The Role of the Nurse Case Manager and Voc Rehab Counselor in a Workers’ Comp Case

If you’re receiving workers’ compensation checks but have been medically cleared for light-duty work, you may receive a call from either  a nurse case manager (NCM), a vocational rehabilitation counselor (VRC), or both. These professionals collaborate with the insurance adjuster to try to get you back to work and fast-track the end of your benefits.

When you receive communication from an NCM or a VRC, you’ll want to have a workers’ comp lawyer on your side to protect your benefits and rights.

What is a Nurse Case Manager (NCM)?

A nurse case manager – also called an NCM or an RN case manager – is a professional that an insurance company assigns to a comp case to liaise between the doctor, the worker, and the insurer. The NCM monitors your medical progress and reports back to the insurance company. They will also try to get you to see other medical providers or even convince you to switch your treating physician for a doctor whom the insurance company prefers.

NCMs are not legally required in workers’ comp cases, but it’s common for insurance companies to assign them. In the best-case scenario, a case manager will help facilitate your treatment so that you get the most efficient and patient-centered medical care. In the real world, however, NCMs are more loyal to the insurance company they work for. The more serious your injury, the more likely the insurer will assign a case manager to speed up your timeline of returning to work.

If you’ve been contacted by a case manager or if an NCM has shown up to your doctor’s appointment, it’s best to safeguard your rights with the guidance of an attorney.

What a Nurse Case Manager Can and Can’t Do – And What You Should Do in Response

Here are some things a case manager CAN do:

• Attend your doctor’s visits. An NCM may legally show up to your clinic appointment to observe as your doctor is examining or treating you. You can, however, refuse the case manager’s presence in the doctor’s office. In our decades of experience at Slominski Law, we know that it’s best for you to be alone with your physician during consultation or treatment, without the potential influence of a third party.

• Communicate with your doctor. The NCM will communicate with your treating physician to monitor your progress and to evaluate your treatment. Unfortunately, it’s also common for case managers to try to convince doctors to remove your medical restrictions and clear you for regular work. Thus, you may request your physician to avoid speaking to the NCM without you present.

• Describe your job to your doctor. Another tactic that an NCM may use is presenting a description of your pre-injury job to your physician. This job description may be misleading or incomplete, portraying the work as something you may be able to do in your current condition. Make sure you are there when this happens, and don’t hesitate to expound to your doctor about the true demands of your job.

• Arrange appointments with other providers. An NCM is allowed to help set appointments for you with other doctors, therapists, and other healthcare professionals. They will try to convince you to change your treating physician. You don’t have to agree with these suggestions. Even if they say that your current doctor cannot pencil you in for several months, you have the right to refuse to see another physician.

And here are some things a case manager CANNOT do:

• Prescribe or give you any form of treatment (such as medication, therapy, etc.)
• Force you to consult a particular physician or undergo a specific treatment
• Pressure you to say things about your health that you’re not comfortable saying (such as downplaying your pain)
• Insist that they attend your doctor’s visits even if you refuse.

If you find that an NCM is breaching your rights, you can immediately stop working with them. It’s best to contact a workers’ compensation attorney to determine if the NCM’s actions have an impact on your workers’ comp case.

What is a Vocational Rehab Counselor (VRC)?

A voc rehab counselor is a certified professional hired by the insurance company to manage your vocational rehabilitation process. This is a process meant to ease you back to work through services such as job coaching, retraining, and even job placement. The VRC assesses your current job options given your medical condition, then provides the services you need to get an appropriate job.

If your employer or their insurance carrier has sent a voc rehab professional to your case, you’ll generally need to cooperate in the process. Failure to comply could be grounds for the insurer to stop your benefits. Keep in mind, however, that the VRC must work within the guidelines of the Virginia Workers’ Compensation Commission (which we’ll discuss below). It’s important to understand your rights and be aware if these rights are violated.

What a Voc Rehab Counselor Can and Can’t Do – and What You Should Do in Response

Under Virginia guidelines, a vocational rehab provider CAN do the following:

• Arrange meetings with you. Meetings with the counselor are an essential part of vocational rehabilitation, but they must be set at a reasonable time, place, and manner. The counselor must consider your medical condition and transportation options. They must also notify you two days in advance of any scheduled meeting. In addition, you are free to take your attorney with you to the meeting.

• Talk to your doctor. The VRC has to know your medical restrictions and work status, thus they may speak with your treating physician without needing your consent. You can, however, refuse to let a VRC into the doctor’s office when you’re having your medical consultation or treatment.

• Pre-screen and contact potential employers for you. It is the voc rehab specialist’s responsibility to find available jobs that suit your skill set, career history, salary level, and medical restrictions. They can then contact potential employers and arrange interviews for you. The counselor must notify you at least two days in advance if there’s a job interview you must go to.

• Require you to undergo a functional evaluation. It’s common for insurance companies to disagree with the work status your doctor has cleared you for. The insurer, through the VRC, may require you to undergo a functional capacity evaluation (FCE) to get their own assessment of the work you can do. It’s best to comply with this, but you’ll want to have an attorney to help assert your true work capacity.

The Virginia Vocational Rehabilitation Guidelines also state what voc rehab providers CANNOT do:

• Send you to inquire with employers who do not have available jobs for you
• Have you search job listings in the newspaper
• Require you to contact a certain number of employers
• Call you before 7 a.m. or after 10 p.m. (except in emergencies)
• Advise you to withhold information about your injury during a job interview
• Require you to provide personal or financial information irrelevant to the job search (such as your credit history or spousal info)
• Sit in on your doctor’s appointments after you’ve refused to let them
• Interfere with your medical treatment.

Though vocational rehabilitation is intended to help you return to work, it’s worth remembering that voc rehab professionals work for the insurance company. Often, injured workers encounter VRC methods that feel exasperating, pushing workers to stop complying with further rehab instructions. This can unfortunately result in the termination of their benefits.

Going through voc rehab is a balancing act between following instructions and protecting your best interests. Anytime you suspect that a certain party is being unfair or is violating your rights, speak with a lawyer who advocates for workers like you.

Contact Jaleh K. Slominski – Virginia Workers’ Comp Lawyer

For smart legal advice and strong representation, call on Attorney Jaleh K. Slominski. She has been helping Virginian workers for over 20 years as they navigate the complex workers’ comp system. Her service has resulted in maximum compensation and protected rights for many clients, even when faced with powerful employers and insurance companies.

Consult Attorney Slominski if you are unsure about your work disability situation or in need of legal help regarding workers’ comp. Call us at (434) 384-9400 in (Lynchburg) or (540) 554-3762 in (Roanoke).