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Missouri Work Comp. A “Nurse Case Manager.” Who’s that?

Q: There is a “Nurse Case Manager” at my doctor’s appointment. Why is he/she there and can I trust them?

A: Let me start off by saying that a nurse case manager, in Missouri Work Comp circumstances, is NOT YOUR FRIEND OR CONFIDANT. Sure, they are probably friendly faces and appear nice. Don’t be fooled. This person works for your employer’s insurance carrier. Their job is to gather information, keep an adjuster at the insurance carrier up to speed on the case and get your medical treatment wrapped up as soon as possible to minimize the cost to the insurance company.

Nurse Case Managers are usually appointed in more complex cases where an insurance carrier may have to pay a high dollar settlement at the end of the day. Oftentimes, the scenario plays out like this:

  • You are injured at work and are sent to doctor or ER.
  • You see a first doctor (at Concentra or similar occupational medicine clinic) who recommends you see a specialist, like an orthopedic surgeon. Up to this point, you’re on your own at the visits.
  • You either receive a phone call from the adjuster telling you a nurse case manager is being appointed or you show up to your specialist appointment and are greeted by someone new, a nurse case manager.
  • The nurse case manager asks you some questions about your injury, your lifestyle, your limitations. They small talk with you to get to know you a little better. All the while, they are writing notes that will eventually go in to your claim file with the insurance company.
  • You meet with your doctor alone and the doctor says “ok, I think you were hurt by this, and we are going to do “X”…”
  • After you meet with the doctor, you see “your” nurse case manager go in to meet with the doctor separately.
  • The nurse case manager emerges and says “ok, I talked to the doctor, and we are going to do “Y”.
  • You are dumbfounded as to why the plan has changed all of the sudden.

I’m sure some nurse case managers mean well. But the fact of the matter is that they don’t work for you. They receive their paychecks from the very same insurance company that is later going to try to minimize your injury so that they have to pay less, so there is a perverse incentive for them to try to minimize your medical treatment. Workers’ Compensation in Missouri is hard enough. The deck is stacked against you, an injured worker, before a Nurse Case Manager gets involved.

My advice?

  • Tell the insurance company you don’t want the Nurse Case Manager to be involved in your case. That may or may not work.
  • Next, write down or record what your doctor is saying to you in your conversations with him or her.
  • Next, challenge the Nurse Case Manager if his or her opinion is different from what the doctor tells you.

Last, but not least, if you have a case where a Nurse Case Manager is involved, you probably have a case where it is really, really worth it to get an experienced attorney involved. At the very least, consult with an experienced workers’ compensation attorney so that you know your rights.

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