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Can The Worker’s Compensation Insurer Monitor or Attend My Medical Appointments?

doctor and patient wearing mask during health appointment

Under Virginia law, your employer or his or her worker’s compensation insurer is responsible for paying for all medical treatment associated with your injuries suffered in a workplace incident. Insurers often may insist on having a representative present at every one of your physical exams or doctor’s appointments. Insurers use all sorts of different justifications for this, but it almost always leaves the claimant feeling as if his or her rights are or have been violated in the worker’s compensation process.

Typically your first notice that a nurse manager or other representative of the insurer has been assigned to your claim is when you show up to your treating physician’s office for a regular appointment for treatment related to your workplace injury and there is a strange person there who introduces themselves as being from your worker’s compensation insurer. They will often claim to be there as a “patient advocate,” but this is not the case. These individuals are paid by the worker’s compensation insurer and his or her job is to monitor your claim and report back to the insurer. The case manager may even sometimes encourage a claimant’s treating physician to find the claimant is able to return to work sooner than would otherwise be the case. The case manager may sometimes seem as if he or she is there to make sure that you are getting the help you need, but you also need to keep in mind that his or her job is to report back to your employer, its carrier, and the defense attorney. Ultimately, the carrier wants to keep the costs of your claim down as much as possible, so if there is any way that the case manager can help the carrier to do so, he or she will likely do that.

Can I Object to the Presence of a Nurse Case Manager at My Worker’s Compensation Doctor’s Appointments?

Under the rules laid out by the Virginia Worker’s Compensation Commission, a claimant cannot refuse to allow a nurse case manager from attending his or her appointments with the claimant. Instead, it is the physician who decides whether a nurse case manager or other insurance company representative can attend an appointment or not. Nevertheless, the claimant can ask that the physician not discuss his or her prognosis, injury or care outside the claimant’s presence. This would specifically include discussing the patient’s injuries, prognosis or estimated future care needs with the nurse case manager that the worker’s compensation insurer has appointed to oversee your claim. This ensures that any conversation that affects you takes place in front of you and prevents the case manager from trying to interfere with you obtaining the treatment you need to fully recover from your injuries from your workplace incident.

Contact the Experienced Virginia Worker’s Compensation Attorneys at Kalfus & Nachman

If you have suffered a workplace injury in Virginia, then worker’s compensation coverage exists to compensate you for the damages that you suffer as a result of those injuries. Our experienced Virginia worker’s compensation attorneys know how to ensure that your employer and/or its worker’s compensation carrier do not interfere in your treatment for an injury suffered in a workplace injury. We have negotiated sticky situations where a nurse case manager or some other representative of your employer or your employer’s worker’s compensation insurer is seeking to interfere with your treatment for a workplace injury. If you have been injured in a workplace incident in Virginia, please contact Kalfus & Nachman today at (855) 880-8163 or through the form on this page to schedule a free consultation. Our experienced Virginia workers’ comp lawyers are here to help you.

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