Articles Tagged with case nurse

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Fight Unfair Claims Delays And DenialsThe journal ProPublica previously published an investigative article on the companies who profit by handling workers’ compensation claims. These companies, the middlemen in claims, are largely unknown by the public. After all, they manufacture nothing. They produce nothing. They sell nothing of value to consumers.

The ProPublica article starts with a bizarre scene. Somehow the reporter gained entry into the private Las Vegas conference for these claims managers. This is what he saw:

A scantily clad acrobat dangles from the ceiling, performing flips and splits as machines puff smoke and neon lights bathe the dance floor in turquoise and magenta. Dancers in lingerie gyrate on poles to the booming techno. Actors dressed as aliens pose for selfies with partygoers. There’s an open bar and waiters weave through the crowd passing out chocolate truffles.

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Blackwell Law Firm helps Alabama personal injury victimsA large part of my work involves simply interviewing, and talking with, personal injury victims. One theme is clear in my interviews — People suffering a personal injury want to heal and return to their normal life. They want to recover. They are often worried they will not recover. Proper medical care is essential to recovery from serious injuries.

At our office, we spend a lot of time talking with hurting people. And, we spend a lot of time reading medical records. In many cases, communication issues between the doctor and patient delay or hinder medical treatment. In some cases, miscommunication issues get documented and become serious hurdles to medical treatment as well as any injury claims. We try to advise our clients throughout the process to help their treatment and recovery progress.

A recent research article in the Journal of General Internal Medicine deals with the issue of patient-physician communications. The article uses the phrase “patient-centered” medical care. That’s a good phrase. Medical care should be patient-centered. Yet, it is instead too often centered around the insurance company or the flow of the medical facility. According to the research in this article, physicians only elicit the patient’s problems and agenda in 36% of visits. The researchers actually concluded:

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An article asks — Should I trust the nurse case manager for my workers’ compensation claim? The author of that article provides a short answer — “Be careful.”

In workers’ compensation claims, insurance adjusters will often use case nurses. These case nurses claim their goal is to help you with your doctors. Is that their real goal?

I still believe many case nurses truly want to help injured workers navigate a complicated medical system. However, many other case nurses seem to have a different goal. Instead of being helpful, these other case nurses work to delay or deny claims. They accomplish this goal by providing the doctors with bad information, by complicating the scheduling of appointments or by gathering information to help the insurance adjuster wrongly deny your claim.

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