Most Americans understand the concept of workers’ compensation; however, they may seldom think about the need to file a claim. Injury accidents can occur to people in or away from their workplace during their shift.
For example, say a fast-food worker suffered a serious injury on a delivery. A company representative refused the delivery man’s workers’ compensation claim since the injury occurred away from the restaurant. The court ironically ordered the company to perform a delivery of its own in the form of a substantial workers’ compensation award.
The nurse case manager’s duties
Soon after the injured employee files for and receives workers’ compensation, a nurse case manager may contact the worker. Also known as a medical rehabilitation nurse or rehabilitation professional, a nurse case manager kindly offers to assist the employee free of charge. The injured worker feels tremendously relieved by the NCM’s offer to take care of everything. She coordinates the patient’s medical care plan, works with his medical team and even becomes the contact person for his family. The North Carolina Industrial Commission oversees NCMs and regulates their performance.
The patient believes the NCM is on his side, helping him cope with onerous tasks and coordinating his medical care. She is warm and friendly, always nearby for doctor visits. She even sits in the exam room taking notes while the doctor is explaining treatment options or medical procedures to the employee. She shares this personal information with the insurance company.
The nurse case manager’s employer
A smart employee will not allow the NCM to be in the room during exams. The fact that the insurance company pays an NCM is a critical piece of information that workers’ compensation patients do not always understand. The NCM meets privately with the patient’s medical team and may persuade them that expensive procedures are not necessary and pain medications are no longer needed. She may even insist that the unwell patient is ready to go back to work. The NCM’s role is ripe for a conflict of interest and unethical care treatment decisions.
The company wins by saving money when the NCM succeeds in reducing or stopping the employee’s workers’ compensation. Not all NCMs are unethical, but all NCMs are under pressure to get the minimum adequate care for the employee in the least amount of time possible. The insurance company pays her to reduce the time an employee is off work.