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You can’t trust a workers’ compensation nurse case manager

When you’re injured and on workers’ compensation in Maryland, the insurance company handling your claim may assign a nurse case manager (NCM) to your claim.

In theory, the NCM’s role is to assist you with your treatment. NCMs are supposed to have a unique understanding of the medical and vocational issues involved in workplace injuries. They’re supposed to help coordinate your treatment and facilitate better — and more accurate — communication with your treating physicians.

Unfortunately, theory and reality often have little to do with each other where workers’ comp and nurse case managers are involved.

In reality, you need to remember that NCMs work for the insurance company — not the patients they supposedly are there to help. In many ways, they may act as an advocate for the insurance company’s interests — not yours!

No matter how understanding and sympathetic your NCM seems at first, you need to keep a sharp eye out for any of the following problems:

  • The NCM seeks to talk to your doctor without your presence. That’s an indicator that the NCM doesn’t necessarily want you to hear what is being said.
  • You find out that the NCM has communicated with your doctor outside of your presence either personally or in writing.
  • Your NCM starts to pressure your doctor to return you to work after your doctor has already stated that you need more time to recover.
  • Your NCM pressures your physician to change your course of treatment or medications in some way.
  • Your NCM tries to pressure you into allowing him or her into the examination room despite your objections.

In general, you still have a right to your privacy — even when a nurse case manager is involved in your care. You also have the right to be treated with respect and dignity. If you feel that your NCM is behaving inappropriately, a workers’ compensation attorney can help protect your rights.