Examining the Role of a Nurse Case Manager in a Workers' Compensation Case

A nurse case manager can play a vital role in an injured worker's Workers' Compensation case, but utilizing such services must be examined on a case-by-case basis. "The role of a case manager can be that of a helpful liaison, but the opposite can also be true," says Erika Vargas, a partner in the law firm of Gordon, Edelstein, Krepack, Grant, Felton & Goldstein, LLP (GEK).  The law allows for assignment of a nurse case manager, but it does not mandate it.   The insurance company pays for the nurse case manager's services.   In determining whether a nurse case manager is needed in a case and will be allowed, consider their role and responsibilities in a case.

Case management nurses have a wide range of responsibilities, including coordinating patients' care, advocating for them when necessary and getting them the necessary services and education. Their tasks can include the following:

• Developing and managing an overall long-term healthcare plan for patients with serious or chronic conditions.
• Booking patients' doctor appointments, and following up to ensure they keep them.
• Serving as a resource for patients, providing education and guidance to patients and their family members.
• Acting as a liaison between patients and their insurance providers.
• Routinely reporting to all parties as to the patient's progress.

A nurse care manager addresses a patient's physical and psychosocial care needs, and can be very useful in certain cases, especially catastrophic ones. However, if an injury doesn't require coordination of care between various treatment providers and doesn't entail complex medical issues, a nurse care manager is not needed.

In some cases, nurse case managers are hired to help move a case along if it seems to be stagnating. They will often question doctors on treatment protocol, even challenging physicians to move along the "healing process" even when doctors want to try other treatment modalities.
When it comes to injured workers who have legal representation, nurse case managers must ask the attorney for permission to remain on the case. "Involvement of a nurse case manager should be reviewed on a case-by-case basis," says Vargas. "I suggest that any injured worker makes sure his or her attorney agrees with any such involvement. Oftentimes the client doesn't know he or she can say no to the use of a case manager." 

Depending on the injured worker's experience with the case manager, and the worker's needs in a given case, a decision should be made by the worker and his or her attorney as to whether there is an ongoing need for nurse case manager services.