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  1. #1
    Join Date
    Mar 2012
    Location
    myrtle beach,south carolina
    Posts
    3

    Lightbulb Assigned a Nurse Case Manager

    Here's a new twist, I have just been assigned a nurse case manager by the IC to oversee the rest of my care. she claims her job is to work with me through out the rest of my treatment to ensure a speedy recovery. Why would the insurance carrier, after stalling and delaying my case for over three years now be willing to pay someone bird dog me on every Dr. visit and procedure?? Has anyone else ever heard of this??

  2. #2
    Join Date
    May 2010
    Posts
    312

    Default Re: Nurse Case Manager

    Quote Quoting kdhdfct View Post
    Here's a new twist, I have just been assigned a nurse case manager by the IC to oversee the rest of my care. she claims her job is to work with me through out the rest of my treatment to ensure a speedy recovery. Why would the insurance carrier, after stalling and delaying my case for over three years now be willing to pay someone bird dog me on every Dr. visit and procedure?? Has anyone else ever heard of this??
    Happens all the time....as for the 3 years of crap, that may be odd.....That case assigned nurse. I'll bet you will learn to hate!.....I hope Im wrong, but they are no help to us the injured worker!!!!! Get well soon!

  3. #3
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,045

    Default Re: Nurse Case Manager

    You do not have to permit the NCM in the exam room with you when you see your Dr.

    You do have to allow the NCM to discuss your treatment plan with your Dr though, and you should make every attempt to be present for that discussion.
    NCM is key in getting any prior authorization for treatment your Dr may request...that means keeping a civil relationship with the NCM, not doing so could delay getting treatment for your injury.

    The ultimate goal in WC is treatment to a stable condition or MMI, and return to work, even if that is a sedentary position...light duty, or modified work prior to being declared MMI. They want you earning wages, not disability benefits.

  4. #4
    Join Date
    Jul 2010
    Posts
    150

    Default Re: Nurse Case Manager

    I have had three NCMs in the two years I have been stuck in the WC system and this is the short version of what I have learned from dealing with them.

    NCM number 1 was put on my case about 9 months after my injury. She came to my follow ups with the doc but I made her sit in the waiting room and she came in after the exam and the doc, NCM and myself discussed treatment and how I was doing. She tried once or twice to force the doctors hand and she tried to have input on what my restrictions would say but the doc had none of it and pretty much shut her down. She stayed on my case for about 90 days and then I got a letter saying that she was no longer needed and she was finished with my case.

    NCM number 2 was put on my case at the 14 month mark when I started pain management. She was not pushy and I actually liked her a lot. She was for the most part honest with me and after a few months I let her come into my meetings with the pain management doc. She helped get my prescriptions filled and set up all my appointments, therapy and so on. After about 7 months of being on my case I get a call from her office saying that she was no longer with the nurseing company that she had quit. However I had her personal cell number and gave her a call and she gave me a much different story. She said that she was FIRED for failing to contain cost and direct treatment! That is what they are really for. The job the claim to do for you is help you out but they are hired to help the IC deny your care and save everyone in the equation money by screwing you at every turn.......and if they fail then looks like even they can get fired.

    NCM number 3 took the place of NCM #2 after she was fired. She didn't have a clue about what was going on. Unless she was a bold face liar (which I try to give people a chance to be honest) she claimed that she had just been hired and had only been with the company for 2 months. She said she had never worked in the WC industry and that she had been a ER nurse for 23 years. After a 1 hour conversation and watching her fumble around with her paperwork, knowing nothing about WC terminology, claiming to have never attended a IME I started to believe her. Didn't matter though because she was only on my case for about 3 weeks and then she called me up and said that they had closed the case and taken her off it.

    These are some of what I dealt with in my relationships with these people. They can be helpful but as a rule not to be trusted. Understand what there purpose is and like any tool if you handle it wrong it can hurt you. Any thing you say to them ultimately goes back to your adjusted and to their lawyers. Could be different for you but this is what I dealt with. Good luck friend.

  5. #5
    Join Date
    Oct 2011
    Posts
    60

    Default Re: Nurse Case Manager

    I am from the state of NY and you don't have to have a ncm. I had one on my case right from the start, she started causing all kinds of trouble trying to get my md to do this and to do that, but he wasn't going for it. In the beginning the ncm was very nice and she was not a trouble maker. Finally i got tired of her so my attorney removed her off the case and said to the ins. co. and my former employer not to put any more ncm on, and i haven't had one since. You should talk to your attorney about getting rid of the ncm because they are only trouble makers for us injured workers.

  6. #6
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,045

    Default Re: Nurse Case Manager

    Quote Quoting aressiont27 View Post
    I have neither heard nor experienced such cases. What are the steps you are going to take now? Have you think of it?

    ----------------
    nursing case management
    The info in the link you provide in your "signature"... has nothing to do with WC...

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