Work injuries create many problems; pain and loss of function from the injury, medical bills, lost wages and fear of employer-retaliation to name a few. But today I want to post about another hassle that comes with a work injury:

Nurse case managers.

Nurse case managers are nurses from the insurance company or workers’ compensation claims administrators who attempt to “manage” medical care for injured workers. While nurse case managers talk about “patient advocacy”, they work for the insurer or claims administrator. From what I can tell, their version of “patient advocacy” is to talk doctors into releasing injured workers from care without restrictions and without future medical care.

Nebraska courts hold that nurse case management services benefit employers. So why does Nebraska allow nurse case managers to run amok, while other states strictly regulate them? Nebraska’s state constitution and our state’s workers compensation rules explain why nurse case managers can get away with violating the privacy of injured workers.

The right to privacy under state constitutions

Nebraska does not recognize a right to privacy in our state constitution.  Montana and Illinois recognize a right to privacy in their state constitutions. That right to privacy under those state constitutions is part of the reason why nurse case managers on a tight leash in those states. Courts in those states have ruled that injured workers have a strong privacy interest in their medical records and laws that impair that privacy should be subject to strict scrutiny.

But it’s not just nurse case managers who try to interfere with the doctor-injured worker relationship In Nebraska attorneys for employers and insurance companies often to talk to the doctors of injured workers.  These conversations are usually had for the purpose of getting doctors to change their mind about their opinions in the case. Since these lawyers are representing an insurance company who pays their bills, most doctors are willing to speak with these attorneys. (It’s a different story for lawyers who represent injured workers in workers compensation cases.)

Like defense attorneys, nurse case managers are a representative of the insurance company/employer. They have a right to communicate with medical providers under Nebraska law. And again, the nurse case managers have some leverage over medical providers. They may also develop professional relationships with providers that can help their work.

Will Nebraska amend our state constitution to guarantee a right to privacy? The right to privacy is often used to support abortion rights, so any effort to amend our state constitution to allow for a right to privacy would likely be opposed by anti-abortion activists who are influential in Nebraska.

Why the Rules of Discovery undermine privacy

But even if Nebraska had a right to privacy in our state constitution, Nebraska would either need to pass legislation and or change the workers’ compensation court rules to regulate nurse case managers. I’m not sure that would be feasible without some other changes to rules within the Nebraska Workers’ Compensation Court.

The rules of civil discovery apply within the Nebraska Workers’ Compensation Court. Those rules give employers and insurance companies broad leeway to pry into the medical history of injured workers. States like Illinois adjudicate workers’ compensation claims as administrative claims. In administrative systems employers have more restricted access to an injured workers’ health history.

Fighting back against nurse case managers

While Nebraska law permits the use of nurse case managers, Nebraska law can be used against nurse case manager. Many attorneys in Nebraska believe that nurse case manager notes are discoverable. Those notes often reveal admissions that help injured workers.

Our firm routinely tells nurse case managers not to have contact with our clients. Sometimes that means nurse case managers will stay out of examination rooms. I have used the discovery rules against nurse case managers on the issue of when they knew about permanent impairment for the purposes of penalties under Neb. Rev. Stat. 48-125. I think it’s fair to inquire about any licensing issues a nurse case manager may have had through discovery. I think its also fair to impeach a nurse case manager with evidence of licensing issues on cross-examination.

Final thoughts on nurse case managers

Overall, Nebraska has good workers’ compensation laws – particularly in comparison with neighboring states. But, Nebraska law is less favorable than other states when it comes to nurse case managers. If one gets involved in your workers’ compensation case, it might be a good idea to call a lawyer.

(Credit to Mark Perper and Tom Murphy for sharing Illinois and Montana claw on this issue on the WILG listserv)