Do I Have To Let A Nurse Case Manager Attend My Medical Appointment?

Can They Do That? Know Your Rights!

Do I Have To Let A Nurse Case Manager Attend My Medical Appointment?

If you have an accepted workers' compensation claim, you may get calls from a nurse case manager (NCM). Who are they and what is their role in your claim?

The NCM is a medically trained nurse hired by the insurance company to help you get the treatment that you need to recover. While you can’t choose your NCM, you can choose whether to talk with them and you can say “no,” if they ask to go into your medical appointments or speak with your medical providers. The NCM’s role in your workers’ compensation claim is limited. They cannot direct, select, or cancel your medical care. You and your medical providers still get to make the decisions about your treatment. Denying the NCM access to your medical appointments does not give the insurance company a valid reason to deny payment for treatment.

Some NCMs are very helpful. They use their medical knowledge to get referrals, arrange medical appointments and transportation, and get pre-authorization for necessary tests and treatments. A good NCM makes your recovery easier. But NCMs are employed by the insurance company and they sometimes apply pressure rather than showing support. A biased NCM forces contact with you, intrudes on your doctor-patient relationship, and tries to hurry you back to work or tries to end your weekly checks early.

It’s important to know your rights. Give us a call to talk about how we can help you manage your nurse case manager to benefit you, not the insurance company.

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