How to Tell If You Need a Nurse Case Manager for Your Workers Compensation Claim

Nurse case managers (NCMs) coordinate medical care and determine extent of disability. However, there are times when the NCM doesn’t serve a specific purpose and is assigned to the claim to get the claim moving. At times, NCM’s are used to do some of the tasks adjusters are supposed to do. Your job is to clarify when nurse case management is warranted and useful.

The injury coordinator can evaluate these aspects of both telephonic case management and field-based case management first of all by emailing the adjuster and stating the above.

Also, the injury coordinator should know whether your NCM is an RN or a Licensed Practical Nurse (LPN). You should be charged less for a LPN or a NCM with less experience or fewer credentials.

Require the NCM to provide you with frequent updates. If you review the insurer’s file notes online and do not see NCM notes, contact the NCM to provide an update.
Ask your third party administrator or adjuster to work with you to determine when the use of nurses serves to resolve claims quickly and ensures good quality medical care for the employees.

Ask the following:

Do you have any suggestions of when we should use nurses, what types of claims?
Can we get a list of all claims which have NCM assigned?
Shall we touch base about this on our regular risk management conference call?

Make use of a Nurse Case Manager:

In complex cases with multiple provider coordination.
In new lost-time claims if the length of time out of work is disproportionate to the injury.
When an employee is missing medical appointments.
When surgery, including arthroscopy, is anticipated.
For all hospitalizations.
If there is diagnostic testing including MRIs, CAT scans, or myelograms.
For severe injuries including: severe eye injuries, severs lacerations, back and knee injuries, cumulative trauma cases and severe sprains, strains or dislocations.
And remember: Not all nurse case managers are equally effective. If your assigned NCM is not effective, ask for a replacement.

Author Michael Stack, Principal, Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%. He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: https://blog.reduceyourworkerscomp.com/

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.