The Role of Nurse Case Managers in Indiana Worker's Compensation Claims

Personal Injury Lawyer Fort Wayne Indiana

Recent Update From the Indiana Worker's Compensation Board Regarding Nurse Case Managers. 

The Indiana Worker's Compensation Board recently issued updated guidance to combat abusive conduct of nurse case managers in worker's compensation claims.

In some worker's compensation claims it is not uncommon for the worker's compensation insurance company to retain a nurse case manager to oversee the injured worker's medical treatment. Essentially, a nurse case manager acts as the worker's compensation insurance company's claim adjuster's eyes and ears on the ground.

On April 17, 2018, the Indiana Worker's Compensation Board issued an update regarding its nurse case manager guidelines. According to the Indiana Worker's Compensation Board, "ideally, a nurse case manager is a liaison among the medical provider, the employer and the injured worker.  While not an indispensable player in the Indiana worker’s compensation process or specifically governed by the Worker’s Compensation Act, the nurse case manager can play an integral role in the coordination of medical treatment and the stay-at-work/return-to-work process."

In its updated guidelines, the Indiana Worker's Compensation Lawyer Board noted a couple of interesting things.

Fort Wayne Worker's Compensation Lawyer
Injury Lawyer Nathaniel Hubley
First, the Board noted that the nurse case manager's role includes, among other things, providing information and communication among the parties and medical providers, scheduling appointments, helping to facilitate care recommended by the treating physician and reporting back to the employer and/or carrier.  As a result, the Board established that "any written notes or report prepared by a nurse case manager and provided to the employer, adjuster or medical provider should also be made available to the injured worker upon request or shall be provided upon Board order." The significance of this is that the nurse case manager's notes/records were typically not provided even with formal discovery requests on the grounds that the documents were privileged.

Second, the Board noted that nurse case manager's communication with the injured worker should be limited to details of the workplace, the relevant injury, medical treatment and pertinent history. The Board specifically stated that "[i]t is not the role of the NCM to determine compensability, make decisions regarding the administration of workers compensation benefits, deliver or direct treatment, or provide medical opinions to either the injured worker or the medical provider regarding the worker’s appropriate course of medical care." The significant of this is that the Board seems to be cracking down on worker's compensation insurance company's use of nurse case managers to adversely impact the outcome of the injured worker's treatment course.

I always recommend to injured workers that if they feel that the nurse case manager is overstepping their bounds they need to contact a Fort Wayne Indiana Worker's Compensation Lawyer for help. The nurse case manager can be very helpful to the injured worker in the handling of the claim but the nurse case manager can also adversely impact the injured worker's claim.


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