Missouri law requires an employer to pay for injuries that are sustained in the workplace. Because of this, insurance companies that have issued individual plans will often deny coverage for injuries that were sustained in the workplace. Although we think this is a run around of obligations by insurance companies, coverage for your workplace injury by individual insurance policies is unlikely. Still, sometimes an individual plan will authorize care for a workplace injury on a case by case basis.
Determining which treatments will be authorized by an insurance plan also occurs when you are receiving workers’ compensation benefits. Insurance companies will often assign a nurse case manager to make this determination. In theory, determining whether a particular course of treatment is authorized under a policy should be clear under the language of the policy. However, more often than not nurse case managers actively work to limit the amount of care injured workers receive.
What happens in practice is that the nurse case manager will attend an appointment with the injured worker and push the doctor to limit treatment. Suppose a doctor believes that your injury would best be treated with surgery. The nurse case manager will then speak with the doctor and argue for the insurer’s interest and ask that the surgery be delayed to see if the injury will heal on it’s own.
Another common fact pattern occurs when doctors prescribe physical therapy. Frequently, the nurse case manager will try and get the doctor to limit the amount of recommended therapies, and suggest a lower amount.
Nurse case managers often also work in concert with insurer approved doctors to limit partial permanent disability payments. Doctors make a lot of money by purposely lowering their determination of these ratings in return for the insurance company decreasing their payment. By observing the doctor, the nurse case manager insures that the comply with the wish of the insurance company.
Time and again, we see doctor’s prescribe surgeries and then rate the patients as having no permanent partial diability. This is completely absurd because clearly these surgeries are caused by some underlying condition that hasn’t been completely cured by the surgery. The nurse acse manager will influence the doctor to come to this decesion.
If you have been injured while working, you need to have an attorney represent you that is aware of the pitfalls that these nurse case manager’s pose to your recovery. Burger Law can help you get the recovery and treatment that you deserve. We fight hard to maximize recovery and do not charge a fee unless you win.