Case Management Focus: Working with Attorneys

Sarasota, FL (WorkersCompensation.com) -- You may sometimes work with an injured worker who has retained an attorney. When this occurs, Workers' Compensation Nurse Case Managers need to understand their company’s policy and procedures as there may be specific "rules" to follow.

As an independent nurse case manager, I would work with the adjustor on the file to see what they wanted me to do.

If I had permission from the adjustor to talk to the attorney, I would call the attorney and let them know my role. We should both have the same goal – to assist the injured worker in accessing the medical care needed to help them return to gainful employment. 

Some attorneys will allow a nurse case manager to work with the injured worker as they would with any injured worker, but some attorneys do not. Whatever the case, you need to follow the directions of the claims adjustor and the attorney.

If the attorney or the adjustor does not permit you to work directly with the client, you can still work the case, but you cannot speak to the injured worker. In this case, you will need to go behind the injured worker and get updates from doctors after visits, follow up with those working with the injured worker like physical and other therapies. In this case it is important to be organized so you get all of your questions answered and know how to coordinate care and keep the case moving forward.

If you are allowed to speak with the injured worker, follow the core components of case management and keep all stakeholders informed and up to date. Case Managers are masters at negotiations and improving communications. We take the red tape that is customary when you are involved in the complex healthcare system.

When an attorney sees you are on the client's side and are moving the case forward with the patient making progress everyone wins: the injured worker, the family, the employer, all members of the healthcare team, the claims providers, and the attorney. The goal is to ensure the injured worker can reach maximum medical improvement (MMI) and move on with their lives.

Nurse Case Managers help break down barriers that might cause an injured worker to retain an attorney. Having an attorney involved slows down the process and increases the overall costs of the claim. There are times when an attorney needs to  be involved, but limiting that to complex cases is important.

 Again, the goal is to have the injured worker move through the system as smoothly and efficiently as possible. When we do this, the need for an attorney is reduced. Case managers should share their outcomes with all stakeholders so we show the value we bring to improving the overall process.

The bottom line is that when litigation becomes a part of the nurse case management bring dynamic, timely and effective communication between the case manager and injured worker’s attorney, both advocates, can't be undervalued.

Reference:

Attorney Involvement Continues to Increase the Cost of Commercial Claims

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