What are Case Managers and Why Are They Involved in My Case?

Jan 25, 2024 | WC & Other Laws

What are Case Managers and why are they involved in my case? – When you are injured on the job in Colorado, you will attend many medical appointments. You might suddenly find that a “case manager” starts attending the appointments with you. They tell you they are here to help. They may even tell you that you have to let them participate in your medical appointments. What’s true? What are your rights? Do you have a choice?

Why is a case manager showing up at my medical appointments?

In Workers’ Compensation, there are a lot of people that often get involved in your life when you are injured and one of them is the adjuster from the insurance company and another is the doctor who is treating you. Sometimes a person called a “case manager” may contact you and they may tell you “I’m here to help make sure everything goes smoothly and to make sure that you get the care you deserve.” They could also make it seem like you don’t have a choice about them attending your medical appointments. When it comes to dealing with case managers, it can get complicated, so let’s talk about your rights, what a case manager is, what they are supposed to do, the red flags you need to look out for, and when to tell them to get out of your life.

What is a Case Manager supposed to do?

As you can imagine, work injuries can be pretty complicated, not just from a legal point of view but also from a medical point of view. Oftentimes, insurance company adjusters don’t have any medical training, and so they hire a case manager, or sometimes a nurse case manager to help manage the claim. Theoretically, it’s supposed to help everyone. It helps the injured worker because the case manager makes sure the injured worker understands what’s going on; they make sure the injured worker’s care is on track. It helps the insurance company because if things aren’t on track, the insurance company is going to have to pay more, either because they’re paying more in lost wage benefits or they’re paying more in terms of care.

The case manager also helps the doctors in the system because now there is another person to help communicate with the injured worker- this is particularly true if the injured worker isn’t savvy or familiar enough with the medical system or if they speak a different language. Again, a case manager theoretically can help lots of people involved.

How can a good case manager help me?

Ideally, good case managers help to make sure that the injured workers’ treatment is on track. They help you, as an injured worker, to stay as informed as possible about your medical appointment schedule and the treatment plan. Their job is to also help with interpretation and transportation to and from doctor’s appointments if transportation is an issue. Good case management will also make sure you’re not having to wait as long to get approved, authorized, or scheduled for treatment. A good case manager will help explain to the injured worker what’s going on and put the medical situation in plainer English than the doctor can explain.

If all of those things are happening, it’s a good sign that you have a helpful case manager on your side.

What are the signs of a bad case manager?

Here’s where case management can go wrong. You might have a bad case manager if they start to argue against or second-guess the doctor. For example, the doctor says, “I think you need eight visits of therapy,” and you notice the case manager is saying, “Why eight? Why can’t we just do six?” or if the doctor is saying, “In addition to injuring your left knee, you also have an injury on your left hip.” and the case manager says “Well the left hip is not related so we’re not going to approve that.” It’s a big indicator that you might have a bad case manager if they keep pushing back against what the doctor says. Along with that, if you see the case manager isn’t doing a good job getting your treatment scheduled or getting things approved, then it’s not worth having a case manager.

This part is important; if the case manager is starting to ask you about a settlement, or about quitting, or how you feel about your boss, trying to get you to badmouth your employer, or trying to gather any information from you that isn’t related to your current medical condition, then you might have a bad case manager and they’re not going to give you the help you need.

If I have a bad case manager, do I have to work with them?

You might be worrying about having to work with a bad case manager because, after all, they did say they have to come with you to all of your medical appointments. But that’s why it’s important to know your rights. Understand that you are the only one who can control who has access to your medical records. You control who has access to your medical appointments, you do not have to permit a case manager into the appointment, and you don’t have to permit an employer into your appointment. Your appointment with the medical doctor should be between you, the doctor, and anyone else you alone decide.

The problem is that often, insurance companies will have you sign lots of papers, and one of them is a release form that allows verbally binding permissions, so be careful about what kind of permissions you’re giving. With that said, you still have control over who gets to speak with your doctor. If you think a case manager is not being helpful, you, or your attorney, can say to them “no thank you, please cease your assistance, I don’t need it at all.” Those are your rights as an injured worker in Colorado.

We’re here to help.

If you or someone you know is injured on the job in Colorado, let them know about Kaplan Morrell Attorneys at Law. We’ve been helping injured workers since 1995 and we would love to orient you on your rights. We offer free and confidential consultations. To learn more call us at 970-356-9898 or visit our website at https://kaplanmorrell.com for more information.

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