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

Nurse case managers (NCMs) coordinate medical care and determine the extent of disability. However, there are times when the NCM doesn’t serve a specific purpose and is assigned to the claim to get it moving. At times, NCMs 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 by first 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 an LPN or an NCM with less experience or fewer credentials.

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

Ask the following:

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

Make use of a Nurse Case Manager:

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

 

Michael Stack, CEO of Amaxx LLC, is an expert in workers’ compensation cost containment systems and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%. He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaching injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors. IMR software simplifies the implementation of these best practices for employers and ties results to a Critical Metrics Dashboard.

Contact: [email protected].

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