A Nurse Case Manager- Who Are They?

When a worker sustains a serious injury, the subsequent medical treatment is usually extensive.  There are doctors’ appointments, diagnostic services, physical therapy appointments, hospital visits and sometimes home health care with medical equipment.  Each appointment and service must be authorized by the insurance adjuster, who must in turn justify why they are authorizing the treatment.  The nurse case manager will attend appointments and work to co-ordinate the authorization for treatment as recommended by the authorized treating physician.  The North Carolina Industrial Commission has rules specific to the use of nurse case manager in workers’ compensation cases.

While the injured worker who retains an attorney will no longer need to communicate with the insurance adjuster, Campbell & Associates encourages our clients to deal directly with the nurse case managers.  The nurses are a great source of information for understanding your medical treatment.  They often help to bridge the gap between what the doctor puts in his medical notes and what the insurance adjuster needs in order to authorize treatment.

Most importantly, the nurse case manager is tasked with assisting the injured worker and acting independently of the insurance company in the medical setting.  Campbell & Associates works closely with nurse case managers, who, more times than not, are excellent sources of information and provide a great way to expedite treatment authorizations.  Conversely, nurse case managers are prohibited from involving themselves in settlement negotiations or investigative activity for the benefit of the insurance company. Call Campbell & Associates at 704-333-0885 if you have questions or concerns about your nurse case manager’s involvement in your work injury claim. We have convenient office locations in Charlotte, Gastonia, Hickory and Rock Hill, SC to help you and your loved ones through any workers compensation injuries or personal injuries that you may have suffered.

Written by Melanie Meacham, Workers Compensation Paralegal, Campbell & Associates, Attorneys at Law