What is a Nurse Case Manager in North Carolina Workers’ Compensation Law?

May 6, 2021 | By Riddle & Brantley Accident Injury Lawyers
What is a Nurse Case Manager in North Carolina Workers’ Compensation Law?

What is a nurse case manager?

In serious workers’ compensation cases, the insurance company may assign a nurse case manager to your claim. Under North Carolina Workers’ Compensation Act, an insurance company is allowed to assign a nurse case manager for the purpose of facilitating the recovery of the injured worker, and ensuring that the medical care received by the injured worker is cost-efficient and medically appropriate.

Our workers’ compensation lawyers have experience working with nurse case managers in North Carolina and can help advise on all aspects of your case. For a FREE, no-obligation consultation with an experienced workers’ comp lawyer, please call 1-800-525-7111.

Insurance Adjusters vs. Nurse Case Managers

Many people confuse the role of an Adjuster and the role of a nurse case manager. An Adjuster works for the insurance company. Adjusters must have certain licenses, and they represent the interests of the insurance company. Their job, essentially, is to protect the interests of the insurance company.

In North Carolina, a Nurse Case Manager is hired by a Workers Comp insurance company to help facilitate cost-efficient and effective medical care for the injured worker - Riddle & Brantley

The nurse case manager role is very different. While nurse case managers are hired or contracted by the insurance company, they are healthcare professionals and as such, they have duties to the injured worker similar to the ones any doctor or nurse has to their patient. 

A nurse case manager has a very different type of license than an adjuster. They must be a Licensed Nurse, or Registered Nurse, or have some equivalent degree, and they must also periodically take certain continuing education courses on the duties and responsibilities of a nurse case manager in North Carolina. A detailed list of licenses and education requirements can be found online at the North Carolina Industrial Commission.

The North Carolina Industrial Commission website also contains a link to a list of Nurse Case Managers currently qualified to serve on claims.

What Does a Nurse Case Manager Do in a Workers’ Comp Claim?

At their initial meeting with the injured worker, the nurse case manager must explain their role to the injured worker, and provide a written copy of the North Carolina Rules for Nurse Case Managers and Rehabilitation Professionals.

According to North Carolina law:

  • The patient always has the right to a private exam. The injured worker has the right to meet with his or her doctor privately, without the nurse case manager present. As part of the doctor-patient privilege, this is every patient’s right. If the injured worker elects this right, the injured worker can meet with the doctor, have a private examination, consult with the doctor, and then invite the nurse case manager into the room.
  • The nurse case manager does NOT have the right to talk to the doctor outside the patient’s presence about the patient’s medical care. Now, a nurse case manager IS allowed to talk to the doctor or the doctor’s staff about things like scheduling the next visit, or setting up an MRI or physical therapy appointment. But they should not be talking to the doctor about the injured workers’ diagnosis or plan of care. Nurse case managers are meant to FACILITATE medical care, not DIRECT medical care.
  • If the nurse case manager creates reports of any type, the injured worker has a right to copies of these. So, if the Nurse is emailing monthly reports to the adjuster, he or she should be emailing the same reports to the injured worker or his or her attorney.

Facilitating Medical Care in Work Injury Cases

So…what exactly does it mean to facilitate medical care? Well, that is a question that is often debated and even litigated.

A good nurse case manager helps everyone, meaning he or she helps the doctors, helps the patients, and helps the insurance company.

For example, say an orthopedic doctor evaluates a patient and refers him or her for an MRI and prescribes some medications. A good nurse case manager helps make this plan of care happen. He or she locates a radiology center that can perform the MRI quickly and at a fair price. He or she gets the prescriptions into the hands of a pharmacy that is within the insurance company’s network, and gets them pre-approval to fill the prescription. This means the injured worker is getting quick access to good medical care, and is hopefully going to recover and get back to work sooner rather than later. This is a win/win for everyone.

On the other hand, a bad nurse case manager might put their finger on the scale against the injured worker. He or she may try to influence the doctor into believing the injured worker is not really hurt, or push the doctor to return the worker back to work before he or she is really ready.

For more answers to frequently asked workers’ comp questions, please check out our workers’ compensation FAQ.

Injured on the Job?

Our Workers Comp Lawyers have experience working with nurse case managers and can handle all aspects of your claim - Riddle & Brantley

At Riddle & Brantley, our workers’ compensation lawyers are familiar with many of the nurse case managers in North Carolina, and we often know which ones are ethical and which ones need to be watched. We also help ensure your rights are protected, and that you understand your rights.

For a FREE, no-obligation consultation with an experienced workers’ comp attorney, please call 1-800-525-7111 or complete the short form below.

There is no obligation and you won’t pay any attorney fees unless we win your case and you receive workers’ comp benefits.

"I never felt like just another client, but like family."

-D. Montague, Riddle & Brantley client

Call 1-800-525-7111 and let’s review your claim.

Our work injury team is led by two Board-Certified Specialists in Workers’ Compensation and together they have recovered millions of dollars in compensation (see disclaimer below) for injured North Carolina workers, including a recent $2.475 million settlement for an injured welder (see disclaimer below).

In cases involving long-term disability, we also have Social Security disability attorneys available to help with those claims and appeals.

*** Disclaimer: The results mentioned are intended to illustrate the type of cases handled by the firm. These results do not guarantee a similar outcome, and they should not be construed to constitute a promise or guarantee of a particular result in any particular case. Every case is different, and the outcome of any case depends upon a variety of factors unique to that case.