As a nurse, you know of the potential you have for injuring yourself as you care for others. Whether you work in a hospital, nursing home, medical office, or homecare setting, your duties expose you to hazards that could lead to an injury that leaves you unable to work as you recover. According to the Occupational Safety and Health Administration (OSHA), hospital workers are more likely to miss work due to injury than workers in the construction or manufacturing industries.
While caring for incapacitated patients, nurses lift and move patients during tasks that require nurses to lift them as they attend to wounds and personal needs and move them into wheelchairs and onto gurneys, putting themselves at risk for back, hip, and knee injuries. Wet floors, electrical cords, and medical equipment creating slipping and tripping hazards for nurses in hospital rooms and clinics. Exposure to bodily fluids of infected patients and sharp needles place nurses at risk of contracting infectious diseases or being exposed to toxic substances.
Patients suffering from dementia or the side effects of medications may become violent and attack their caregivers. Nurses are frequently the victims of assault. Because of these hazards, you may suffer from serious injuries including, but not limited to, sprains, strains, broken bones, infections, and open wounds. These injuries and illnesses will require medical treatment and time away from work. Because the incident that caused the injury occurred at work, you should receive workers’ comp benefits to cover your losses.
The New York workers’ comp board or your self-insured employer may look for any excuse to deny your workers’ comp claim and assume that you will back down and accept whatever decision they make. You have too much at stake to do this.
In some cases, the workers’ compensation insurance carrier may employ a nurse case manager to assist the injured worker with these tasks. It is important that the injured worker understands his or her rights during the workers’ compensation process and the limits of the nurse case manager’s role.
The majority of nurse case managers are registered nurses, and they act as a medical case worker. They may, with the patient’s permission, attend doctors’ and hospital appointments and communicate with the patient and the authorized physician about the patient’s treatment.
A nurse case manager is responsible for helping an injured worker to obtain the medical care that he or she needs; serving as a liaison between all parties involved in the workers’ compensation claim, including doctors, the injured worker, the employer and the insurance company; providing information to an insurance adjuster regarding doctors’ visits and treatment authorization.
For the physician, the case manager is incredibly important because the case manager can facilitate the accurate communication between the patient and treating physician. For the injured worker, not only can the nurse case manager validate information that the worker provides, but the nurse case manager is also responsible for “assuring that medical care is progressing effectively and identifying problems related to that care.” If appropriate care is not given, a nurse case manager can raise concerns and take action to alleviate the problem.
Theoretically, nurse case managers work independently of the insurance company. While they do provide the insurance company with relevant information about a patient’s condition and medical treatment, they should not advocate against the patient during settlement negotiations or otherwise perform investigative activity on the insurance company’s behalf.
Some argue that nurse case managers take on the role as a second insurance adjuster. They may present facts in a light that favors the insurance company’s position. Some argue that nurse case managers take on the role as a second insurance adjuster. They may present facts in a light that favors the insurance company’s position.
If you suspect that this is occurring, it is important that you share this information with your attorney immediately. If you suspect that this is occurring, it is important that you share this information with your workers’ compensation attorney immediately.
When you are injured on the job and a nurse case manager is assigned to your case, you will likely have questions about the nurse case manager’s role and what your legal obligations are in terms of working with the nurse case manager. Nurse case manager is meant to serve as an objective third party who is “uniquely experienced in medical, social, vocational and situational issues.
New York workers’ compensation law provides that a treating medical provider may discuss an injured employee’s medical history, diagnosis, causation, course of treatment, prognosis, work restrictions and impairments with the workers’ compensation insurance carrier, the employer or certified rehabilitation professionals (nurse case managers).
However, before any discussion may take place the injured employee must be notified by the employer, insurance carrier or its representative, or nurse case manager about the discussion at least ten days before the anticipated communication; be allowed to be present during any such discussion or communication, along with the employee’s attorney if represented; regularly be informed by the employer, insurance carrier or nurse case manager about the nature of the communication before the discussion
For more information and enhance your company’s fall protection program this spring and summer contact HURT-511 and our personal injury lawyers help injured workers recover the benefits to which they are entitled by law. For a free consultation with an experienced workers’ compensation lawyer, call us toll-free at 800-4878-511 or complete our online form. Our firm handles accident and injury claims throughout all five boroughs of New York.
HURT-511 operates in all boroughs of New York including all Bronx neighborhoods, namely: Bedford Park, Belmont, Fordham, Highbridge, Hunts Point, Jerome Park, Kingsbridge, Morris Park, Morrisania, Mott Haven, Parkchester, Riverdale, Spuyten Duyvil, Throgs Neck, University Heights and Woodlawn.