The Involvement of Nurse Case Managers in Indiana Claims

When discussing medical benefits for work-related injuries in Indiana, it is often said that the employer is responsible for directing medical care for injured workers.  Members of the Indiana Worker’s Compensation Board are often quick to correct the common misconception that the employer “directs” medical care.  Instead, pursuant to Indiana Code 22-3-3-4, it is the responsibility of the employer to “furnish” an attending physician for the treatment of an employee’s work-related injuries.  The attending physician then directs the medical care.

To assist with furnishing medical care and adjusting their worker’s compensation claims, employers or their insurance carriers sometimes enlist the services of a nurse case manager (“NCM”).  Generally, a NCM should act as a liaison among the involved parties including the employee, employer/carrier, and medical provider.

The Indiana Worker’s Compensation Act does not contain specific provisions governing the involvement of nurse case managers in worker’s compensation claims.  However, by way of a written notice on its website, the Board has provided that:

A NCM may be involved in a claim to schedule appointments, help facilitate care suggested by the medical provider, and to report back to the employer and/or carrier.  However, a NCM should not express opinions, to either the injured worker or the medical provider, regarding an injured worker’s course of medical care or otherwise attempt to influence the process.  Additionally, a claims adjuster should not attempt to direct the care provided to an injured worker by the authorized treating doctor.

While NCMs often provide a useful tool for adjusting claims in Indiana, it is important for claims handlers and NCMs to be familiar with and to follow the guidelines set forth by the Board.  To that end, it is plainly apparent from the above guidelines that the role of the NCM should be limited to that of a facilitator or liaison and that any attempts to direct or influence an injured worker’s medical care may be in direct conflict with the Board’s guidelines.

The above guidelines were handed down by the Board quite some time ago; however, the involvement of NCMs in worker’s compensation claims continues to be a topic of discussion among attorneys and the Board.  Recently, it has been suggested that the Board is considering amending these guidelines.  Please continue to follow our blog for further updates on this topic and feel free to contact us to discuss this and any other topics involving worker’s compensation claims in Indiana.

Thanks to attorney Dane Kurth for this important summary.  Dane represents employers in both Illinois and Indiana on behalf of the firm.

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