The Potential Drawbacks of Having a Nurse Case Manager

While many NCMs are genuinely committed to helping their claimants recover fully, they do have a potential conflict of interest because they're hired and paid by the employer's insurance company, which likely wants to spend as little money as possible on medical bills and get the claimant back to work sooner rather than later.

What Is Considered Unacceptable NCM Behavior?

The insurer pays the NCM a salary. To justify that salary and keep the job, an NCM might not want your doctor to recommend expensive treatments or might encourage a return to work before you're really ready to resume your duties. In the worst scenarios, unacceptable NCM behavior might include:

  • Disagreeing with your doctor's diagnosis or treatment plan
  • Questioning the work restrictions you're given by your doctor
  • Accusing you of exaggerating your symptoms or level of pain
  • Inaccurately report the content of communications with your doctor
  • Challenging your impairment rating
  • Discouraging you from consulting an attorney about your case

This could be considered unethical behavior on the part of an NCM becuase it deprives you of your right to fair workers' comp benefits. In this case you're well justified in taking action to protect yourself.

Exercise Your Right to Protection

As a workers' comp claimant and a patient of your primary doctor, you have certain rights that you can exercise to protect yourself from any inappropriate behavior on the part of your NCM.

You Are Entitled to Private Medical Exams

Although your NCM is permitted to accompany you to your doctor's appointments, you have the right to be examined in private by your doctor. It's a good idea for you to exercise that right. When only you and your doctor are present, you can speak openly and honestly about your symptoms, pain, progress toward recovery, and anything else that the doctor needs to know. If you disagree with something the NCM has told you to do or not to do, discuss your options with your physician during your private exam.

You Have a Right to Full Disclosure of Doctor-NCM Meetings

Although the NCM has the right to consult with your doctor about your treatment and recovery, you have the right to be present during their meetings. You must also be given copies of any questions submitted to your doctor in advance, and your NCM's communications with your physician are not permitted to interfere with your treatment. If there is anything being discussed that you don't understand, ask questions. If you disagree with anything said or reported by either party, say so and demand clarification. If you can't get clear answers or you're still not satisfied with the role your NCM is playing in your recovery, contact a workers' comp attorney for a consultation on your case.

Have You Been Assigned a Nurse Care Manager After a Workers' Compensation Claim?

If you've been hurt at your job, you can speak with a workers' compensation lawyer. Please contact us online or call our Florence office directly at 843.488.7540 to schedule your consultation. We are also able to meet clients at our Conway, Florence, Myrtle Beach, Murrells Inlet, Mt. PleasantNorth Myrtle Beach, Charleston or North Charleston office locations.

Dirk J. Derrick
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South Carolina Lawyer Dirk Derrick helps victims recover from car accidents, personal injury & wrongful death.