Beginning in the early 1990s, workers’ compensation insurance carriers discovered the cost-saving and treatment advantages of disability management, giving rise to the now-ubiquitous nurse case manager. Still, nearly 30 years later, despite its proliferation, the profession remains vastly misunderstood, often seeming to exist only as an ambiguous and threatening figure on the periphery of an injured worker’s claim.
For many injured-workers’ attorneys, the increased utilization of nurse case managers merely represents a shifting business model of the adversarial party—resulting in, among other detriments, hastened treatment regimens and an undermining of the traditional doctor-patient relationship. In the most extreme examples, claimants’ lawyers instruct their clients to refuse all communication with nurse case managers, characterizing their presence as unwelcome, harmful, and driven by the sole motive of espionage. As is often the case in such delicate subjects, the truth value of these beliefs falls into a grayer area, with ample anecdotal evidence and widespread myth distorting the reality of just who these professionals are and precisely what they do.
With the use of nurse case managers now commonplace in workers’ compensation claim management, both injured-workers’ and defense lawyers are better equipped in their respective positions by fully understanding these professionals and the sphere in which they operate. It is the continued absence of information and education regarding nurse case managers that provides the backdrop and purpose for this article.
Seeking to provide some semblance of clarity, context, and guidance as to the proper and legitimate role of nurse case managers in the workers’ compensation arena, this article reviews the historical professionalization of disability managers; their modern role in workers’ compensation claims today; and a sample of leading regulations and case law pertaining to the legal obligations, duties, and exposures that may present in the context of disability management.
The Professionalization of Disability Managers
To properly conceptualize the disability management field and its import to workers’ compensation claims, it is critical to understand that disability managers exist in multiple forms; to wit, not all case managers are nurse case managers. As the name implies, this term only refers to registered nurses (RNs) who engage in case management. Other backgrounds represented in disability management include social workers and those with a health or human services baccalaureate or master’s degree.
Case Management Society of America. The late 20th century saw the first major efforts to professionalize the disability management workforce in the United States. In 1990, the Case Management Society of America (CMSA) was founded, which today stands as the leading nonprofit and interprofessional association dedicated to the support, development, and advancement of case management.1 In 1995, CMSA introduced the Standards of Practice for Case Management (Standards), a comprehensive manual, or “code of conduct,” for the professional disability manager.2 Since then, the manual has undergone multiple revisions, with the most recent finalized in 2016.3 This publication offered the industry’s first cohesive source for guidance related to the proper roles, responsibilities, principles, processes, and behavioral expectations in disability management.
As of 2016, the Standards defined “case management” as “a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote patient safety, quality of care, and cost effective outcomes.”4 CMSA’s philosophy posits that when an individual reaches an optimum level of wellness and functional capability, all parties benefit, including the client (the individual being treated), the health-care delivery system, the payer, and the employer.5 CMSA purports to achieve these results through communication, health education, identification of service resources, and service facilitation.6
The Standards establish a code of conduct for disability managers, similar to that of many other professions, such as physicians and attorneys. In this respect, the manager is tasked with (1) identifying the client’s care needs or opportunities that would benefit from case management interventions; (2) establishing care goals with measurable outcome indicators to be achieved within specified time frames; (3) maintaining qualifications, including current, active, and unrestricted licensure or a degree in social work (for jurisdictions not requiring licensing), as well as supervised field experience; (4) adhering to all applicable federal, state, and local laws and regulations, including those related to client privacy and confidentiality; (5) advocating for the client to improve the quality of care and reduce health disparities; and (6) engaging in scholarly activities and maintaining familiarity with current knowledge, competencies, case management–related research, and evidence-supported care innovations.7
As of 2017, CMSA counted 36,000 disability managers among its members, organized throughout the country by 80 local and international chapters.8
Commission for Case Manager Certification. While CMSA serves as the leading professional organization of disability managers, actual accreditation is provided, and regulated, by the Commission for Case Manager Certification (CCMC). In March 1991, a national task force on case management convened in Dallas, Texas.9 There, 30 professionals, representing 29 health-care-industry stakeholders, came together in an effort to design a credentialing process governed by members of the community itself. By 1993, an examination was developed whereby case managers could obtain the official certified case manager (CCM) credential; in its first year alone, the examination drew 12,000 candidates. Just three years later, in 1996, CCMC adopted a code of professional conduct. Finally, in 1999, CCMC was granted accreditation by the National Commission for Certifying Agencies.
Today, over 42,000 individuals hold the CCM certification.10 Of those certified, 89 percent are registered nurses, 7 percent are social workers, and the remaining 4 percent come from other “allied health” backgrounds.11 Based on numerous conversations held with industry professionals, it is this author’s impression that disability management companies now require, or at least strongly prefer, workers with the CCM certification.
Code of professional conduct. Perhaps most important as it relates to implications in the workers’ compensation context, CCMC publishes the Code of Professional Conduct for Case Managers. Originally adopted in November 1996, with the most recent revision completed in January 2015, the code establishes standards for behavior, ethics, competency, legal compliance, advertising, and privacy.12 Further, the code provides extensive detail regarding the procedures involved where a case manager is alleged to have violated the same.13
At the outset of the Code of Professional Conduct for Case Managers, CCMC establishes eight principles by which CCMs are to conduct themselves. CCMs are to (1) place the public interest above their own at all times; (2) respect the rights and inherent dignity of all of their clients; (3) always maintain objectivity in their relationships with clients; (4) act with integrity and fidelity with clients and others; (5) maintain their competency at a level that ensures their clients will receive the highest quality of service; (6) honor the integrity of the CCM designation and adhere to the requirements for its use; (7) obey all laws and regulations; and (8) help maintain the integrity of the code by responding to requests for public comments to review and revise the code, thus helping to ensure its consistency with current practice.14
Browsing the Code of Professional Conduct for Case Managers, the reader is left with the impression that CCMs unequivocally view themselves as advocates for their clients (the disabled individuals). This advocacy is often effectuated by educating clients in complex health-care matters so that they may make their own informed decisions regarding treatment. Further, the manager operates at the center of the claim, interacting with, in the workers’ compensation context, the injured worker, the injured worker’s lawyer, the adjuster, and all treating doctors. Given this central location in a claim, case managers are often subjected to the various pressures of multiple parties involved in a claim—and their corresponding, often conflicting, interests.
The Role of Disability Managers in Workers’ Compensation
In the handling and litigation of workers’ compensation claims, the proper role, boundaries, duties, and obligations of the nurse case manager are paramount concerns for claimants, attorneys, employers, and insurance carriers. In the extensive commentary provided to this author by those throughout the workers’ compensation and medical case management fields, several common themes emerged that are important to all parties involved—namely, advocacy, ethics, education, and communication.
Advocacy and ethics. Barbara E. Holmes, renowned injured-workers’ counsel, commented that around 25 percent of her office’s active files include the presence of a nurse case manager.15 As the claimant’s legal advocate, Holmes believes it necessary to ensure that nurse case managers know their legal limits and boundaries. For example, a recent scenario unfolded wherein a client relayed to Holmes that the nurse case manager was joining the claimant in the examination room during appointments with the treating physician. Holmes was adamant that this behavior was unacceptable, contrary to the rights of the claimant under Pennsylvania law, and informed the manager accordingly.
Reflecting on the potential concerns of a nurse case manager’s involvement in a claim, Holmes noted that such managers will always use the providers and resources that they prefer. In doing so, nurse case managers will often “wedge themselves” between the doctor-patient relationship, thereby challenging the authority and competency of the treating provider and potentially creating mistrust between the claimant and the claimant’s physician. Still, Holmes acknowledged that some benefits can be derived from the use of a nurse case manager, including more efficient referrals to specialists and physical therapy facilities and increased access to diagnostic testing.
Ann Marie Loiseau, a former workers’ compensation nurse case manager who now serves in an academic faculty position, similarly noted that, as with any profession, both good and bad behavior can be found among nurse case managers.16 In the time that she managed cases, Loiseau always viewed her role as an educator, coordinator, and advocate. She emphasized that nurse case managers are often assigned to claims where “red flags” have been identified; for this reason, it is no surprise that the involvement of a disability manager might naturally exacerbate the suspicion already present between the claimant and carrier.
Debbie Keisling, owner of Evaluation Specialists LLC, an independent examination service, works closely with nurse case managers; she noted that disability management requires a “return-to-work” mentality but that the same is not inconsistent with also being the claimant’s advocate.17 She stated that the best nurse case managers are those advocating for the claimant’s highest possible functionality—even if that means, in some cases, educating an insurance adjuster as to the disability’s severity and necessary treatment. It has been Keisling’s experience that adjusters are typically receptive to the opinions of nurse case managers and regularly follow their advice.
Michelle Repman-Pifer, owner of Presque Isle Rehabilitation Service, LLC, echoed these sentiments.18 When asked what she would say to claimants’ attorneys who express uneasiness toward the use of nurse case managers, Repman-Pifer responded:
We are here to do our job—which is to assist the injured worker in the coordination and facilitation of medical treatment in a timely manner, with a goal of medical stability, recovery, and return to work when feasible. We all have the shared goals of making the worker healthier and advancing their recovery.19
Repman-Pifer acknowledged that not every file requires a case manager—just as not every file demands an attorney. She stated that case management should be considered in cases where particular factors present, such as catastrophic injury; multiple comorbidities; aggravations of preexisting conditions; emotional distress; delayed treatment and progress in patient recovery; and poor communication between the insurance carrier, practitioner, and injured worker. Repman-Pifer cautioned that many other circumstances can develop during the life of a claim, creating a need for case management where one may not have existed before; this, she said, should be examined on a case-by-case basis.
Loiseau emphasized that a nurse case manager’s duty to the insurance carrier should always be disclosed to the claimant. This includes the obligation to relay all learned information to the adjuster. In this way, an honest conversation can be had between all parties involved, with all competing interests known and understood.
She further noted that if a nurse case manager only considers the cost variables of a claim, and thereby neglects the importance of quality of care, all parties are disadvantaged. Indeed, low-quality care often results in higher expenses over the life of a claim. Recalling experiences where adjusters balked at the cost or utility of a certain treatment prescribed, Loiseau said that at times she found herself explaining to an adjuster that the applicable law required that the carrier provide the particular treatment modality at issue. In this respect, her ethical obligation was, ultimately, to the claimant’s recovery and the controlling law of her jurisdiction. Reflecting on her time as a nurse case manager, she stated, “There’s a lot of ethical dilemmas in case management—you have to stay true to being honest with the patient and their families. I always saw myself as a nurse first and a case manager second.”20
Education. Loiseau indicated that she views the primary role of a nurse case manager to be that of educator. To wit, the job often includes the educational aspect of teaching “low health-literacy individuals” medical terminology, health-care processes, and treatment options. Loiseau stated that a significant portion of workers’ compensation claimants know very little about the world of medicine, regardless of their educational background; in her experience, even highly educated individuals can have difficulty understanding the complexity of their own treatment. This, in turn, creates a significant need for the nurse case manager’s expertise and experience navigating the world of medicine and health care.
Communication. Holmes noted that if a particular claimant has trouble filtering communication or experiences high levels of stress, she may make an effort to communicate more regularly with the manager assigned to the case; conversely, if a claimant has some social savvy, Holmes will permit the claimant to communicate with the manager directly and will simply instruct the case manager to provide regular updates. Holmes made clear that she prefers to maintain cordial and respectful relationships with nurse case managers, noting that “if you go in with antagonism from the beginning, that’s how it will remain.”21
Offering suggestions for improving the relationship between injured-workers’ lawyers and nurse case managers, Holmes stated:
Once the case manager knows who the client is treating with, they could provide a list of providers that the insurer doesn’t typically have trouble with. Even more, they could communicate with the adjuster to approve medications, and be generally proactive. If they could call the adjuster and brief them on upcoming testing and new medication, the process would be smoother.22
Loiseau endorsed this same perspective, stating, “It’s all about communication. As the nurse case manager, call the claimant’s lawyer, even if they have instructed you to stop talking to the claimant!”23 In this sense, Loiseau suggested that better relationships could be fostered with open dialogue among all interested parties.
Indeed, Repman-Pifer agreed, stating, “It really needs to be a collaborative effort between injured worker, employer, case manager, insurance company, and all providers involved.”24 Reflecting on past claims, Repman-Pifer stated:
At the time of case closure, most injured workers are thankful for the assistance they receive from the case manager. The injured workers who share the same goals of the case manager are the ones who are most receptive to case management, and most likely to return to work depending on the severity of the injury and their job at the time of loss.25
Commenting on prior positive experiences, she noted:
Not only are the injured workers thankful for the services they have received, but many times I have had claimants’ lawyers approach me, as the owner of the company, stating what a good job we have done assisting the injured worker with treatment facilitation and recovery. This is especially true in states where preauthorization for medical treatment is required or no treatment guidelines exist.26
Keisling, too, emphasized the need for open dialogue between the nurse case manager, counsel, and adjuster. She recalled, in her experience, the trusting bonds she had formed with some of her locale’s most aggressive claimants’ attorneys, simply by always being accessible and honest. In being so willing to communicate openly with injured-workers’ lawyers, Keisling found that some became more willing to cooperate with her and, at times, even pleased upon learning that she was involved in the management of a claim.
State Statutes and Regulations
Responding to the now-widespread use of nurse case managers, some legislatures and administrative agencies have passed legislation and regulations, respectively, regarding a disability manager’s rights, duties, and obligations in a workers’ compensation claim. As evidence of the need for authoritative guidance, some states, lacking established law, have issued policy statements in an effort to provide some measure of direction. The most notable examples are included here.
Colorado. Colorado, by statute, has instructed that the employer or insurer shall provide injured workers with a brochure, written in easily understood language.27 The law establishes what information the brochure must provide, including notice of “[t]he claimant’s right to discuss with his or her doctor who should be present during a claimant’s medical appointment, and the right to refuse to have a nurse case manager . . . present at the claimant’s medical appointment.”28
Georgia. State Board of Workers’ Compensation Rule 200.2 limits the use of case managers in noncatastrophic injuries, requiring employers and insurers to obtain consent of the injured employee, or the injured employee’s counsel, to work on the claim.29 Consent is to be provided in writing anytime the manager wishes to attend a medical appointment. Notably, the consent may be withdrawn at any time. Most striking, the consent of the injured worker is not required for a medical case manager to contact the worker’s treating physician “for purposes of assessing, planning, implementing, and evaluating the options and services required to effect a cure or provide relief.”30
Further, the use of a medical case manager is required in cases designated as “catastrophic.”31 The employee has no right to refuse such involvement. Rule 200.1 also requires that those serving as medical case managers hold proper credentials, such as that of a certified rehabilitation counsel (CRC), CCM, certified rehabilitation registered nurse (CRRN), or licensed professional counsel (LPC), among others.32
Indiana. The Worker’s Compensation Board of Indiana, in the absence of any formal legislation or regulation, has offered the following administrative guidance:
The NCM’s [nurse case manager’s] role in worker’s compensation in the State of Indiana includes, among other things, providing information and communication among the parties and medical providers, scheduling appointments, helping to facilitate care recommended by the treating physician and reporting back to the employer and/or carrier. . . . It is not the role of the NCM to determine compensability, make decisions regarding the administration of workers compensation benefits, deliver or direct treatment, or provide medical opinions to either the injured worker or the medical provider regarding the worker’s appropriate course of medical care.33
Michigan. The Michigan Workers’ Disability Compensation Agency (WDCA) has published information on medical benefits for injured workers. Addressing nurse case managers, the WDCA states:
Nurse case managers are advocates of proper medical care and treatment, and they can be tremendous advocates for your safe return to work. Case managers can act as liaisons in the claim management process, and are tasked with coordinating the activities of the various medical professionals and necessary community resources, all while working with the insurance claims adjuster to achieve maximum functional outcomes as quickly and safely as possible. The ultimate goal is a safe return to work.34
The WDCA material notes that the Michigan Workers’ Disability Compensation Act does not specifically address nurse case management services. However, curiously, the WDCA material instructs that the injured worker has the right to request a new case manager, or deny further case management assistance entirely.
South Carolina. In South Carolina, a 2012 statute establishes that any employee seeking treatment for a disease or injury for which workers’ compensation benefits are sought necessarily consents to the release of medical records related to such treatment.35 The medical records must be released to the insurance carrier, the employer, their respective attorneys, and certified rehabilitation professionals. Failure to produce these requested documents within 30 days may result in a monetary fine.
The statute goes on to note that a health-care provider who examines or treats an employee for a workers’ compensation claim may discuss or communicate the worker’s medical history, diagnosis, causation, treatment, prognosis, work restrictions, and impairments with the carrier, employer, their respective attorneys, and certified rehabilitation professionals without the employee’s consent. The employee need only be notified in a timely fashion prior to the communication, advised of the nature of the communication, and provided a written copy of the questions at the same time they are submitted to the provider. The employee must then be supplied a copy of the responses offered by the provider. Notably, the statute forbids any discussion or communication that conflicts with, or interferes with, the employee’s examination or treatment.
Vermont. Under Vermont law, the use of medical case management is nonvoluntary; injured workers have no authority to request or deny the use of a case manager in their claims. The Vermont Department of Labor has provided guidance related to the use of medical case management.36 The department defines such management as “the planning and coordination of health care services appropriate to achieve the goal of medical rehabilitation.”37 This type of management may include care assessment, including a personal interview with the injured worker; assistance in developing, implementing, and coordinating a medical care plan; and evaluation of treatment results. The department further notes that the goal of case management is to assist injured workers in understanding all available treatment options, better enabling them to make an informed choice regarding their health.
The department indicates that most medical case managers are registered nurses. In fact, the Vermont workers’ compensation system actually requests that managers obtain licensure from the Vermont Board of Nursing. If case managers lack the requisite work experience in the Vermont workers’ compensation system, the department then advises that such individuals first work as interns under the direct supervision of an experienced case manager.
The department’s guidance on this subject identifies the case manager as an agent of the employer and insurance carrier and cautions that case managers may therefore “ask questions or perform activities that are beneficial to the employer/carrier.”38 For this reason, the case manager is encouraged to provide a “disclosure statement,” formally notifying the worker of this relationship.39 The department goes on to suggest that case managers can provide benefits to the injured worker, such as providing referrals to physical therapy providers, diagnostic testing facilities, and specialists.
In the event that a dispute arises from medical case management, the department advises that informal resolution be pursued. However, the department indeed accepts the submission of complaints by letter and can provide informal conferencing to reach a satisfactory resolution.
Leading Case Law
Despite the regularity with which nurse case managers are now utilized in workers’ compensation claims, limited precedential authority exists establishing the legal duties, obligations, and exposures applicable to these professionals. Therefore, for those jurisdictions in which no authoritative precedent exists, guidance can be derived from cases addressing similarly situated parties, such as plant doctors and nurses, and contracted third parties. With these considerations, the following precedents have been selected as representative of the leading disputes involving nurse case managers (or similar third parties) and the analytical framework that has been applied to their potential liability.
Florida. In a Florida case, the court held that a nurse case manager who revealed sensitive information regarding the claimant to the claimant’s employer was entitled to the standard statutory immunity provided to employers under the state’s Workers’ Compensation Act.40 There, an injured worker, who was receiving workers’ compensation benefits, was assigned a nurse case manager. Frustrated with the handling of his claim, the worker expressed to the case manager his anger over the ordeal and insinuated that he might retaliate with violence. The nurse case manager thereafter emailed the employer, seeking advice on how best to handle the situation. Eventually, the Miami Police Department became involved, resulting in a criminal investigation.
The claimant filed suit against the workers’ compensation insurance carrier, alleging a variety of torts, including negligence, defamation, libel, fraud, and intentional infliction of emotional distress. The court dismissed all counts, holding that the nurse case manager’s actions did not rise to the level of separate and independent torts, as required to establish a claim outside the statutory immunity provided to the employer under the Workers’ Compensation Act. The court characterized the nurse case manager’s conduct as, at worst, amounting to simple negligence; ultimately, her conduct was interpreted as a mere attempt to solicit guidance from her superiors.
North Carolina. In a North Carolina case, plant nurses, negligent in their care of an injured worker, were also held entitled to statutory immunity under the state’s Workers’ Compensation Act.41 There, the claimant was an employee of Smithfield Packing, and the defendants—registered nurses—were employed by the Smithfield Packing Medical Clinic. The claimant was injured in the course of employment and sought medical treatment from nurses at the clinic. Over the course of the following days, the claimant returned to the clinic a total of four times, alleging continued symptoms related to the injury, and received various treatments from multiple nurses. None of these visits resulted in a referral to a medical doctor. Finally, the claimant presented to a hospital, where she was diagnosed with a complete Achilles tendon tear and septic ankle—an injury far more severe than that identified by the clinic’s nurses.
The claimant filed suit against the nurses, alleging negligence in the care and treatment provided. Dismissing the case, the court held that the state’s Workers’ Compensation Act provides exclusive protection, beyond the employer itself, to those conducting the employer’s business. Both defendants in the case were registered nurses, employed by the employer at the company’s medical clinic, and were considered to be conducting the employer’s business when the alleged tortious acts occurred. Therefore, the court concluded, the claimant’s remedy was limited to that provided under the Workers’ Compensation Act.
Pennsylvania. In a leading Pennsylvania case, a tort suit was permitted to proceed against a nurse case manager where the alleged negligence that occurred was independent of the original work injury.42 There, the claimant had suffered an orthopedic injury and sometime later developed psychiatric symptoms. A nurse case manager who was assigned to the claim informed the claimant that, in order to continue receiving benefits, he was required to submit to the treatment deemed necessary by the insurer. The claimant subsequently underwent electrical shock therapy, which resulted in severe adverse effects. It was later revealed by another physician that the claimant’s psychiatric complications were not work-related but instead were service-related post-traumatic stress disorder associated with his experiences in Vietnam.
The claimant filed suit against the insurance carrier and nurse case manager, alleging negligence in directing and coordinating medical care. The appellate court held that the claim was permissible as falling outside the protections of the exclusive remedy. In other words, the suit did not merely allege “bad faith”—a tort barred by the employer’s immunity under the Workers’ Compensation Act. Here, the tortious conduct was unrelated to the actual processing of the compensation claim and, instead, constituted an activity “subsequent to and independent of” the work injury itself.43
South Carolina. In an unreported South Carolina case, a nurse case manager who failed to accurately inform the claimant of his medical diagnosis was held immune from tort, pursuant to the exclusive remedy of workers’ compensation.44 There, the claimant was receiving workers’ compensation benefits when a nurse case manager was assigned to his case. In the course of coordinating the claimant’s care, the nurse case manager failed to properly and accurately inform the claimant of his true diagnosis, resulting in an exacerbation of his condition. Consequently, the claimant brought suit for negligence, breach of fiduciary duty, and breach of good faith and fair dealing.
The court noted the long-standing principle that employers are immune from tort actions by their employees for work-related accidents or injuries via the Workers’ Compensation Act’s exclusive remedy. This immunity extended to the employer’s carrier except where the carrier stood in the position of a third party, unrelated to its function as a compensation carrier. The court determined that this exception did not apply, instead finding that the nurse case manager was an employee of the carrier, acting in the scope of her employment and in furtherance of the carrier’s function as an insurance carrier service to its employer client. Therefore, the insurer and, by extension, the nurse case manager were entitled to statutory immunity from tort liability.
Analysis. A review of these precedents reveals that common themes emerge among the sampled jurisdictions. The starting position of most courts’ analyses focuses on the default presumption that all work-related injury claims fall within the exclusive remedy provided by a state’s workers’ compensation statute. However, in circumstances where courts have permitted tort claims related to nurse case managers and treatment rendered by the insurer, the tortious acts at issue can be characterized as arising separately and distinctly from the original work-related injury. In this respect, the damages alleged are not a natural result of negligence in the claims-handling process or coordination of treatment. Instead, the threshold for independent tortious conduct is typically met by actions having a non-work-related genesis, committed by actors outside the scope of the traditional employer-employee relationship.
It is this type of factual scenario that presents potential exposure to nurse case managers in a number of jurisdictions. Still, in cases where the alleged negligence or intentional act maintains a causal nexus with the work injury, the exclusive remedy largely remains intact, granting immunity to nurse case managers in their capacity as extensions of the employers and carriers.
In nearly every state, workers’ insurance carriers now regularly utilize nurse case managers as a method of containing costs, improving recovery outcomes, and increasing the overall efficiencies of claims. It is this author’s impression, based on extensive research and conversations with industry insiders, that the nurse case manager will continue to be a prevalent figure in the workers’ compensation community.
For this reason, injured workers, counsel, employers, and carriers should all seek a professional, respectful, and courteous working relationship with nurse case managers; such camaraderie is imperative for all parties to derive the maximum benefits that have been proven attainable from the disability management model. Any parties harboring suspicion toward the mere concept of the nurse case manager are reminded of the extensive ethical and professional standards to which these individuals are held.
In this respect, where a nurse case manager acts within the bounds of the Code of Professional Conduct for Case Managers and the law, and serves as an advocate for the claimant’s maximum functionality, a common goal is shared among all actors involved in a claim. Positive outcomes of this professional synergy can manifest in faster healing times, reduced overhead in the management of claims, and fewer injured workers frustrated by the medical complexities and governmental bureaucracies that lead to extended litigation and, ultimately, prolonged disability.
1. Case Mgmt. Soc’y of Am., Standards of Practice for Case Management 5 (2016).
2. Id. at 3.
4. Id. at 11.
5. Id. at 12.
7. See generally id. at 20–30.
8. Press Release, Comm’n for Case Manager Certification, CMSA, CCMC Strike Collaborative Agreement for Professional Case Manager Development (June 13, 2017), https://ccmcertification.org/press-releases/cmsa-ccmc-strike-collaborative-agreement-professional-case-manager-development.
12. Foundational Principles: Newly Revised Code of Professional Conduct Provides a Framework for Ethical, High-Quality Care, CCMC IssueBrief, Feb. 2015, https://ccmcertification.org/sites/default/files/issue_brief_pdfs/23_-_updated_code_of_conduct.pdf.
13. See generally Comm’n for Case Manager Certification, Code of Professional Conduct for Case Managers with Standards, Rules, Procedures, and Penalties (2015).
14. Id. at 3.
15. Interview with Barbara E. Holmes, Partner, Blaufeld Schiller & Holmes LLP (Jan. 3, 2018).
16. Interview with Ann Marie Loiseau, Dir. of Servs., Ne. Rehab. Assocs. (Jan. 12, 2018).
17. Interview with Debbie Keisling, Owner, Evaluation Specialists LLC (Jan. 10, 2018).
18. Interview with Michelle Repman-Pifer, Owner, Presque Isle Rehab. Serv., LLC (Jan. 10, 2018).
20. Interview with Ann Marie Loiseau, supra note 16.
21. Interview with Barbara E. Holmes, supra note 15.
23. Interview with Ann Marie Loiseau, supra note 16.
24. Interview with Michelle Repman-Pifer, supra note 18.
27. Colo. Rev. Stat. § 8-43-203 (2016).
29. Ga. Code Ann. tit. 34 app., § 200.2 (2019).
31. Id. § 200.1.
34. Medical Benefits, Mich. Workers’ Disability Comp. Agency, https://www.michigan.gov/leo/0,5863,7-336-94422_95508_79556_79557-407200--,00.html (last visited May 4, 2021).
35. S.C. Code Ann. § 42-15-95 (2019).
36. Medical Case Management & Returning to Work, Vt. Dep’t Lab., https://labor.vermont.gov/workers%E2%80%99-compensation/injured-workers/medical-case-management-returning-work (last visited May 4, 2021).
40. Marshall v. Amerisys, Inc., 943 So. 2d 276 (Fla. Dist. Ct. App. 2006).
41. Johnson v. Gooden, 791 S.E.2d 283 (N.C. Ct. App. 2016).
42. Taras v. Wausau Ins. Cos., 602 A.2d 882 (Pa. Super. Ct.), appeal denied, 615 A.2d 1313 (Pa. 1992).
43. Id. at 889.
44. Altstaetter v. Liberty Ins. Corp., No. 2007-UP-299, 2007 S.C. Unpub. LEXIS 356 (S.C. Ct. App. 2007).