Is the Insurance Company Using a Workers’ Comp Nurse to Watch Over Me?

When you’re hurt on the job, experience has taught us that one of the insurance company’s primary concerns is cost control.

If your injuries are serious, the insurance company will often assign a workers’ comp nurse to closely monitor your medical treatment and the recommendations your doctors make.

It’s important to know the purpose of the nurse’s involvement – and how you can protect yourself if your rights are violated. Below are important things to know if a workers’ comp nurse becomes involved.

Who Is a Workers’ Comp Nurse?

Workers' comp nurses are case managers, coordinators & more who don't provide direct care.

Workers’ comp nurses are case managers, coordinators, and rehabilitation nurses who do not provide direct medical care.

Contrary to your physical therapist or occupational therapist, a workers’ comp nurse is more of an overseer.

How Does a Workers’ Comp Nurse Become Involved in My Case?

Most frequently, workers’ comp nurses become involved at the request of the insurance company. The insurance company selects the nurse and pays them.

Nurses are often brought in when serious injuries occur, or when medical costs begin to rise. You can also request that the Industrial Commission assign a nurse free of charge.

What’s the Point of a Workers’ Comp Nurse?

According to the Industrial Commission, workers’ comp nurses are directed to coordinate and plan medical care with the goal of assisting you back to your pre-injury level of function. They are supposed to communicate with your doctor about your treatment plan and work capabilities.

However, in our experience, some workers’ comp nurses have ended up becoming more of a mouthpiece for the insurance company, focusing more on costs rather than what is best for the injured worker. Workers’ comp nurses should not:

  • Direct medical care (tell the doctor or you what treatment you should or shouldn’t have)
  • Advocate for one type of treatment over another
  • Advocate for a change in your treatment plan
  • Advise you on any legal matters involving your workers’ comp claim

Workers’ comp nurses are allowed to come to your doctors’ appointments, but you can request a private exam with your doctor, in which case the nurse will speak with your doctor after the appointment (with you present).

Nurses will often speak with your doctor about your work restrictions and ability to return to work. The nurse should not be pressuring your doctor to ease your restrictions or release you to your full duty of work.

If looking at alternative work you might be able to do, the nurse can only recommend you for, or direct you to, suitable employment – jobs that are within the restrictions assigned by your doctor.

What Are My Rights When a Workers’ Comp Nurse Is Involved?

Your rights when a workers' comp nurse is involved on your case.

If you have a workers’ comp nurse assigned to you, remember this:

  • You are entitled to a private exam with your doctor, outside the presence of the nurse
  • You are entitled to be present when the nurse talks with your doctor
  • You can request the nurse be removed from your case for advocating for the insurance company or for violating the rehabilitation rules

In our experience, some workers’ comp nurses have focused more on costs instead of health.

NC Workers’ Comp Lawyers Evaluate Your Case FREE

If you are having problems with a workers’ comp nurse looking out for the insurance company and not for your health, contact us online or call 1-866-900-7078. We can file a claim and work to try to ensure the workers’ comp nurse understands their limits, so you can focus on your recovery.

Brian Clemmons

About the Author

Brian Clemmons practices workers’ compensation law in North Carolina for the Law Offices of James Scott Farrin. He was named on the 2022 “Best Lawyers”a list for Workers’ Compensation Law – Claimants by Best Lawyers in America. Brian has presented at numerous continuing legal education courses and has many decades of experience in a variety of practice areas. He also has a great deal of experience as a defense attorney for insurance firms, so he has seen personal injury law from both sides of the table.

aFor more information regarding the standards of inclusion, please visit www.bestlawyers.com.

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