Do I have to have a case manager?

[jimmy moon]

What is the name of your state? Post office/Federal worker comp
I have just been assigned a case manager who is following me to all of my doctors visits and asking me a lot of questions that I assume will be used against me. Can I refuse her services without any "cons" or do I have to have a case manager? Thank you in advance for your help.
Jim

 

[SVCgirl]

a nurse case manager has been assigned to follow your medical treatment & coordinate your doctor's requests if the requests are within guidelines Typically the nurse works as an advocate for the claimant(you) and as a go between the adjuster and the medical doctor. You can refuse to speak with him/her however she/he will continue to attend the visits and speak to the doctor regarding your treatment whether you want it or not. I would use the nurse to your advantage. Have her attend the visits and regularly discuss your medical issues with her. She in return can notify your adjuster and expedite your care and treatment.

 

[seagoing]

The nurse case manager is not on your side,but on the side of the Ins.co paying the bills.Their job is to get you back to work asap.Which is a good thing,as long as it doesn't further hurt you and as long as your getting ALL the medical treatment necessary.I had one yrs.back.Long story short,she and I came from the same part of town in a different state.She gave me all the dirt and at the time was awaiting a job in a hospital because she was tired of Ins.Co's srewing HER patients ans stopping her from doing what she became a nurse for,That was to help,not hurt people.You dont have to allow a CM into the exam room with you,and its wise not to.They can twist things they see and hear to bite you later.Also,be sure to be present when CN speaks to the Dr,in fact ask the Dr.if he/she will ONLY discuss your care to the CNin your presense.Many Drs (at least in FL)dont want them bothering the Dr.mainly because they try and persuade the Dr to do other than what the Dr wanted.Also,push to put you lite duty.Lite duty for some could certainly disrupt their life.For instance the Post Office could send you anywhere whithin 50 miles,if your office dont have lite duty.But it gets the ins.co.from paying disability benefits.After the cn I mentioned left,I got a new one,I was warned by the first about her.The new one sent me to a MRI place and the films were so bad my Dr.had the office receptionist call the cn and HE told her Don't send anymore patients to me with films from store fronts.I then had another MRI,at that visit ,at the Hospital the Dr had his office in.Totally different report.like I was 2 different people.SOOOOOOOO,how could it have gotten so screwed?Got off topic hee,bottom line,know what is going on your case,DONT trust representitives for the INS CO.Its all about $$$$ to them

 

[SVCgirl]

That's just one opinion from the claimant's side of a nurse case manager. I handle a case load of 162 injured workers collecting benefits. Doctor's are supposed to generate reports every 45 days. alot of doctors dont and this can interupt a claimant's benefits. I assign a nurse case manager to inform me what is going on and to advocate for the injured worker. You sound bitter with your entire wc experience. Yes, the ins co. is going to push you back to work. Why would anyone want to stay on disability forever? The biggest complaint from injured workers is that they cannot pay their bills. If you work with the nurse case manager it benefits you the injured worker. You can request the doctor not to speak with the case manager or that you be present however keep in mind the insurance company is the one paying the doctor. If a report is not generated the doctor is not going to get paid. If the doctor works with the nurse he gets paid additional monies therefore doctors generally take the time for the nurse. The purpose of workers' compensation is to rehabiliate you to you back to your pre-injury capacity. My advise to you remains the same, work with the nurse to get the most out of your benefits.

 

[seagoing]

OK SVCGIRL,I agree the ins Co.is paying the bills.Would you agree or disagree that Ins.Co's look to save money a little harder than provide the BEST CARE possible to the injured worker?surely in you experience you SHOULD have witnessed resistance from the Ins Co's.It is quite rampant based on what I've read ,and experienced during my W/C case.Lets not forget I heard it from a nurse case manager ,whom is also now working in a very good hospital here in S.Fl.I have no doubt that there are NCM's that look to help the patient as #1 goal,however their hands are tied tooooooo often and many avenues of treatment are not explored in the name of the almighty buck.Had I been treated properly at the onset,I might not have the PERMANENT injuries I now have to my spine.It was a W/C Dr and original CNM(I had 3)that decided I should go bact to work LITE DUTY .take steroids and pain meds while going to physical therapy 3x a week.Around my second week the therapist ,the THEAPIST realized something is wrong.The CNM and DR.didn't want to send me out for the MRI,it was felt it was too early???.P/t refused to treat me in writing,I got a lawyer involved,it was the lawyer that got things moving ,like a new Dr.the the crap with the MRI started.In my case ,in fairness,its obvious the NCM (who was let go from my case at that point)was not looking in my best interest.My opinion is,if you get hurt ,whether at work or elsewhere,you go to someone that you choose,has a relationship thats is primary to the patient,not the INS.Co.Because of lack of care ,I don't work anymore,at %0 plus yrs.hard labor all my life ,disabled,I am not very employable and my financial delimma grows each day .In closing,I one of thousands of permanenly disabled workers who have been put through a nightmare of W/C 's lack of considerations because of money.Money that I have lost much of because of their corrupt system.The ones that win are those of whom are working the system,Ins.Co's and the medical cohorts that TAKE their money as a basic payoff.I(f you happen to believe the W/C system is on the level?then I must inform you that you are at least naive.