There’s a pretty simple rule I tell people to follow if they have an Illinois workers’ compensation claim. It’s this:
If someone has an interest that is competing with yours, don’t listen to them.
We see this more with nurse case managers than in any other part of the claims. Typically these are individuals with some sort of nursing degree who are contracted out by an insurance company to do what they can to gather information and limit your medical care.
As you can imagine, since they are contracted out, getting hired on future cases can depend on how they do on your case. So in other words, they have a motivation to do things that are in their best interests, not yours.
Case in point, you might get told that you need to sign a form which allows them to talk to your doctor. You don’t have to do that. They might tell you it’s customary for them to be in the exam room with you. It’s not. Some will schedule your medical appointments for you under the guise of being helpful, but really do it based around their schedule. That shouldn’t happen. Others will call the doctor without your knowledge and cancel your appointment. That shouldn’t happen either.
A recent caller to my office was frustrated at how the nurse case manager (NCM)was interfering with her care and asked if it was time to get a lawyer. The NCM of course told her that wasn’t necessary and had the nerve to state that it would cost them money.
I’m not saying that everything that a NCM does is a lie or immoral, but I am saying that they are not there looking out for you. If your doctor wants a MRI, they’ll push back. If your doctor, you know the person who is looking out for you medical needs, says that you need a surgery, they’ll try to fight it.
These tactics are how they get evaluated and saving the insurance company money makes them money. It’s a direct competing interest.
The caller asked me if we should do something about the case manager and I said, “Heck yes we should!” The NCM’s are pests, but we have the best bug spray for those pests. Under Illinois law, they can be removed from a case any time we want. Without your permission, which can be revoked even if you signed something, they can’t talk to your doctors or schedule your appointments, or cancel them or come in to the exam room or do anything other than ask for copies of medical reports and bills.
NCM’s can be stressful, but like other problems, they are only stressful if you let them be. And there’s no reason that you should.