Today is Halloween. If you are an injured worker, you shouldn’t be scared of ghosts, goblins, witches or even an over-abundance of trick-or-treaters coming to your door. No, the scariest thing to you or any other injured worker in Illinois should be a nurse case manager.
Their title sounds innocent enough and they aren’t all trying to ruin your case, but many of them will do things that they shouldn’t be doing. The worst offense is that they’ll try to talk to your doctors and convince your doctor that the treatment plan is wrong for you and that another (cheaper) course of action should be taken.
Another frightening thing they will do is try and convince your doctor that you should be working even when your physician has said you should be off of work.
Of course when they do these things it puts your health at risk. Let’s say your doctor says you can’t return to work because your normal job requires you to regularly lift 50 pounds or more and you have a herniated disc in your back. So the nurse case manager talks to your doctor and says, “Is it ok if he goes back to work as long as he doesn’t have to do any lifting at all?” The doctor says yes because that sounds reasonable, but you know that type of job doesn’t exist at your company. So you go back to work and try not to lift anything, but then your boss is asking for help and calling you a wuss if you refuse. So you try to help and then make your injury ten times worse when if you had just rested a couple of weeks you would have been 100%.
These nurses do other frightening things like trying to schedule your appointments around your schedule or even telling you that they need to let them in to the exam room with the doctor, even if you are disrobed!!
What’s really frightening is many of these nurse case managers will act as if you have no say in the matter and that they are doing this all with your best interests in mind. Of course they are really just concerned about the bottom line of the insurance company and saving them money. They aren’t thinking about your health.
Beyond that, you do have a say in the matter. Many of these case managers will discourage you from hiring a lawyer because they know that the second we get on the case, we are going to prevent them from abusing you. The first thing a good attorney will do is standup for their client and that’s something that should exist throughout a case. Unless we give permission otherwise, they are not supposed to do anything other than request copies of medical records and bills. All the other stuff is nonsense and abusive and we typically put a stop to it right away. We certainly wouldn’t want them in the exam room with you or talking directly to your doctor.
So be scared, but not too scared. Just as I used to tell my kids when they were young that there was nothing to worry about at night when the lights were off, you don’t have to worry about this interference in your case. That is you don’t have to worry as long as you know your rights. And enforce them.