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What Is a Nurse Case Manager and Do I Need One?

A Nurse Case Manager is a nurse that is hired by the insurance company to help manage the medical aspects of an injured workers’ compensation claim. Frequently, this person will meet the injured worker at the doctor’s office and will go into the appointment with the injured worker. They will ask pertinent questions of the doctor that the injured worker may or may not know to ask. A Nurse Care Manager is also helpful in pointing out pharmacies that the insurance company has contracts with and can assist in making sure that the injured worker has their pharmacy card.

If the injured worker needs specialists in addition to their Primary Treating Physician, a Nurse Care Manager can help make appointments to see all specialists that the injured worker needs to see.

That all sounds good, right? Not so fast. In many cases, Nurse Case Managers are great and can be very beneficial to the injured worker in getting proper treatment. However, there is also a downside to having Nurse Case Managers. It’s important to understand that insurance companies want to make money. If the insurance company is willing to pay a nurse $50 to $75 an hour, there must be some benefit for them.

The primary benefit is that the Nurse Case Manager can help move a case along if it seems to be stagnating. Nurse Case Managers will frequently question doctors on their treatment protocol. Workers’ Compensation applicant attorneys will hear clients say that their Nurse Case Manager asked their doctor, “When will the healing phase over be complete?”, and even challenge the doctor to push for the healing phase to be complete, despite the doctor’s wishes to try different healing modalities to see if further healing can take place.

So, bottom line, if you are assigned a Nurse Case Manager, it can be either a positive experience or a negative experience depending on the Nurse Case Manager assigned to your claim. If an injured worker retains counsel, any Nurse Case Manager that has been assigned to the case must call the attorney to ask permission to remain on the case. When a Nurse Case Manager calls the attorney of an injured worker to ask if they can remain on the case, a skilled attorney will then talk to their client directly and ask them what experience of having a Nurse Case Manager has been like. If it has been a positive experience, and the client doesn’t have any sense that the Nurse Case Manager is putting the insurance company’s interest above the injured worker’s interest, and the injured worker likes their Nurse Case Manager, attorneys will generally allow the Nurse Case Manager to remain on the case.

If injured workers’ experience has been negative, such as the Nurse Case Manager pressuring the Treating Physician or the injured worker, and the injured worker hasn’t been comfortable with the Nurse Case Manager, the injured workers’ attorney will have the Nurse Case Manager removed from the case. So again, it is a case by case basis.

It is important to understand that the injured worker who is having a negative experience with their Nurse Case Manager, can only exercise the option to have the Nurse Case Manager removed if they have retained counsel. An attorney can remove a Nurse Case Manager from a case; An injured worker who is representing themselves cannot.

An injured worker without counsel is defenseless against the whims of the insurance company.

Sacramento Workers’ Compensation Lawyer:

We hope this answers some questions you may have about Nurse Case Managers and if you need one, and if you don’t want one, how to have them dismissed. For any additional questions about California Workers’ Compensation please call The Law Office of Alice A. Strömbom at 916-444-7557. We’re here for you.


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