When it comes to a workers’ compensation case, a nurse case manager often gets assigned to a claim. They may seem friendly and eager to help you, but it’s important to remember that the nurse case manager is not on your side.
The workers’ compensation insurance company hires them to help reduce the cost of your medical care and treatment. With this in mind, knowing what NOT to say to a nurse case manager in Florida during your workers’ comp case is essential.
If you need help with a claim or have questions about your workplace injury or nurse case manager, call us at (866) 519-3831 or complete our online form to schedule your FREE consultation with a workers’ comp attorney.
Understanding the Role of a Nurse Case Manager
A nurse case manager for workers’ compensation (NCM) is often positioned as a mediator between the injured worker, healthcare providers, and the insurance company. They appear to be there to ensure you receive optimal care and that your recovery process goes smoothly.
However, it’s crucial to understand that nurse case managers are typically hired by the insurance company.
This means the NCM has a vested interest in saving costs for the insurance company, which could mean advocating for less expensive treatment options or hastening your return to work.
What NOT to Say to a Nurse Case Manager
When you have the support of an experienced workers’ comp attorney, they will proactively handle interactions with NCMs on your behalf. They will contact the NCM and make it clear that any communication should go through their office, ensuring you have a strong advocate protecting your rights.
However, if you haven’t yet sought legal representation, it’s essential to be aware of what NOT to say to an NCM. Without an attorney by your side, here are the key things to avoid in your conversations.
“I’m Feeling Fine”
It’s important to be honest with your healthcare team about how you’re feeling, even if you are feeling great. However, if you tell the NCM that you are feeling fine, they may use this against you later if you experience a setback.
Be truthful about even minor symptoms you may be experiencing to ensure your treatment plan is tailored to your actual needs.
“I Don’t Need Medical Treatment”
If you say anything that suggests you don’t need medical treatment, the NCM will view this as an opportunity to minimize the medical benefits the insurance company pays out.
You should avoid saying anything that indicates a reduction in your need for medical care, regardless of how you feel.
“I Don’t Mind If You Change My Doctor”
Your treating physician’s opinion carries significant weight in your case. Do not allow the NCM to switch your physician, especially if the current one’s recommendations do not favor the insurance company.
“I Don’t Want Surgery”
If your doctor recommends surgery, it’s important to follow their advice and move forward with the procedure. If you tell the NCM you don’t want surgery, they will report this to the insurance company.
The insurance company can then use this information against you and argue that you are not doing everything you can to recover, which can compromise your benefits.
“I’ll Do Fine With Physical Therapy”
While physical therapy is often helpful after an injury, it’s not always enough to make a full recovery. Telling the NCM that you believe physical therapy alone will return you to baseline is a mistake that can lead to reduced benefits. Be careful with what you say when discussing your treatment with the NCM.
“I Have Pre-Existing Conditions”
The NCM will want to know your medical history, but it’s important to remember that pre-existing conditions can be used to reduce or deny benefits. While you shouldn’t lie about your medical history, you should be careful about how much information you share.
“Sure, You Can Join My Private Examination”
You have the right to a private examination with your physician. Don’t allow an NCM to infringe upon this privacy.
“I Don’t Want to Take Time Off Work”
One of the main goals of workers’ comp should be to help you recover as fully as possible. If your treating physicians recommend time off work to facilitate your recovery, you should follow their advice.
If you tell the NCM that you don’t want to take time off, they may try to use this to reduce or deny your lost wage benefits. Remember that your health should always be the top priority.
“I Don’t Need My Attorney Present”
Even seemingly casual conversations with an NCM could have implications for your case. Always involve your attorney in these interactions to ensure your rights are upheld.
“I’ll Sign Whatever You Need Me To Sign”
Insurance adjusters and NCMs may pressure you to sign forms or other documents related to your workers’ comp claim. It is important to remember that you have the right to seek legal counsel and review any paperwork before signing it.
Do not sign anything without understanding the implications, and consult with your workers’ comp attorney if necessary.
What to Say to a Nurse Case Manager
Having established what not to say to an NCM, it’s equally important to understand what you should say. Here are seven things you can confidently communicate to ensure you safeguard your interests:
“I Would Like My Attorney to be Present”
Reiterate the importance of having your attorney present during any discussions. This reinforces your commitment to ensuring all communications are through appropriate legal channels.
“I’m Following My Doctor’s Treatment Plan”
Make it clear that you’re following your medical professional’s guidance regarding treatments, medications, and recommended rest periods. This shows that you’re actively involved in your recovery process.
“I Trust My Current Doctor’s Expertise”
Reinforce your confidence in your treating physician. This can deter attempts to change your doctor to someone more likely to favor the insurance company’s interests.
“I Will Return to Work Based on My Doctor’s Recommendation”
Make it clear that any decision about your return to work will be based on your treating physician’s advice, ensuring your health remains the priority.
“My Attorney Will Provide Relevant Medical History”
Divert questions about your medical history to your attorney. They’ll know what information is pertinent to your case and what might be used against you.
“I Prefer to Have My Consultations in Private”
Reinforce your right to privacy during medical consultations. This helps ensure that your discussions with your doctor remain confidential.
“I Believe in My Doctor’s Treatment Recommendations”
Express trust in your doctor’s treatment recommendations over any other suggestions. This conveys that you value your healthcare provider’s expertise more than cost-saving measures.
While we have provided valuable insights on what NOT to say and what to say to an NCM, we’d like to emphasize the importance of hiring an attorney to navigate the complexities of your workers’ compensation claim.
By having an attorney on your side, you benefit from ongoing communication and tailored guidance throughout the entire process. Your attorney will proactively handle interactions with the NCM, ensuring that any communication or scheduling goes through their office. This relieves you of the burden and ensures that your rights are protected.
Frequently Asked Questions
Q: Why Is a Nurse Case Manager Calling Me?
A: A nurse case manager typically calls you as part of their role in a workers’ compensation claim. They are tasked with overseeing your medical care and reporting back to the insurance adjuster. Their goal is to facilitate your recovery process. However, remember that they are employed by the insurance company, which could impact their actions.
Q: Can I Refuse a Nurse Case Manager?
A: Yes, you can refuse a nurse case manager. You are not obligated to talk to them or allow them to be present during your doctor visits. However, doing so might necessitate you to coordinate your care and communicate with the insurance adjuster directly. It’s advisable to consult with your attorney to understand the implications fully.
Q: Why Was I Assigned a Case Manager?
A: The insurance company assigned you a case manager to monitor your care and recovery. They act as a liaison between you, your healthcare providers, and the insurance company. However, their loyalty primarily lies with the insurance company, so it’s essential to handle communications with them carefully.
Q: What if a Nurse Case Manager Wants to Change My Doctor?
A: If a nurse case manager suggests changing your doctor, it’s crucial to consult with your attorney before agreeing to anything. The insurance company could be trying to switch to a more “cooperative” doctor who may not necessarily have your best interests at heart. Always make such decisions with legal guidance.
Q: Can a Nurse Case Manager Influence When I Return to Work?
A: A nurse case manager could try to push for an early return to work to minimize the insurance company’s payout. However, any decision about returning to work should be based solely on your treating physician’s advice. If you feel pressured, reach out to your attorney for support.
Don’t Let Insurance Companies Dictate Your Recovery
Dealing with an NCM can be an overwhelming part of navigating your workers’ compensation claim. It’s crucial to have experienced legal representation on your side, ensuring your rights are protected, so you can focus on your recovery.
Don’t allow insurance companies to influence your treatment plans or rush your return to work. Let us fight for your rights and ensure you get the compensation you’re entitled to.
Lyle B. Masnikoff and Associates are workman’s comp attorneys with years of experience advocating for workers’ compensation claimants in Florida. Our team is ready to provide you with the guidance and support you need during this challenging time.
Contact our office today at (866) 519-3831 for a FREE consultation and take the first step towards securing your workers’ comp benefits. If more convenient, you can also fill out our online form here. Let us go the extra mile for you!
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The information in this blog post (“post”) is provided for general informational purposes only and may not reflect the current law in your jurisdiction. No information in this post should be construed as legal advice from the individual author or the law firm, nor is it intended to be a substitute for legal counsel on any subject matter. No reader of this post should act or refrain from acting based on any information included in or accessible through this post without seeking the appropriate legal or other professional advice on the particular facts and circumstances at issue from a lawyer licensed in the recipient’s state, country, or other appropriate licensing jurisdiction.
Lyle B. Masnikoff & Associates, P.A.
543 NW Lake Whitney Place, Suite 106
Port St. Lucie, FL 34986