DON'T LET A NURSE CASE MANAGER INTERFERE WITH YOUR CLAIM

Shortly after suffering a work injury, an injured worker usually receives a call or letter from a claims representative who investigates and processes the claim for the employer's workers' compensation insurance company.  Eventually, the insurance company may assign a nurse case manager to the claim.  Like the claims representative, the nurse case manager usually calls or sends a letter to the injured employee and may ask the injured employee questions about his or her treatment plans.  In addition, the nurse case manager may begin scheduling appointments for the injured worker, attending those appointments, and even speaking with the injured worker's doctors.

Pennsylvania law does not give a nurse case manager the right to do any of these things.  Furthermore, Pennsylvania law does not require the injured worker to speak with a nurse case manager or follow a nurse case manager's directives in order to receive workers' compensation benefits.  Most importantly, an injured worker's doctor cannot speak with a nurse case manager unless the injured worker first provides the doctor with express authority to do so.

You should never allow a nurse case manager to interfere with your doctor-patient relationship. Your employer's workers' compensation insurance company can obtain all of the information it needs to monitor and pay for your medical treatment by simply obtaining the appropriate medical and billing records from your doctors.

Of course, the insurance company will never tell an injured worker any of this. Instead, the insurance company simply will mail you forms to sign and return. Most likely, those forms will authorize your doctors to provide certain information to the insurance company. Many times, those authorizations are very broad and give any of your past, present, or future doctors the authority not only to release records to the insurance company but also to speak with nurse case managers.

Before returning any form the insurance company asks you to sign, you should always seek a free consultation from our law firm (412-288-6000).  Even if you already unknowingly gave your doctor permission to speak with a nurse case manager, we may be able to help you revoke that authorization so that the nurse case manager cannot interfere with your claim anymore.