The Nurse Case Manager assigned by the insurance company to your Pennsylvania Workers' Compensation claim will act like your best friend. They will set themselves up as the voice of reason, there to will help you and guide you to get the treatment you need and to protect you from the whims of the evil insurance adjuster -- who just doesn't understand what you are going through.
All the while, the Case Manager will be reporting to and working closely with that same Insurance Adjuster. Their goal is to keep you on a track that will save the insurance carrier money, by limiting your rights and/or by shutting down your claim as soon as they can arrange an opportunity. If the Case Manager attends your medical appointments, it is not to somehow help you in your interaction with the doctor, but instead to try to influence the doctor to downplay your injury or to speed you back to work. When dealing with doctors in front of you, they may try to create the opposite impression -- hence the "wolf in sheeps clothing" image -- but they are working for and with the insurance company and their goal is to report back on how they can manipulate your claim by manipulating you.
Not all claims get a Nurse Case Manager. Some insurers are more aggressive in their use, but normally they are assigned when it appears to the insurance carrier that an extra push will be needed to keep down the long-term costs of a given claim. The case manager is then sent in to try to gain your trust while leading your claim in the direction most desired by the insurer. For example, the insurer-referred doctors may be at the point of recognizing a more substantial injury than the insurance company would like, or might be inclined to propose expensive forms of treatment, advanced diagnostic testing, costly surgery or making some other move that might document your work-related injury as having long-term or permanent effects. The Case Manager may be brought in by the insurance company to attend your appointments and try to influence the content or wording of the doctors' notes, to keep them as close as possible to the minimal description of injury the insurance carrier prefers, or to encourage the doctors to refer you to some other medical provider over whom the adjuster may have better control.
If the adjuster feels that sending you for diagnostic testing (such as MRI or EMG) will help the insurance carrier argue that they have ruled out
a serious condition, they may involve a case manager. That case manager will then explain that she is fighting to get you the diagnostic testing you need, when her real goal is to ensure that the test is performed by a very insurance-oriented provider so that it has the maximum probability of helping the insurance company more than it helps you.
Many workers' compensation claimants make the mistake of assuming they have nothing to fear, simply because their claim is legitimate, their injuries are real, and they have nothing to hide. The insurance company may know all of these things, but they do not care. The insurance adjuster does not care how legitimate your injuries are. The job
of the insurance adjuster is to treat every claim as if it were a fraud, to treat every claim as if were a game, and to minimize costs for her employer. A Nurse Case Manager's mission is to convince the injured worker she is sympathetic while convincing that worker's doctors to support a return to work and to minimize the manner in which the work injury is documented. This is what she is paid to do. This is what her promotions will be based on. This is how she keeps her job. How she can then sleep at night is anyone's guess.
Do not be fooled by the "good cop/bad cop" interplay with the Case Manager and the Adjuster. Both work for the insurance carrier. Both have the same objective: weakening your claim and denying or limiting your long term rights.
If a Nurse Case Manager is involved in your claim, do not allow yourself to feel relief that you have finally gotten away from dealing with a difficult adjuster. Your claim is in more danger with a Case Manager's involvement than without. This is particularly true if it has been less than ninety days since you first missed work due to your work injury, and if you are recieving benefits under a Notice of Temporary Compensation
(NTCP). The case manager will always be working to position the insurance carrier with the best possible evidence to defeat your rights, ahead of a plan to stop your benefits at or before the ninety day deadline to do so under an NTCP.
If this is your status, run, don't walk, to the nearest telephone and call workers' compensation attorney Tim Kennedy at 484-453-8144. Learn how you can work to avoid a "Notice Stopping" that would cut off your right to benefits and force you into a long fight with the insurance company and your employer. Learn how to keep your benefits flowing, and how to position your side of the case to either avoid fights with the insurance carrier or how to be in best possible position to win that fight if and when they make a fight unavoidable.