When Should You Use a Nurse Case Manager for Your Workers’ Compensation Claim?

By July 5, 2021 No Comments
nurse case manager workers comp

Nurse case managers are an important part of the claim process. They are a valuable resource when filing a claim and providing appropriate care for injured workers. They can help navigate the process, and provide expert advice based on their experience with medical professionals. How do you know when it’s necessary to have a workers’ compensation nurse case manager for each case?

Below are some situations where a nurse case manager will be helpful for your workers’ compensation claims.

Wage loss claims

A workers’ compensation nurse case manager can help when it comes to wage loss, or if an injury is affecting the ability of an employee to work. They are trained on how injuries affect the body and what can happen long-term with those effects.  A nurse case manager will also help injured workers and work with the employer to put together an appropriate return-to-work plan.

Surgical claims

If a surgery is medically necessary, a nurse case manager will help assess the risk for complications and what will happen after the procedure. They are also trained to work with surgeons to make sure that they are aware of any preexisting conditions or other risks before proceeding.

A skilled nurse case manager is an asset when it comes to assessing surgical claims because they can provide the injured worker with the best possible outcomes after a surgery.

Attendance issues at medical appointments 

A workers’ compensation nurse case manager can help identify any problems regarding attending medical appointments and assist with encouraging the injured workers’ compliance. They will make sure to provide constant reminders regarding appointments or arrange transportation to and from all appointments if necessary. They can also help reschedule an appointment if needed and follow up with the provider to make sure they are aware of the current situation at hand. 

A nurse case manager will act as an advocate during any interactions, which means that you have someone on your side who knows what should be done to get the best possible outcome.

Malingering employee

Malingering is when an employee is attempting to exaggerate or feign illness in order to escape work. A nurse case manager can intervene when this happens. They can coordinate with all the parties involved, and find a mutual understanding. Another thing a nurse case manager can do is recommend an IME to the assigned claim handler.

Mental health claims

Some insurance companies and providers will require that a nurse case manager be used for any mental health claim. This is because it can be difficult to discern whether someone who has asserted a mental health condition has an actual physical injury. Trained nurse case managers have the capabilities to provide continuous care services to patients who have a compensable mental health condition.


A workers’ compensation nurse case manager is a key player in the workers’ compensation process. They are highly trained to handle the complex dynamics that arise during this sensitive time for an injured worker and their employer. They can help reduce program costs by ensuring that appropriate care, rehabilitation, and return-to-work plans are being implemented throughout treatment.

For more information about Novare’s medical case management program, both telephonic and field case management, give us a call or email us at 866-532-1929 / info@! We look forward to hearing from you!