Why the answer may surprise you
Your client recently suffered greatly from an injury and is seeking what he feels represents adequate compensation so he can recover and return to the workplace – if returning to work is possible.
Then you learn that the insurance company has engaged the services of a field nurse case manager to actively work the case. Immediately, you assume that they plan to severely limit your client’s compensation – the compensation they are owed – or, even, may begin to push for a return to work.
In your mind, the list of drawbacks can go on and on. Bottom line, you may think that the hiring of a nurse case manager by an employer or payor is not a good sign and poses a direct threat to your case.
Well, not exactly.
Don’t fall prey to flawed assumption
Yes, plaintiff attorneys commonly assume that the influence of an authoritative nurse case manager can only spell trouble for the plaintiff’s case. But don’t fall prey to this flawed assumption. An experienced nurse case manager with high integrity can be just as much of an asset, if not more, for the plaintiff as she is for the defendant.
Examine this assumption by considering the true objective of the nurse case manager: They are tasked with guiding a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s health needs through communication and available resources to promote quality cost-effective outcomes, according to the Case Management Society of America.
The professional nurse case manager should focus on the best treatments available, helping to move and navigate the injured worker through various diagnostics; physicians and providers; treatments; rehab; and, eventually, a return to work, if and when appropriate.
Insisting on best practices
In addition, she uses her knowledge, experience and observation to ensure that the physician and other providers follow these best practices through the entire case. She can do this for the plaintiff’s case just as well as she can for the defendant’s.
Those findings may favor the injured worker. They can enlarge the plaintiff’s case, provide for a stronger case and support the award of more substantial proceeds.
Those findings also can backfire on the insurance company or employer – more quickly than a clogged blunderbuss if they have not focused on best medical practices, attempted to do damage control or are trying to cut corners just for expediency.
The professional nurse case manager can provide supportive and verifiable information and numbers that may indicate that your client might never be able to return to work or a normalized lifestyle. They may even find that your client also needs further and much more complex medical help.
On the other hand, the information may also indicate your client is on track for recovery and a return to work.
The nurse case manager has a difficult job. She is involved with the case on many levels. She must remain impartial and accurate with the information that she reports.
If all parties, including the injured worker, plaintiff counsel, insurance representative, providers, employer, nurse case manager and defense counsel, truly act and report ACCURATE medical information, as well as return-to-work abilities, then the case usually moves along fairly well. A nurse case manager often can help with those efforts and provide important information.
Problems, however, can arise when the involved parties are at cross-purposes. With so many people involved in a case, the parties naturally become compartmentalized with their own responsibilities and goals. A nurse case manager can help keep everyone on course and focused on the best outcome possible.
Facts are facts. Good medical care is good medical care. All parties should be putting forth the best, most honest and accurate information and effort as possible.
Defendant or plaintiff, it doesn’t matter. Not all cases go smoothly. There are sometimes less than optimal outcomes and results.
But don’t just assume the nurse case manager is the bad guy. She often is the one person that keep things moving along.