Who does your nurse really work for?

In some Workers’ Comp cases in North Carolina, the case and employee will be assigned a Nurse to help coordinate benefits, schedule doctor’s appointments, and basically make sure that the medical treatment is progressing as it should.  The nurse is supposed to be employed by an independent company, such that they are not unduly influenced by the insurance companies.  Most nurses that I’ve dealt with are great to work with, and I’ve generally had very few problems. The purpose of this post is not to bitch and moan about how the rehab nurses are really working for the insurance company, however…

Today I received a call from a new nurse on a case.  The old nurse had been taken off the file – for reasons unknown to me (again, I’m not going to speculate that she was doing too good of a job for MY client, as opposed to doing what the insurance company wanted her to do).

That being said, when I returned the call, the number went straight to the insurance company, and my newly assigned nurse has an extension at the insurance company.  (Although she does “technically” work for an independent agency – for all I know her office is next door to the adjuster’s office).

So next time you (injured worker) start up a conversation with your rehab nurse about the status of your condition and your case in general, just remember who they are really working for.  Just my 2 cents for the day.  That’s all.

The Rehab Nurse – Who do they really work for?

If the insurance company decides to accept liability for your workers comp claim, then they are able to direct your care.  As part of that care, the insurance adjuster will assign you to what is called a Rehabilitation Nurse to manage your care.  According to the NC Industrial Commission Rules for Utilization of Rehabilitation Professionals in Workers’ Compensation Claims, the purpose of these Rehabilitation Counselors is to provide for the “medical and vocational rehabilitation of the injured worker”.

The North Carolina Industrial Commission has also provided a brief summary of these “Rehab Rules” for the injured worker.

Although the Rehab Professional is supposed to be working to help you with your care, in reality they are working for and with the insurance company to assist in the effort to terminate your Worker’s Compensation benefits.  The Rehab nurse is an employee of the insurance company, and often times works side-by-side with the adjuster assigned to your case.  These nurses have a clear understanding of who signs their paychecks and how their company makes money.  No bones about it – they will do what they can to turn off your benefit checks.

While we encourage all of our clients to follow closely the instructions of the Rehab nurse very carefully, there are some things that you need to watch out for which are clear violations of the Rehab Rules outlined above.  If you nurse engages in any of the following behaviors, it is a violation of the Rehab Rules and you should contact an attorney immediately:

  1. They attempt to tell the doctor what to do or when to release you to return to work;
  2. They attempt to tell the doctor where to send you for an MRI or physical therapy, or they tell the doctor which specialist to refer you to;
  3. They attempt to give you legal advice regarding the merits of your claim or tell you what will happen if you go back to work;
  4. They are corresponding with doctors or other healthcare providers or to the insurance adjuster without copying you on those communications;
  5. They are talking to your doctor without you being present, or they insist on sitting in on your examination with your doctor; or,
  6. They try to get you to sign a release that authorizes them to talk to your doctor without you being present.

There is another type of rehabilitation specialist called a Vocational Rehab professional, whose job is to find you a new job.  The pitfalls related to these professionals will be discussed in a future post.