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Nick Avgerinos
Nick Avgerinos
Contributor •

What Is a Medical Case Manager Doing In My Workers’ Compensation Case?

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We frequently receive phone calls from individuals asking whether a nurse retained by the workers’ compensation insurance company in Illinois and Iowa workers’ compensation cases has the right to attend their medical appointments and talk to their doctors. In most cases, the answer is “yes.” However, it is necessary to understand the limits that should be placed with respect to the contacts that the nurses may have with the injured worker and doctor.

In general, the medical case managers, or nurse case managers as they are often called, are retained by the employer or insurance carrier to serve as liaison between the injured worker and the workers’ compensation insurance company. Their job responsibliities consist of, but are not limited to, reporting to the insurance company on what was said at the medical appointments, laying out a roadmap of what the goals and objectives are for a worker’s course of recovery for his medical condition, and passing along information to the doctors regarding an employer’s ability or inability to accommodate work restrictions.

Some individuals find the nurse case managers pushy, more concerned with the insurance companies interests than theirs, too quick to advocate for a return to work even if the worker or doctor is skeptical as to their abilitiy to perform certain work, etc. In certain circumstances a worker has every right to request a new medical case manager or, perhaps, refuse their services altogether — a decision best addressed on a case by case basis.

Where a nurse case manager is retained, several ground rules must be established right off the bat, including:
1. That the nurse case manager will promptlly provide the worker’s attorney with all reports that are prepared for the insurance company,
2. That the nurse will not induce the worker to change doctors or medical service providers,
3. That the nurse is not allowed to have communications with the medical providers unless the worker is present, and,
4. That the nurse case manager is not allowed in the examination room.

Keep these principles in mind when a nurse case manager is “on your case.”