An injured worker going through the workers’ compensation process in South Carolina will likely be tasked with attending doctors’ appointments, scheduling and attending hospital visits, obtaining necessary medical equipment and prescription medications and participating in physical therapy.
In some cases, the workers’ compensation insurance carrier may employ a nurse case manager to assist the injured worker with these tasks. It is important that the injured worker understands his or her rights during the workers’ compensation process and the limits of the nurse case manager’s role.
What Does a Nurse Case Manager Do?
The majority of nurse case managers are registered nurses, and they act as a medical case worker. They may, with the patient’s permission, attend doctors’ and hospital appointments and communicate with the patient and the authorized physician about the patient’s treatment.
A nurse case manager is responsible for:
- Helping an injured worker to obtain the medical care that he or she needs
- Serving as a liaison between all parties involved in the workers’ compensation claim, including doctors, the injured worker, the employer and the insurance company
- Providing information to an insurance adjuster regarding doctors’ visits and treatment authorization.
According to The Case for Clear Guidelines for Nurse Case Managers by Steven M. Birnbaum, workers’ compensation case managers are also responsible for making sure that physicians keep the insurance carrier up-to-date regarding relevant medical matters, including patient prescriptions, treatment, future prognosis and a possible date for the worker to return to his or her job.
What is the Impact of Nurse Case Managers on Workers’ Compensation Claims?
In The Role of Case Management and Its Impact on the Workers’ Compensation Claim Process by Judi Williams, the author explains that nurse case manager is meant to serve as an objective third party who is “uniquely experienced in medical, social, vocational and situational issues.”
For the physician, the case manager is incredibly important because the case manager can facilitate the accurate communication between the patient and treating physician.
For the injured worker, not only can the nurse case manager validate information that the worker provides, but the nurse case manager is also responsible for “assuring that medical care is progressing effectively and identifying problems related to that care.” If appropriate care is not given, a nurse case manager can raise concerns and take action to alleviate the problem.
Theoretically, nurse case managers work independently of the insurance company. While they do provide the insurance company with relevant information about a patient’s condition and medical treatment, they should not advocate against the patient during settlement negotiations or otherwise perform investigative activity on the insurance company’s behalf.
Some argue that nurse case managers take on the role as a second insurance adjuster. They may present facts in a light that favors the insurance company’s position.
If you suspect that this is occurring, it is important that you share this information with your workers’ compensation attorney immediately.
Your Rights As an Injured Worker
When you are injured on the job and a nurse case manager is assigned to your case, you will likely have questions about the nurse case manager’s role and what your legal obligations are in terms of working with the nurse case manager.
Nurse case manager is meant to serve as an objective third party who is “uniquely experienced in medial, social, vocational and situational issues.
South Carolina workers’ compensation law provides that a treating medical provider may discuss an injured employee’s medical history, diagnosis, causation, course of treatment, prognosis, work restrictions and impairments with the workers’ compensation insurance carrier, the employer or certified rehabilitation professionals (nurse case managers). However, before any discussion may take place the injured employee must be:
- Notified by the employer, insurance carrier or its representative, or nurse case manager about the discussion at least ten days before the anticipated communication
- Allowed to be present during any such discussion or communication, along with the employee’s attorney if represented
- Informed by the employer, insurance carrier or nurse case manager about the nature of the communication before the discussion
- Provided a copy of any written questions submitted to the treating physician and the responses of the physician to those questions
If you have been injured while working in South Carolina and have questions about the process of filing a claim or your rights during the workers’ compensation claim process, it is highly recommended that you seek legal help from an experienced workers’ compensation lawyer as soon as possible.
Get Help from Our Workers’ Compensation Lawyers Today
Understanding the workers’ compensation process and the role of workers’ compensation nurse case manager can be confusing. If you do not possess a thorough understanding of these concepts, your workers’ compensation case may be in jeopardy.
Further, some of your rights during the claim process may be violated by the nurse case manager, such as your right to have a private medical examination by your treating physician.
To guide you through the process, it is important that you have an workers’ compensation attorney on your side with experience in handling workers’ compensation cases and who is dedicated to helping you.
At Jebaily Law Firm, we have just the team that you are looking for. Our injury attorneys are not only experienced but passionate about helping our clients.
Initial consultations with our workers’ compensation lawyers at Jebaily Law Firm are always free. To learn more about our services, schedule a free case consultation with us today by using our online form or calling us directly. We serve clients in Florence and throughout South Carolina.
