nurse case manager

Independent Medical Examination

independent medical examYou have a right to an independent medical examination (IME). You may request an IME if you feel you were returned to work too soon and/or if you feel you would benefit from additional medical treatment.

To make this request, you will need to mark the Report of Claim Status/Request for Independent Medical Examination (Form 38911) accordingly. This form will be mailed to you from the insurance carrier at the time your TTD benefits are terminated. This may coincide with the time that you are also released by the doctor at maximum medical improvement. Please note that you only have seven days from the date of receipt to return this completed form to the Workers’ Compensation Board of Indiana.

The Board will review your request, consider your medical treatment and prognosis, and then likely schedule you for an IME with a doctor they have chosen. If they schedule you for an independent medical examination, the doctor they send you to will only evaluate whether or not you need additional medical treatment and whether or not you should be working given your condition.

This doctor will not do the following:

  • Prescribe you medication
  • Discuss future medical needs
  • Give you a permanent partial impairment rating

Below is a list of items you need to take to the independent medical examination:

  • Original X-Rays, MRIs, CT Scans or any other radiology film
  • Any medical records for related treatment with your personal doctor(s)

Of note, if a nurse case manager or rehabilitation nurse has been assigned to your case, he or she is not permitted to attend the independent medical examination scheduled by the Board.

The outcome of this evaluation will carry a lot of weight in the direction of your case. In other words, if the IME doctor decides that you can return to work and you need no further treatment, it will be difficult for you to prove otherwise since this is a doctor that was personally selected by the Board. Likewise, if the IME doctor indicates you need more treatment and/or that you should remain off work, the Board will likely stand behind their doctor and order that your workers’ compensation benefits will be reinstated.

Q: Who pays for the Board ordered medical evaluation?

A: Your employer or their workers’ compensation insurance carrier.

Q: I have not received a form that lets me get an independent medical examination, but I have been released from the workers’ compensation doctor. What do I do?

A: You can contact the workers’ compensation insurance carrier and ask about it. If you find out that you are not eligible for an independent medical examination through the Board, then you can seek one of your own at your own expense and try to use your doctor’s report as leverage to get your benefits reinstated. Obviously this would only happen if the doctor’s report is favorable to you. If you do seek an IME, make sure you select a doctor with an excellent reputation or the Board may discount your doctor’s opinion.

New Guidelines for Nurse Case Managers in Indiana

A Nurse Case Manager is a Registered Nurse who is hired by the insurance company to oversee your medical treatment. A good Nurse Case Manager can be very helpful to your recovery, but a poor Nurse Case Manager can interfere with your medical treatment.

The Indiana Workers’ Compensation Board has issued new guidelines for Nurse Case Managers.

The Indiana Worker’s Compensation Board has issued guidelines for the use of Nurse Case Managers (“NCM”) in the administration of compensation claims.  A NCM may be involved in a claim to schedule appointments, help facilitate care suggested by the medical provider, and to report back to the employer and/or carrier.  However, a NCM should not express opinions, to either the injured worker or the medical provider, regarding an injured worker’s course of medical care or otherwise attempt to influence the process.  Additionally, a claims adjuster should not attempt to direct the care provided to an injured worker by the authorized treating doctor.

If you feel a Nurse Case Manager is interfering with your medical treatment in a workers’ compensation case, please call us at 317.569.9644 to discuss your case.

Nurse Case Manager Misconduct

nurse case manager

 

 

Have you been hurt at work and the insurance adjuster assigned a nurse case manager to accompany you to your medical appointments?

We represented a worker who had a nurse case manager attend all doctor’s appointments with him. A nurse case manager is a nurse who is supposed to take a look at a workers’ compensation claim from a broad view, considering both the medical and legal aspects of the case. Some of the duties of a nurse case manager include:

  • Schedule appointments
  • Act as a liaison between the injured worker, medical provider, employer and workers’ comp benefit provider
  • Ensure the doctor keeps the employer/insurance agency informed of recommendations including work restrictions
  • Help facilitate care suggested by the medical provider

Before the nurse case manager’s involvement, the injured worker felt like he had a good relationship with the doctor that was treating him…until the nurse case manager came along.

Once the nurse got involved, the client felt that the doctor treated him differently and that the nurse controlled the medical visits. The doctor would defer to the nurse regarding treatment choices, such as authorizing an MRI and even the PPI.

The Indiana Workers’ Compensation Act does not currently regulate the conduct of nurse case managers. However, if a nurse acts improperly, that can result in sanctions being issued against the insurance company. We have seen nurse case managers that attempt to manipulate the medical care being given to our clients. Instead of helping the injured worker recover from his injuries, the nurse case manager is acting in the best interest of the insurance company to cut off your medical care and benefits.

If you have a situation where a nurse case manager is controlling your medical care, we can help. Call us at (317) 569-9644. Don’t let a nurse case manager impact your medical care, get the treatment and rehabilitation you deserve.