Georgia workers compensation is confusing. You suffer an injury at work and you suddenly find yourself thrown into this system that you never wanted to be a part of.
You talk with people from your employer and the workers compensation insurance company. These people often give you information about what you need to do. You probably have an insurance adjuster working on your case. You may also deal with your supervisor or someone in your employer’s human resources department.
Sometimes after your injury, you may also run into a “nurse case manager”. Most people do not know what a nurse case manager is.
Your first encounter with a nurse case manager may happen over the phone. Other times, the nurse case manager shows up at one of your doctor’s appointments.
In this article, I will attempt to provide you with some information on what a nurse case manager does. I will also discuss the Georgia workers compensation rules that apply to nurse case managers.
What is a nurse case manager?
Nurse case managers supply rehabilitation services in workers compensation claims. The Georgia State Board of Workers Compensation requires anyone supplying rehabilitation services to have certain licensing.
Some of the licenses that can allow someone to work as a nurse case manager include:
- Certified Rehabilitation Counselor (CRC)
- Certified Case Manager (CCM)
- Certified Rehabilitation Registered Nurse (CRRN)
- Licensed Professional Counselor (LPC)
This is not a complete list of the licenses that can qualify someone to work as a nurse case manager. State Board Rule 200.1 lists all the licenses that a nurse case manager can have.
Many people get confused because some insurance companies refer to their adjusters as “case managers” or some other similar term. Some insurance companies also have nurses that work for them. Different rules apply to actual employees of the insurance company.
In the past, nurse case managers could only work on your case in two situations:
- If both you and the insurance company agreed to a nurse case manager
- If your case was designated as catastrophic, a special type of nurse case manager called a catastrophic rehabilitation supplier would be appointed to your case.
What rules apply to nurse case managers?
Nurse case managers have at least two different types of rules that apply to them. First, the organizations with which they are licensed will have rules. As I mentioned above, a nurse case manager can have one of several different types of licenses. Because of this, these rules will vary.
Some rules apply to all nurse case managers. These include the rules of the Georgia State Board of Workers Compensation. The main rules that apply are Board Rule 200.1 and Board Rule 200.2. If a nurse case manager does not follow those rules, then they could be subject to penalties or potentially losing their licensing.
But again in recent years rules have been changed so that the insurance can now have a nurse case manager work on your case even if you don’t necessarily agree.
There are too many specific rules to be covered here. But, here is a general overview of what the rules discuss:
- Whether the nurse case manager can attend doctor’s appointments with you
- What the nurse case manager has to explain to you
- What notifications the nurse case manager must give you about attending doctor’s appointments
- Your right to a private examination with the doctor
Does the nurse case manager work for the insurance company?
It depends. The nurse case manager is not an employee of the insurance company. However, the insurance company may hire the nurse case manager to work on your case.
Insurance companies did not always have this right. You used to have the right to refuse a nurse case manager on your case. Now, injured workers no longer have that right.
The insurance company decides if they will hire a nurse case manager. They also decide whom they will hire and pay for the nurse case manager. These facts probably cause you some concern about whether the nurse case manager will have your best interests in mind.
Do I have to let the nurse case manager work on my case?
Before the new Board Rule 200.2 came into effect, you did not have to allow a nurse case manager to work on your case. You could simply say that you did not want them on your case.
Since Board Rule 200.2 became effective, nurse case managers can do some things on your case without your agreement. However, they do have limitations. The State Board rules and the licensing rules limit what nurse case managers can do.
What if I have other questions about nurse case managers?
This article provides some basic overview regarding nurse case managers. You may have some questions about nurse case managers that relate to the specific facts of your case.
Also, it is important to keep in mind that Board Rule 200.2 is a fairly new Board Rule. There may certainly be unanticipated problems with the implementation of this rule. Because of these potential problems, I would not be surprised if the State Board makes changes to Board Rule 200.2 at some point.