Do I Have to Talk to the Nurse Case Manager

The short answer is “no.” However, the better response is a more balanced approach.

The workers’ compensation claims adjuster can elect to assign a nurse case manager (NCM) to contact you regarding your treatment; this primarily occurs shortly after you are injured and are actively treating.

The nurse case manager doesn’t work for you, but rather for the workers compensation carrier. Simply following the money shows that – you aren’t paying them, and there is no law saying they need to be assigned. However, the NCM can be helpful with getting appointments scheduled and doctors’ requests authorized. Be aware that whatever you say can get back to the claims adjuster, so be careful. They may also try to get you back to work before you are ready, as clearing you for work is good for the workers’ compensation carrier.

You do have the right to prevent the NCM from going into the examination room at a doctor’s appointment with you, and you should consider keeping them out. This is because you may not want the NCM to influence the doctor’s plan of care, as opposed to hearing about it afterward. Similarly, you may not want the NCM to influence whether you are totally out of work, on light duty, or cleared to full duty. The NCM can still speak to your doctor after the appointment to learn what happened; they are an extension of the workers’ compensation carrier and so you can’t keep them away from your physicians. However, you can keep them out of the examination room.

We have a conversation with our clients as to whether they wish to keep speaking to the NCM directly or whether they want all communication with the NCM to go through us. The best approach is on a case specific basis.

This article is general information about Virginia workers' compensation and is not legal advice. Every case is different, so please contact us to discuss your individual situation.