Having a nurse case manager on a file can prove to be invaluable, but not all files need one.  The role of a nurse case manager in workers’ compensation is to coordinate care for the injured employee and to act as a liaison between all involved parties – the injured worker, medical provider, employer and adjuster.  It would be great if we could assign a nurse case manager to every claim, however, that approach is not cost effective.

The following are the main reasons a nurse case manager will be assigned to a claim:

1.   The employee has suffered a severe injury requiring long term treatment.

2.   The employee has other medical conditions which may lengthen the healing process.

3.   The employee requires ongoing treatment for a moderate to severe injury AND does not speak English.  This is key because it increases continuity of care to have someone with a medical background who is able to interpret for the employee as well as the physician.

4.   The employee does not seem motivated to follow up with medical care or to return to work as recommended. 

Nurse case managers can be a valuable asset to a workers’ compensation claim, but limitations are needed.   Adjusters are constantly evaluating to be sure that the benefit of assigning a nurse case manager to a file outweighs the cost.