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The Nurse Case Manager in Workers’ Comp

Episode 74: In this episode, Calloway County workers’ compensation attorney Jeff Roberts discusses the nurse case manager’s role in your workers’ comp claim.  This nurse does not work for the doctor treating your workplace injury.  Instead, the nurse case manager works for the insurance company handling your claim.

Jeff begins by noting the nurse case manager is generally involved with workers’ compensation claims.  She/he will often attempt to attend doctor’s appointments with the injured worker.  One of the objectives is to handle communications between the doctor and the insurance company. 

While you are used to seeing nurses in a doctor’s office or clinic, the nurse case manager performs a different function.  Yes, she/he is a nurse, but they are not there to provide treatment.  They don’t work for the medical provider.  This is why you need to understand the role of a nurse case manager in workers’ comp.

Jeff explains that the nurse case manager can help to get medical appointments and/or diagnostic testing approved because they are in frequent contact with the insurance company.  However, they are also taking down statements you may make and other relevant information the insurance company may use in your claim.  This is not always to the benefit of the injured worker.  They can be fairly assertive in trying to get the doctor to release you to return to work, as quickly as possible.  This is a way to save significant cost for the insurance company.

the role of a nurse case manager in workers' comp

Attempts to Influence Your Doctor

In addition to trying to get the doctor to accelerate your return to work, the nurse case manager looks for other ways to reduce costs related to your workplace injury.  For instance, she/he may try to convince the doctor to prescribe a more limited number of weeks for physical therapy, at least from the outset. 

Your Doctor’s Appointment Should be Private

It’s not uncommon for the nurse case manager to attempt to be in the room during your medical exam or discussions with your doctor.  While this may seem okay, after all this person is a nurse, they are there to exert influence, including what might get documented in the doctor’s notes. Influencing the doctor is a primary objective of a nurse case manager in workers’ comp claims.

Jeff puts conditions on the nurse case manager, if they are going to be present during your visits to the doctor.  One condition requires that the nurse case manager not be in the room during examinations and consultations, unless the client is comfortable with it.  Another condition is there are no oral conversations with the doctor, without the client/patient being present.  It’s okay for them to communicate in writing, but not orally.  It’s too easy for them to influence the doctor and the notes, if no one is there to give additional details or context.

Notes from Your Doctor’s Appointment Are Very Important

Doctors see thousands of patients.  Assuming he/she might be called into a deposition to give their perspective on your case, including treatment, it’s obvious they may not specifically recall a certain conversation with you.  The deposition could be months after your actual exam.  For this reason, the doctor will refer to your medical record, which contains his/her notes.  If the nurse case manager influenced what was recorded in those notes, it may give an inaccurate account of the full situation.  Again, this may not be in your best interest as it relates to your workers’ compensation benefits.

Influencing Prescriptions

In Kentucky workers’ comp cases, the law requires the doctor to prescribe generic medications, unless there’s a specific reason.  However, if a newer medication is available that doesn’t necessarily have a generic version, the nurse case manager may attempt to steer the doctor toward a different medication that has a generic version, because it would save the insurance company money.

The doctor does retain the ability to make decisions that are in the best interests of his/her patients.  Workers’ compensation claims often include additional paperwork and approvals.  Nevertheless, he/she can refuse to listen to the nurse case manager, although sometimes it’s just easier to go along.  This is an unfortunate reality related to a nurse case manager in workers’ comp.

Influencing the Choice of Specialists

It’s not uncommon for a doctor to refer a patient to a specialist for treatment or follow up.  Jeff sees this frequently.  The issue is that certain specialists might be more inclined to make decisions more favorable to the insurance company.  This might occur because that specialist values the volume of patients that get referred to them, as a result of the insurance company and nurse case manager. 

Some of these decisions could involve which additional treatments, surgeries or medications you receive.  When they recommend you return to work.  What type of limitations you may have when you return to work, and other important decisions.  Again, the result is less cost for the insurance company as it relates to your workers’ comp claim.

In Episode 68, Jeff explained the Designated Physician Form 113.  This form can be used to trap you, if you’re not careful. 

It’s Not Always a Bad Thing

A significant part of this episode has dealt with the negative issues related to nurse case managers.  Jeff points out that at times, they also play a positive role.  A good case manager can help to get diagnostic testing approved more quickly (such as an MRI). 

Influencing Your Impairment Rating

An impairment rating is a factor in the decision related to your permanent disability benefits from Kentucky workers’ comp.  This include permanent partial disability and permanent total disability. 

Doctors examine you and your ability to perform specific movements and tasks. Doctors assign a number that relates to your impairment.  However, depending on the type of work you perform, it could be different.  For instance, an attorney with a back injury may receive a lower impairment rating than a construction worker with the same injury.  The impairment rating you receive is extremely subjective.  There are prescribed ranges of the impairment rating and the doctor choses how high/low they feel the impairment rating should be. 

Typically, the higher the impairment rating, the more benefits the insurance company may have to pay the injured worker.  The nurse case manager may try to recommend which doctor is used to assign the impairment rating.  They may be able to use a doctor more inclined to assign a lower rating.

Experience on Your Side

Jeff Roberts has represented injured workers for the past 32 years.  Because so many of the issues are complicated and can be influenced to benefit the insurance company, you should have an experienced workers’ compensation attorney on your side.  Jeff can step in to place conditions on what the nurse case manager can and cannot do.  He can work to get additional treatments ordered by the doctor (regardless of how the nurse case manager tries to limit them).  Jeff can get alternative impairment ratings from another doctor to potentially present a more accurate indication of your situation. 

PSTD-Related to Your Workplace Injury

In Episode 51, Jeff discussed how there are psychological issues that can impact your ability to ability to either return to work.  First responders often deal with PSTD-related issues.  Additionally, people how have been involved in a car wreck may suffer from PTSD.  If you’re a trucker, delivery driver or a sales rep, this condition can have a very negative effect on your ability to perform your job. 

Other conditions might include depression, anxiety or other issues related to your workplace injury.  Whether these psychological conditions can be considered in determining your workers’ compensation benefits, is an important part of your claim.

Unfortunately, unless some type of physical contact was involved in your incident, the judge may not be able to allow psychological affects to be considered in valuing your benefits.  Again, an experienced attorney can recommend mental health professionals who may be able to assess your particular situation.

In summary, if you’ve been injured on the job and a nurse case manager gets involved in your case, let your attorney know.  While there are some things the nurse case manager can do to facilitate decisions related to your treatment, there are many ways she/he can negatively influence the treatment and care you actually receive.  At the end of the day, that case manager works for the insurance company, not your doctor.  It’s why you should carefully deal with a nurse case manager in workers’ comp claims.

What Do Other Clients Think About Jeff?

We always encourage listeners to read the Google Reviews Jeff Roberts has received from many of his clients.  A 5-Star rating and the comments are earned recognition and demonstrate Jeff’s commitment to his clients.  As a solo attorney, he has more Google Reviews than some firms with multiple attorneys.  Jeff shares the credit with his staff at the Roberts Law Office.  Successfully representing a victim of an automobile accident is a team effort.  It’s why Jeff likes to say his firm offers small town service with big city results.

Jeff Roberts Represents Injured Clients Throughout Kentucky

With offices located in Calloway County and now Christian County, Jeff has a history of representing personal injury clients, workers’ compensation clients and social security disability clients across the state.  He’s represented clients from Paducah, Bowling Green, Louisville, Covington, Whitesville and many other Kentucky locations.  He’s not just a Western Kentucky injury attorney. 

We hope you found this episode insightful and helpful.  Thank you for listening!                                                                                              

Is It Time to Speak with an Attorney about Your Workers’ Compensation Claim?

The office phone number is (270) 753-0053 or toll free at 800-844-5108.  For more information, visit This podcast is meant to provide information and is not legal advice.  Jeff’s principal office is located at 509 Main Street, Murray, Kentucky.  Co-host Jim Ray is a non-attorney spokesperson.  This is an advertisement.