How to Deal with the Workers’ Comp Nurse Case Manager

A workers' compensation case might involve working with a nurse case manager. How can you navigate this situation and get the best results?
Nurse Case Manager talking about disease with old patient in hospital reception lobby, showing diagnosis on laptop to give recovery treatment.

A nurse case manager is one of the people you might find yourself involved with when dealing with a workers’ compensation claim. Workers’ compensation insurance companies often hire nurse case managers to monitor the injuries and recovery progress of injured workers, as well as monitor their ability to return to work. Many people can find nurse case managers stressful to deal with and feel like the nurse case manager is intruding on their personal medical care. As they work for the insurance company, they are usually more interested in getting the best results for the company than they are in the best interests of the injured worker.

With a few tips, you can learn how to work with a nurse case manager and ensure you get the best results.

Key Tips for Dealing with Nurse Case Managers

Understand the Role of a Nurse Case Manager

Firstly, it’s helpful to understand the role of a nurse case manager and what they can and can’t do. They might carry out a range of tasks as part of their duties so that they can report back to the workers’ compensation insurance company.

Some of the things that a nurse case manager might do include:

  • Attending medical appointments (with permission from the worker)
  • Talking to the physician about medical care and a treatment plan
  • Helping to schedule medical appointments
  • Reporting to the workers’ compensation insurance company about medical treatment
  • Authorizing payment for medical care


Nurse case managers indeed have a job to do for the insurance company. However, that doesn’t mean that they’re all bad. Some will do their best to be helpful to the injured party. However, there are also plenty of nurse case managers who may not be so helpful. They are tasked with helping to ensure the insurance carrier doesn’t have to pay any more than necessary, so they can come across as pushy as they try to get your doctor to put you back to work as quickly as possible or to choose less expensive treatment options.

You Don’t Have to Let the Nurse Case Manager Attend Examinations

Keep in mind that you have the right to be privately examined by your doctor without the nurse case manager being present. Anyone else who wants to attend the appointment needs your permission, and you’re not required to give it to the nurse case manager. Seeing your doctor privately means you can talk with them freely, allowing you to discuss any medical issues you want to bring up.

Sometimes the nurse case manager will also try to talk to your physician after the appointment. You can prevent this from happening by staying until the end of the appointment. If the nurse case manager wants to talk to the doctor, you can request that you be present for any conversations.

Make Your Treatment Plan With Your Doctor

Nurse case managers often try to dictate your medical treatment or influence your doctor’s decision-making. If a nurse case manager is in the exam room with you and your doctor and a discussion comes up about your treatment plan the nurse case manager will often attempt to insert their opinion into the conversation to steer the doctor in a direction most beneficial for the insurance company, whether that is releasing you back to work or pursuing less expensive medical care. And sometimes, doctors are swayed by the nurse case manager’s request which almost always ends up being detrimental to the injured worker. Do not let the nurse case manager influence your medical treatment.

When you meet with your doctor do not let the nurse case manager be in the room during your examination. This allows you and your doctor to come up with a treatment plan and agree on appropriate work restrictions. The nurse case manager will undoubtedly talk with your doctor after your exam is over, but by that time, you and your doctor have agreed on a treatment plan and it is much more difficult for the nurse case manager to influence decision-making after a decision has been made.

Stick With Your Doctor

One of the things a nurse case manager might try to do is change your doctor. This can happen if the insurance company doesn’t like the doctor who is treating you and wants to change them to a doctor who will say what they want to hear. They might do this by telling you that your chosen doctor isn’t available for a while but there’s another doctor you could see sooner. This is something to watch out for if you want a doctor who has your best interests in mind.

If you have chosen a doctor but the next appointment is far away, you can still go with them. You might have to wait longer, but you could get better treatment and results from the doctor who is more in demand. If the office won’t call you, you can call the office yourself to try and get in touch. It can be helpful to work with an experienced workers’ compensation lawyer, who will know which doctors insurance companies in Virginia prefer and which ones are more likely to keep your best interests in mind.

Remember, the Nurse Case Manager Works for the Insurance Company, Not You

It is important to remember that the Nurse Case Manager is always hired and paid by the insurance company. Typically, insurance companies use a specific company, or specific nurse case manager, for ALL of the injured workers. This means a substantial part of the Nurse Case Manager’s business comes from one or two insurance companies. The insurance companies use these specific Nurse Case Managers because they receive a financial benefit from the Nurse Case Manager’s involvement in the case. The question begs, would a Nurse Case Manager take action that would endanger their income from the insurance company?

In some instances, the Nurse Case Manager is actually an employee of the insurance company! How this cannot be a conflict of interest for the Nurse Case Manager is mind-boggling, but Virginia law permits their involvement in your case.

Update Your Attorney About the Nurse Case Manager

Talking to your lawyer about the nurse case manager assigned to your case is smart. They need to have the latest, most relevant information so that they can give the best advice. Keep your lawyer updated on the discussions you have with the nurse case manager, as well as their actions. This is particularly important if you believe that they are trying to work against you.

Get Legal Advice from Experienced Workers’ Compensation Lawyers in Virginia

Get in touch with Renfro & Renfro for advice and support with your workers’ compensation case. Our experienced workers’ compensation lawyers can help you navigate the ins and outs of your case, including working with a nurse case manager. Contact us today to discuss your situation.


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