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Nurse case managers and workers' compensation claims

If this is the first time you are filing a workers' comp claim for an on-the-job injury in North Carolina, you may not expect the stressful process of claiming workers' compensation. An insurance representative or an attorney from your company may try to pressure you into signing a North Carolina Workers’ Comp Settlement. It sounds like an excellent way to end the bureaucratic stress, but you stand to lose important rights. Once you sign, you cannot recover compensation if future complications arise from your injury.

When you are in pain, it is hard to educate yourself about worker's comp, make decisions about medical care and fight your way through the inevitable maze of paperwork. Work-related injuries can cause you significant distress as you worry about how to pay your bills and whether you can work again.

What is a nurse case manager?

A nurse case manager may contact you. He or she states that an NCM helps you organize all necessary appointments, medical treatments, and documentation for your injury claim.  

Nurse case managers may not be your friend. They may challenge whether you need specific treatments and insist you are ready to return to work when your doctor does not agree. An unethical NCM often does everything possible to save your employer from further insurance costs for treatment or time off work that you legitimately deserve. NCMs do not work for you; they work to benefit the insurance company and your employer.

Does a nurse case manager need credentials?

The North Carolina Industrial Commission regulates NCMs. They must have a professional license, training in their medical area of expertise and NCM certification. They must behave ethically and explain conflicts of interest. If an NCM tries to force you to act against your doctor's treatment plan, you have the right to fire the NCM.

Can a nurse case manager participate in treatment decisions?

NCMs can attend any authorized doctor appointments with you, but they cannot stay in the room if you prefer private interactions with your doctor. They can meet alone with your doctor; however, an NCM may never attempt to influence the type or length of medical treatment you receive or insist that you are fit to return to work. They also cannot give you legal advice.

While there are ethical NCMs, the field is wide open to conflicts of interest. Some NCMs can and do exploit their positions. They know that you are probably unaware of your rights, and your doctor may not understand the NCM's participation limits. 

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