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What is a Workers Compensation Nurse Case Manager?

A few years ago, the Georgia State Board of Workers’ Compensation changed its rules about nurse case managers.  Since that rule change, nurse case managers are more common in workers compensation cases.

If you have a nurse case manager on your case, you probably have some questions:

  • What is the nurse case manager’s job?
  • Who does the nurse case manager work for?
  • Will the nurse case manager attend my doctor’s appointments?
  • Can I choose my nurse case manager?
  • Do I have to have a nurse case manager?

In this article, I am going to try to address those questions and a few others so that you have a better understanding of case management in Georgia workers compensation cases:

Doctor and nurse meeting with womanWhat is the nurse case manager’s job?

Because of the changes in Georgia’s workers compensation rules, the answer to that question is a little confusing.  There are currently two separate rules that address nurse case managers and rehabilitation suppliers.  Those rule are Rule 200.1 and Rule 200.2

Rule 200.1 is the older rule on rehabilitation services.  It explains how rehabilitation suppliers (in catastrophic and noncatastrophic cases) should act.  Among other things, Rule 200.1 covers appointment, communication, certification, and discipline of rehabilitation suppliers.

Rehabilitation is required in cases that have been designated catastrophic.  Rule 200.1 also covers rehabilitation by agreement of the parties which can be done in noncatastrophic cases if you and the insurance company agree.

Board Rule 200.2 was only passed within the last few years.  It is a new rule.  It addresses an insurance company’s ability to hire a nurse case manager on your case even if you do not agree.

When rehabilitation is provided under Rule 200.1, the rehabilitation supplier has a number of different jobs including the following:

  • Delivering services under an individual rehabilitation plan
  • Coordinating medical care
  • Providing vocational counseling
  • Analyzing jobs

Unfortunately, it is not as clear what the nurse case manager’s job is when the insurance company uses Rule 200.2 to hire a case manager.  Under the rule, it is not clear whether the nurse case manager works directly for the insurance company or not.

Who does the nurse case manager work for?

This can be very confusing.  Some nurse case managers are employees of insurance companies.  This means that they work directly for the insurance company.

You should be able to find out that this is the case by asking the case manager who their employer is.  If Travelers is the workers compensation insurance and the nurse case manager is an employee of Travelers, then they are a direct employee of the insurance company and not an independent case manager.

Board Rule 200.1 and Rule 200.2 case managers are case managers who are not employees of insurance companies.  But, the insurance company still pays for these case management services even thought they are not direct employees.

When a case manager is hired under Board Rule 200.1 in a noncatastrophic case, it requires both you and the insurance company to agree.  This means that the case manager can be fired by either of you.

When the insurance company hires a case manager under Board Rule 200.2, it is almost like they are hiring a contractor.  In this situation, the nurse case manager is not an employee of the insurance company but may still be working for the insurance company.  Because this rule is relatively new, there is little guidance about how the State Board of Workers’ Compensation will interpret it.

Patient with PTSD receiving psyschological counseling from therapistWill the nurse case manager attend my doctor’s appointments?

Maybe.  Nurse case manager do sometimes attend doctor’s appointments.  But, it will really depend on whether the nurse case manager is providing case management services under Board Rule 200.1 or Board Rule 200.2.

If you agree to case management services under Board Rule 200.1, the nurse case manager can probably attend doctor’s appointments.

If you do not agree to case management, the insurance company may use Board Rule 200.2 to hire a nurse case manager to work on your case.  Under Rule 200.2, the nurse case manager may not be able to attend doctor’s appointments unless you agree in writing.

Even if they do not attend doctor’s appointments, nurse case managers will often communicate with your doctors or the doctors’ offices.   Under Rule 200.2, you should receive documentation of any communications that the nurse case manager has with the doctor.  You should also receive at least 10 days advance notice of any time the nurse case manager will meet with one of your doctors.

Can I choose my nurse case manager?

The rules of the State Board of Workers’ Compensation do not give you the right to choose the nurse case manager.  You or your attorney could certainly talk to the insurance company and try to agree on a nurse case manager to work on your case.  The insurance company may agree to a case manager you want to use.

Do I have to have a nurse case manager?

No.  You do not have to agree to a nurse case manager.  But, Board Rule 200.2 now allows the insurance company to hire a nurse case manager even when you do not agree.  The difference is that the case manager hired by the insurance company without your agreement can do less on your case.

Woman with glasses on phone using computerAre the rules different if my case is designated catastrophic?

Yes.  If you qualify for a catastrophic designation, a catastrophic rehabilitation supplier will be appointed to work on your case.  A catastrophic rehabilitation supplier has to have more training and certification than a regular nurse case manager.

You do not get a choice about case management services if your case is catastrophic.  The catastrophic rehabilitation supplier assigned to your case will communicate with you and develop rehabilitation plans to help make sure that you have the best possible recovery from your injury.

Board Rule 200.1 provides a lot of specific guidance about what catastrophic rehabilitation suppliers do.  You can also find a lot more information on the Managed Care and Rehabilitation Division’s page on the State Board of Workers’ Compensation’s website.

If you would like to learn more about what a catastrophic designation is and how you could possibly qualify, here is an article I wrote that discusses catastrophic designation in more detail.

What if I have other questions about workers compensation?

Georgia’s workers compensation system can be very confusing.  You have to worry about getting the treatment you need and paying your bills while also worrying about not missing any deadlines that could cause you to lose your right to receive workers compensation benefits.

If you have questions, I would recommend that you try to get answers.  To find out more about how to schedule a time to talk to me about your workers compensation questions, just read this short article.

Jason Perkins is an attorney who specializes in representing injured workers.  He regularly publishes videos and write blog articles about Georgia’s workers compensation system and issues that are important to injured workers and their families. To be notified of Jason’s new workers compensation videos, subscribe to his Georgia Workers Compensation Video Series channel on YouTube by clicking the subscribe button below.

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Jason Perkins

Workers' Compensation Attorney

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