If you’ve been hurt on the job, you may hear the term nurse case manager early in your workers’ compensation claim. A nurse case manager is a registered nurse hired by the insurance company to coordinate your medical care—not to provide treatment. And because every claim is different, working with an experienced workers’ compensation lawyer can help ensure your rights are protected and that your medical care remains focused on your best interests. Here are the top four things you need to know when working with a nurse case manager:
1. What Is a Nurse Case Manager?
A nurse case manager (often called an NCM) is a registered nurse assigned to help coordinate your medical care in a workers’ compensation case. The insurance company hires and pays for this nurse.
An NCM helps manage the process of your medical care, including:
- Attending doctor’s appointments
- Communicating with your medical providers
- Coordinating referrals and testing
- Helping schedule appointments
- Facilitating communication between the doctor, employer, and insurance carrier
2. Their Primary Role
A nurse case manager’s primary role is coordination, not control.
They are supposed to ensure that your treatment plan is followed, that recommendations are understood, and that return-to-work issues are clearly communicated. They may ask questions at appointments to clarify work restrictions or recovery timelines. They may also help remove logistical barriers, like scheduling delays.
What they are not supposed to do is direct your medical care, pressure your doctor, or influence treatment decisions for the benefit of the insurance company.
3. Independent Healthcare Professionals
Although insurance carriers hire NCMs, they are not supposed to act as advocates for the insurance company. They are licensed healthcare professionals with independent ethical obligations.
In both North Carolina and South Carolina, nurses must follow professional standards requiring patient advocacy, confidentiality, unbiased communication, and integrity.
In North Carolina, nurses are bound by the North Carolina Industrial Commission’s Rules of Utilization of Rehabilitation Professionals in Workers’ Compensation Cases, as well as the North Carolina Board of Nursing. In South Carolina, nurses are regulated by the South Carolina Board of Nursing and must also follow state law and professional ethical standards.
4. Why This Matters to You
If you are receiving workers’ compensation benefits, it’s important to understand that an NCM’s presence does not mean the insurance company controls your medical decisions. Your doctor makes treatment decisions. You have rights. And the nurse is bound by professional standards that require fairness and honesty.
If you have concerns about how a nurse case manager is handling your case, consider speaking with an experienced workers’ compensation attorney such as Bradley H. Smith.
Understanding the roles of everyone involved helps you stay informed, confident, and focused on what matters most: your recovery.