker. Yet they may be detrimental to the employee’s continued medical care and to their compensation claim.
If you have been injured in a workplace accident in New York and have a workers’ compensation nurse case manager assigned to your claim, you can reach out to a qualified attorney. Here at Paul Giannetti Attorney at Law, we provide legal advice and representation to our clients who are involved with workers’ compensation claims after a workplace accident or illness. We ensure that you receive the required medical attention you need and only return to work when you are capable of doing the job tasks while receiving the compensation you need to pay for your medical expenses. Contact our office today for a free consultation.