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Is The Case Nurse A Helpful Friend Or Insurance Company Investigator?

Alabama Work Comp LawyersCase nurses are common in Alabama workers’ compensation cases. Many insurance companies use case nurses to “assist” with medical care.

If you suffered a work-related accident and injury, the work comp process can be challenging. Maybe frustrating is the better word.

Suddenly, you have a serious accident. Your life changes immediately and drastically. When can you return to work? When will you heal? Can you take care of your family? You are hurting and you are worried. Now, you are leaving messages for an insurance adjuster or sitting in waiting rooms simply to see a doctor.

At the time of your greatest worry, a friendly case nurse appears. She speaks a few encouraging words. She tells you the insurance company has assigned her to assist with medical care. But, who is she really assisting?

I frequently advise my injured clients concerning insurance case nurses. Instead of being a helpful medical advocate, a few of these nurses really serve the insurance company. They do this by gathering information (investigating) for the insurance company OR by interfering with your relationship to the treating doctor. Some case nurses really are dedicated to helping you. However, as an injured worker, you won’t know the difference until too late.

What are some ways case nurses work for the insurance company and against you? Here are five:

  1. They ask questions about non-medical issues. Is the case nurse simply making small talk while you sit in the doctor’s waiting room? If so, why is she asking questions about your finances, your education, or your work history? Why did she ask about bankruptcies or arrests? This information may be valuable to the insurance company looking to deny or defend your claim. The nurse may be gathering information for the insurance company. You don’t have to answer her questions. You would be wise to avoid providing personal information.
  2. They work to present your problems as “pre-existing.” This is a huge issue. Here’s what you need to know at the start — You are NOT required to be in perfect health prior to the accident. If you have worked all your life in a hard job, it is very likely that you’ve had a physical problem or two along the way. You may have even had prior pain in the same area. If you were able to perform your job at the time of the accident, you are entitled to benefits. Yet, some case nurses try to find out everything they can about your prior health issues and then magnify those problems to the doctor. It’s all an effort to get the doctor to say your issues pre-dated the accident. And, it’s another reason you should avoid personal talk with the case nurse.
  3. They ask you to sign broad releases or authorizations. I’ve seen authorizations that ask for everything from tax records, bank records, employment records and prior medical records. The case nurse does NOT need this information. Her job is to schedule appointments and to report back to the insurance company about your medical visits. That’s it. Do NOT sign these broad authorizations. It’s simply another insurance company attempt to dig into your past.
  4. They tell the treating doctor unflattering things about you. Years ago, a case nurse told two treating doctors my client abused drugs. It was a complete lie. The first doctor secretly tested my client (the results were negative for any drugs). The second doctor who was a friend of mine picked up the phone and called. Her efforts failed. How often does this behavior succeed in harming an injured worker’s medical care?
  5. They provide you with bad advice concerning doctor choices. Good case nurses help you get the treatment you need. Bad or biased case nurses suggest doctors who will not help you. I’ve seen case nurses convince injured workers to leave a good doctor and choose a terrible, insurance company doctor. Their advice does not help the patient. Instead, it serves the insurance company goal of cutting medical costs (by eliminating needed treatment).

I don’t want you to get the wrong picture. I know many dedicated work comp case nurses. I know these dedicated nurses in northern Alabama because I’ve handled these cases for many years. As an injured worker, you don’t know the good or bad histories of various work comp case nurses. Since they all appear with a smile and helpful words, you must be cautious. Your medical treatment and your work comp benefits depend upon it.

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At the Blackwell Law Firm, our lawyers regularly help injured workers obtain needed work comp benefits. From our office in Huntsville, we have prepared work comp cases for trial in counties across Alabama.