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Nurse Case Managers and Iowa Workers’ Compensation Claims

Posted By Emily Anderson - 02.07.18

After you have been injured at work in Iowa, the workers’ compensation insurance company is required to pay for reasonable medical care related to that work injury.  The insurance company usually hires individuals called nurse case managers to oversee your medical care.

How Nurse Case Managers Handle Your Work Injury Care

Nurse case managers are nurses who are hired by the insurance company to coordinate your care, attend your doctor’s visits, communicate with your doctors, and report back to the insurance company.  They also write reports for the insurance company that can later be used as evidence in your workers’ compensation claim.

I have a great respect for nurses.  My mom is a nurse at a hospital.  And while some nurse case managers can be helpful, you have to remember that all of them are hired and paid by the workers’ compensation insurance company – which means they may not always have your best interests at heart.

Our clients have told us stories about nurse case mangers talking doctors out of certain procedures and tests that have been recommended, or pushing the doctor to lift restrictions and release the injured worker back to work too soon.

Why would they do this? To be honest, I don’t know.  Nurses are supposed to be patient advocates.  The only thing I can come up with is that they are trying to control costs for the insurance company who hired them—and that only hurts you in the end.

I don’t want to paint all nurse case managers with a broad brush – some nurses can be extremely helpful in getting appointments and tests scheduled and getting care authorized.  But the ones who don’t have your best interests at heart can spoil it for the good ones.

3 Tips For Dealing With Your Nurse Case Manager

Because there are some bad apples out there, I give my clients these 3 tips for dealing with nurse case managers:

  1. Be respectful to your Iowa nurse case manager.

    Nurse case managers are humans who are doing their job.  And they are writing reports that can be used as evidence in your claim.  So it’s important that you treat them respectfully, even if you may disagree with them.

  2. Don’t discuss anything other than your work comp injury care with your nurse case manager.

    You can talk to them about what doctors you are seeing, locations of your appointments, and appointment times. However, even small talk in the waiting room with the nurse can be used against you.  It is within your rights to stop all communication with the nurse case manager. Generally, limited communication with the nurse about logistics can be helpful in streamlining your care.

    That’s one good reason to hire an Iowa workers’ compensation attorney for your claim.  Nurse case managers are required to ask the attorney’s permission to communicate directly with you.  The attorney can then set some boundaries for this communication.

  1. Ask to speak with the insurance company doctor privately, without the nurse case manager present.

    You should be examined by the doctor only at first. This way, the doctor can be free to develop his or her own plan of care for you without the nurse’s involvement.  Once the examination is complete, the nurse can be welcomed into the room and brought up to speed on the plan of care.  You cannot stop the nurse from talking to the doctor before or after your appointment—but you can stop the nurse from being in the room during your appointment.

If a nurse case manager is involved in your work injury care, make sure you let your Iowa work comp attorney know that.  It’s good practice for your lawyer to send a letter to the nurse.  This letter should lay out any expectations regarding her interaction with you.

As always, the insurance company has people on their side providing them information about your workers’ compensation claim.  It’s a good idea to have someone on your side, doing the same for you.

If you have any questions, don’t hesitate to call our office at 1-800-433-0283 or download a free copy of the Law Guide to Iowa Workers’ Compensation Claims.

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