Shortly after a severe accident covered by workers’ compensation, you may receive a phone call from a person who is a nurse case manager. This person works for the insurance company that is paying for your workers’ compensation medical care.
This person may tell you he or she is here to make your medical treatments run more smoothly and deal with the medical management stress for you so you can concentrate on getting better. It is a good idea not to believe anything or make any decisions or say anything to this person until you get someone on your side who does not have a conflict of interest.
Your condition after a serious work injury
Soon after your injury, you may require several different types of treatment. You will possibly be in physical pain and mental anguish as you worry about how to pay bills when you cannot work. You may also worry whether your condition will permanently disable you.
This is not the best time for you to make crucial decisions that could affect your health care and workers’ compensation benefits. The nurse case manager knows you are under tremendous stress and will offer all kinds of help. The most important thing is to repeat, «Because of my accident, I am not making decisions right now. Please give me your number, and I will return your call as soon as possible.» This will buy you some time to learn about what a nurse case manager really wants to do. To put it bluntly, he or she may want to limit the amount of money the insurance company has to pay for your workers’ compensation claim. This person works for the insurance company.
The company you work for hired the nurses’ insurance company because all businesses must have workers’ compensation coverage. It is a myth that the state pays for your workers’ comp benefits.
A large conflict of interest
A nurse case manager may persuade your medical team that you can return to work—often sooner than your doctors believe is good for you. When you return to work, your workers’ compensation usually ends. A nurse case manager may try to trick people who are fighting severe injuries into going back to work too soon. The insurance company will also hire the doctors you see. There is a way you can eventually see an independent doctor who has no involvement with the insurance company, but the insurance company doctors may not make it easy for you to do so.
The best thing you can do immediately after the accident is to contact a professional who knows your rights concerning workers’ compensation. The person will work for you, not for your company and not for the insurance people. The goal of the person you choose to represent you is to make sure you do not have to go back to work too soon and that your treatment providers do not deny you treatments like an MRI because the insurance company does not want to pay for expensive tests. Make sure someone is on your side who knows your rights and will advocate for your welfare.