Basics of Nurse Case Managers in Arizona Workers' Compensation

When you have a workers compensation claim in Arizona, you may be contacted by a nurse who was hired by the workers compensation insurance company. Usually, the first contact will be by telephone or letter. This person is called a nurse case manager. More often, a nurse case manager will be assigned in more complicated cases that require multiple specialists sor multiple medical appointments. But, they can also be assigned to cases where you are seeing only one doctor.

What is a nurse case manager?

A nurse case manager is a nurse hired or contracted by the insurance company to manage a workers’ compensation case. It is the nurse’s job to help move the case forward, ensure you are getting medical treatment, act as a contact for you , talk to the doctors or medical providers, gather medical reports, and, moreover, to report back to the insurance company’s adjuster about your medical condition and treatment status. Sometimes the nurse can act as a translator if you do not speak English.

Who does the nurse case manager work for?

The nurse case manager works for the workers’ compensation insurance company. Period. She may work for a company with a different name. Even a medical sounding name, but because she or her company is hired by the insurance company, she is actually an agent of the insurance company. She reports to the insurance company. Her ability to approve medical treatment, talk to the doctors, and schedule office visits is provided by the insurance company.

Is the nurse case manager allowed to talk to my doctors?

You may see your nurse case manager talking to your doctors either during your appointment or even before or after your appointment. This is allowed to the extent your doctor permits it as long as the nurse has an appropriate medical authorization from you.

Do I have to sign the medical authorization from the nurse case manager?

If you want to pursue your claim, you will need to provide a signed medical authorization to your workers’ compensation carrier and its agents or assigns. This includes the nurse case manager.

Is the nurse case manager my friend and advocate?

Remember the nurse case manager is not your friend or advocate. She works for the insurance company. Your particular nurse may be very nice and helpful. She might help you schedule your appointments and help you understand what the doctors are saying. Unfortunately, that is not always the case. Your nurse may also interfere with your treatment, your communications with your doctors, call you a lot, or you may just not like him or her. Remember that the nurse case manager has to report back to the insurance adjuster. This usually includes written reports which may include things you said casually.

Can I choose not to have a nurse on my case?

Unfortunately, it is not your choice whether to have a nurse case manager assigned to your case. The only way to avoid having the nurse call you and attend your medical appointments is to hire an attorney. Once you are represented by an attorney, the nurse case manager or insurance adjuster must request and receive the attorney’s express permission to have direct contact with the injured worker. This is one of the major advantages to having legal representation. Your attorney will be able to control the insurance carrier’s contact with you and protect you from making casual side comments or from having the nurse try to speak for you at your doctor’s appointments or send you to doctors you don’t like.

Disclaimer: This video is intended to provide general introductory information about the workers’ compensation system in Arizona. This is not intended to provide any legal advice. Every case involves unique facts and circumstances. We hope this video provides you with a basic understanding of the topic so that you can have a more meaningful and productive conversation with a qualified legal professional. Watching this video does not form any attorney/client relationship.