What is the deal with the Nurse Case Manager on my workers comp case?
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After being injured on the job and receiving some medical treatment there may come a time when the adjuster or case manager assigns a nurse case manager to your case. You do have rights regarding this case manager and there are some boundaries that the nurse should be aware of. If you are unfamiliar with case managers then it is important to further investigate these rights and not to be afraid to ask for the nurse’s ethical obligations. It is also a good idea to consider obtaining a Maryland workers compensation attorney when a nurse case manager is involved.
The role of the nurse case manager in a Maryland workman’s compensation case.
A nurse case manager is often brought into a case by the adjuster in order to facilitate the progress of medical treatment. The goal is to ensure the injured worker gets the treatment they need without undue delay. Nurse case managers are often very good in this regard as they can quickly obtain the necessary authorization or approval from the adjuster and provide it to the treating physician. In the event a treating provider orders an MRI the injured worker may have difficulty getting authorization, scheduling an appointment, and obtaining the test. Sometimes getting a diagnostic test performed under Maryland workers compensation insurance can take weeks or a month. When there is a nurse case manager involved it may happen within days.
While acting as the liaison between the workers comp adjuster and the doctors, the nurses can often be helpful. However on a regular basis the nurses seemingly cross the line of appropriateness and cause problems for the injured.
What rights does the injured worker have when dealing with a Nurse Case Manager in their Maryland Workers Compensation Case?
A workers compensation nurse case manager is still a licensed nurse and has to abide by the same ethical standards that an ER nurse or clinician would have to abide by. The nurse case manager has taken an oath to a fundamental commitment to the patient. The nurse must consider the injured workers interests first! If this comes in question then the injured worker should not be afraid to question the nurse about this. In the circumstance that the injured worker has difficulty doing so perhaps a Maryland workmans’ compensation attorney is needed to advocate for the claimant. The nurse case manager must still treat the patient/injured worker with respect, dignity, and without prejudice. Unfortunately some practitioners have a pre-conceived notion about workers comp recipients and these notions my, from time to time, interfere with acting respectful and dignified. Perhaps most important is the nurses obligation to maintain the patients right to privacy!
Is the nurse case manager crossing the line?
At some point those injured workers in Maryland who have a nurse case manager assigned to their case may begin to feel that their interests are not being considered to the extent expected. This presumable lack of consideration often comes in the form of the nurse attempting to rush the patients return to work. The nurse may be approaching the treating provider or physician with statements as to when the worker can return to work, or perhaps when treatment should come to an end. Regularly case managers have meeting with physicians, without the patient being present, and discuss the injured workers return to work. In Maryland the injured worker has the right to be involved in any communication the nurse case manager has with the physician!
On occasion there may be some influence placed on the doctors to avoid prescribing certain treatment. Instances when a nurse case manager took it upon her/himself to influence the form of treatment prescribed which essentially materialized into the nurse taking over the treatment prescriptions. This, under no circumstance, is ok!
What can the injured worker and their doctor do if the Nurse Case Manager is overreaching?
First and foremost- the treating physician has the say as to what treatment is appropriate and at what point the hurt worker can return to work. Accompanying this power is the power to refuse to speak with the nurse case manager. The doctor can absolutely refuse to speak with the case manager. Unfortunately many physicians in Maryland are not aware of this.
The injured worker also has options under Maryland law as to how to handle a rowdy nurse case manager. Under Maryland law the injured worker can refuse to let the nurse into the examination room. The injured worker maintains their right to privacy. He or she may also request the doctor not speak with the nurse. It is best to explain to the doctor that conversations with the nurse case manager may affect the physicians impartiality as well as their judgment. In some of the more egregious cases it is necessary for the injured worker to request the nurse have no involvement in their case. While the nurse will limit their involvement to a minimum, often they continue to act as a liaison by requesting medical records and appointment dates from the physicians office. Ultimately the decision falls with the doctor as to providing the medical records and appointment dates and they are limited by Maryland workers compensation laws as to what they can refuse to provide. Medical records requested must be provided to the case manager.