Just imagine that you’re going through your workday, just like you’ve done a hundred times before. But this time, something different happens, you get hurt. It wasn’t on purpose. You accidentally tripped and fell or you got burned while cooking as a chef. There're a million ways that a work injury could happen and you never expect that it could happen to you.
If the unexpected injury does happen, what do you do next? Of course, you tell your supervisor and report the injury. In turn, they should recommend that you seek medical attention. And then you’re officially in “the system”. The Worker’s Compensation System. For most injured workers they have no idea what their rights are and how to navigate the confusing system of physicians, utilization reviews, therapists, and adjusters. And unfortunately, the majority of injured workers are left with little to no help from their employer or from the adjusters at the insurance company. And this isn’t because they don’t care or because they feel as though you are “making it all up”. It’s simply because they don’t have the time to dedicate to helping you get the treatment you need and deserve.
However, a lucky few of those injured workers will not go through the system alone. They will have a Nurse Case Manager assigned to their files. Someone to help manage their medical care, coordinate appointments, set-up referrals, be the liaison between all parties and most importantly be the only person that truly listens to their concerns and answers their questions.
Why do some injured workers get a Nurse Case Manager and other’s don’t? Well, just like everything else in worker’s comp, it’s all according to policies and procedures. Nurse Case Managers aren’t assigned to random claims at random times. But rather, are assigned to specific cases according to the level of injury involved, the complexity of the treatment plan, and/or the desire of the employer, adjuster or attorney.
Here’s the thing. When an injured worker’s injury will require a lot of time to management, the over-worked adjuster or employer simply doesn’t have the time to do it. Therefore, he/she will assign a Nurse Case Manager to assist with handling the medical aspects of the claim to make sure that the proper treatments are being performed and the file is progressing forward. After all, every day that is being missed from work and every treatment that is being performed is costing the insurance company and the employer money. That’s why some employers are involved in handling the claims and assigning the Nurse Case Manager to the claims. A good employee is an investment, and they want to make sure that their investment is taken care of with a return to work as soon as possible, decreasing the amount of missed day from the job.
Assigning a Nurse Case Manager early in the claim process is a win-win from everyone involved. The injured worker doesn’t feel as though they are alone and nothing is being done to help their recovery. The insurance adjuster has “eyes and ears” that can manage the medical aspects of the claim, so they don’t have to. And the employer stays informed of how their employee is doing and when they can expect them to return to work and in what capacity.
So to all of my confused and stressed injured workers out there, who are struggling in the work comp system, request to have a Nurse Case Manager added to your claim. Nurse Case Managers are not “spies” and as an RN we took an oath to always have our patient’s best interest at heart. We will act as your advocate to make sure your voice is heard while we help you navigate the intricacies of a complex healthcare system that wasn’t developed with you mind.
Lolita Korneagay, RN, BSN, MBA, ALNC is a Registered Nurse and Patient Advocate that has over a decade of experience with assisting patients recovery from illness and injuries. She provides expert medical consulting to patients, employers, insurance companies, and attorneys regarding healthcare claims. For a consultation, visit www.korneagaylnc.com for additional information.