Working With a Managed Care Nurse

Working With a Managed Care Nurse

Does the insurance company nurse have to go into your doctor’s appointment?

Frequently, I’m asked whether the insurance company nurse always gets to go into the examination room when the injured employee is seeing that employee’s treating doctor. Upon reporting an injury and seeking medical care, the workers compensation company may assign a nurse to “help” with the injured workers medical care. The managed care nurse usually is responsible for scheduling doctor or physical therapy appointments for the injured worker.

However, sometimes the managed care nurse can create an uncomfortable situation for the injured worker when that managed care nurse attends doctor appointments. Often the interests of the injured worker, workers compensation and doctor are in conflict. The workers compensation insurance company usually wants to save money.

The easiest way to do this is to have the doctor return the injured employee to work with physical restrictions which sometimes the doctor doesn’t want to do. So, the workers compensation insurer has the managed care nurse brow beat the doctor into doing some the doctor may very think is against the interest of the injured worker.

Opposite of this is the injured workers interest and that of the treating doctor. The injured worker usually wants to get well and return to work. Similarly, the treating doctor wants the injured worker to get well also.

South Dakota Codified Laws 62-4-1.3 specifies that the injured worker is required to sign a medical authorization for the workers compensation insurance company to get the injured worker’s medical records. The workers compensation insurance company is entitled to obtain the treating doctors medical records regarding the doctor’s care of the injured worker. However, there is no law that says the managed care nurse is entitled to be in the examination room with the injured worker.

The injured worker has a patient/doctor relationship with his or her treating physician which means that the injured worker is entitled to confer with his or her treating physician confidentially. If the injured worker is uncomfortable with the presence of a managed care nurse during an examination, the injured work should arrive for the appointment about fifteen (15) minutes early. Upon early arrival, the injured worker should request that the receptionist accommodate the exclusion of the managed care nurse. Having practiced in the area of workers compensation law for over twenty (20) years, I have found this to be a very effective technique to avoid an intrusive managed care nurse.

Grant G. Alvine
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