A nurse case manager wants to come to my doctor appointments — what are my choices?

A nurse case manager is a nurse hired by the insurer or the employer to follow a claim, coordinate care, and report back. The nurse is not your doctor, and does not make your medical decisions. Your treating doctor is still your doctor, and your care should be decided by the doctor who is treating you, not by the person reporting on the case.

What a nurse case manager does

• Attends appointments or calls the doctor’s office, and passes information to the insurer.
• Requests records, imaging results, and updates on restrictions and progress.
• May suggest care or ask the doctor about other options, and may push for an earlier return to work.

Your choices

You do not have to let a nurse case manager into the exam room with you. You can ask the nurse to wait outside, to speak with you only in the waiting room or by phone, and to put any request to your doctor in writing. You can also tell your doctor, in general terms, what you are comfortable sharing and what you are not. If the nurse is making care harder to get, or pushing against your doctor’s restrictions, tell your doctor and get advice.

The two-doctor rule and treatment approvals

Remember the two-doctor rule: in general, you may choose your doctor, and you have a limited number of choices. A nurse case manager cannot choose your doctor for you, and cannot replace the treating doctor’s judgment. If a nurse is pressing for a different doctor, or if physical therapy or another treatment has not been authorized, read Physical Therapy and Choose Your Doctor and the Two-Doctor Rule.

When to get help

If a nurse case manager is in the way of your care, or if you are being asked to return to work before you are ready, get advice. Speak with a lawyer or connect with a provider about your own situation.

Verify against the IWCC

Rules and procedures can depend on the facts of a case. Check the current rules with the Illinois Workers’ Compensation Commission before relying on anything on this page. If you are seriously hurt, get emergency care first.

This page is general information only. It is not medical advice, not legal advice, and this site is not a law firm. See the Disclaimer.