Does the Insurance Company Pick My Case Manager?

The term case manager means different things to different people in a workers compensation case. Sometimes, insurance companies will refer to the adjuster or claims manager on your case as a case manager.  That person is not technically a nurse case manager.

The adjuster or claim manager is the person who makes decision for the insurance company about your workers compensation case.  A nurse case manager usually deals with more medical issues on your case.  This article will discuss how a nurse case manager gets on your case and whether you must have one on your case.

What does a nurse case manager do on my case?

For the most part, a nurse case manager deals with your workers compensation medical treatment.  Most people first encounter nurse case managers at one of their workers compensation medical appointments.  Attending medical appointments is one of the primary things that a nurse case manager does.

The nurse case manager may tell you that they have been hired to work on your case and give you some information about what a nurse case manager does.  Sometimes, they may fail to do this.

Usually, they will want to attend the doctor’s appointment with you.  They may want to come in the room while you are being seen.  Often, They may discuss your case with the doctor while you are in there.  They may try to meet with the doctor before or after your appointment.

You may have questions about whether they can do all of this.  There are rules that govern what a workers compensation nurse case manager can do.  I am going to discuss the rules that govern a nurse case managers behavior later on in this article.

Who picks the nurse case manager?

The workers compensation insurance company probably picked your nurse case manager.  In fact, you almost certainly would not have a nurse case manager on your case unless the insurance company decided to appoint one.

I cannot think of a time where an insurance company asked my client which nurse case manager they wanted on a case.  So, you are probably not going to get a choice.

In some situations, a nurse case manager will actually be an employee of the insurance company.  But, in most situations, the nurse case manager is an independent contractor who is hired by the insurance company to work on your case.

Does Georgia workers compensation law require that I have a nurse case manager?

No.  There is no requirement that you have a nurse case manager on your case.  Many Georgia workers compensation cases do not have nurse case managers.

Can I fire the nurse case manager?

The answer to that question used to be real clear. You used to be able to clearly fire the nurse case manager if you did not want them working on your case, as long as you did not have a catastrophic workers’ compensation case.

But, the Georgia State Board of Workers’ Compensation made some changes a few years ago.  After these changes were made, it is not at all clear whether you can fire the nurse case manager if you do not want them working on your case.

What rules does the nurse case manager have to follow?

The Georgia State Board of Workers’ Compensation has rules which control many different parts of workers compensation cases.  There are two primary rules which cover the behavior of nurse case managers.

The first rule is Board Rule 200.1 and the second is Rule 200.2.  Among other things, these rules describe:

• How much notice a nurse case manager has to give when attending a doctor’s appointment,
• What reports the nurse case manager must write,
• How to file a complaint against a nurse case manager,
• How someone gets approved to become a licensed nurse case manager

You can find all the Georgia State Board of Workers’ Compensation rules here.  As you will notice, Rule 200.1 is one of the longest Board rules.

I hope this information has been helpful to you.  If you have questions please feel free to reach out to me at (770) 214-8885 or complete this form to discuss your case and we will reach out to you.