What is a nurse case manager?

A nurse case manager (“NCM”) is a licensed professional hired by the insurer to provide assistance with the medical aspect of the case. The NCM is hired and paid by the insurer. The type of services provided by the NCM depends on the severity of the employee’s injury. Their activities often include coordinating medical appointments, ensuring medical treatment is authorized and scheduled, and facilitating approval of a light-duty job for the injured worker. In most cases, the injured worker can choose whether or not to work directly with an NCM.
Some employees find the NCM to be useful. This is especially true for employees who have sustained significant injuries. The NCM can help the injured worker negotiate treatment with various specialists and obtain such services as home healthcare and medical devices.
In other cases, the NCM can be an annoyance. If the employee’s treatment needs are straightforward, they may not need the NCM’s help. The employee may also feel the NCM is pushing the insurer’s agenda, rather than advocating on their behalf. It can also be uncomfortable for an employee to be examined in the presence of his or her nurse. The State Board of Workers’ Compensation also allows the NCM to assist with having a light-duty job approved by the employee’s doctor, which can affect the employee’s income benefits.
If the employee chooses, they can notify the insurer that they do not want to work with the NCM any longer. Once the insurer receives notice of the employee’s choice not to work with the NCM, the NCM will be forbidden from contacting the employee directly or attending their medical appointments. By law, the NCM will still be able to contact the doctor directly without including the employee.