Under the current workers’ compensation structure in Ohio, state funded employers choose a managed care organization to oversee all treatment issues in a workers compensation claim. While the claims representatives for the Bureau of Workers Compensation administer the claim and pay compensation, the managed care organizations manage the medical benefits and authorize all treatment. Often, the managed care organizations assign a nurse case manager to a case and they can either provide support or put up a road block in any case.
Typically, when a case is first filed, particularly for a traumatic injury, the nurse case manager will do everything they can to get the treatment requested and authorized in an attempt to move the case along. The real problems arise after the initial treatment when the injured worker does not quickly return to work.
An injured worker is not required to speak with a nurse case manager and a nurse case manager does not have the right to attend physician appointments with an injured worker. However, oftentimes injured workers allow the nurse case manager to attend appointments and give the nurse case manager’s information which may not be in their best interest. Specifically, the managed care organization is selected by the employer and therefore has every incentive to push an injured worker back to work and/or deny treatment to keep the claims costs down in a case. I have had several clients who have been adversely affected by the ‘assistance’ of a nurse case manager. Some of the clients have had their compensation terminated because a nurse case manager pressured a Dr. to find the injured workers to be at maximum medical improvement. Other clients have had to return to work prematurely or without sufficient restrictions because the nurse case manager went to the appointment and ‘convinced’ the Dr to release to injured worker.
The bottom line is that injured workers need to be wary of the nurse case manager’s involvement. If in doubt, speak with an attorney about your rights. An attorney can run interference on your behalf.