Nurse Case Managers Can Cut Workers’ Comp Costs
June 1, 2025
By Greg Freeman
Risk managers should consider using nurse case managers for workers’ compensation cases, even though there can be an additional cost, says Marion Martin, JD, partner with the Swift Currie law firm in Atlanta. The nurse case manager often helps keep the overall cost down while optimizing a return to work, Martin says.
“I recommend every case be assessed for whether nurse case management would be helpful. But certainly, if you’ve got a case that’s going on and you feel like there’s some type of issue that a nurse could help with, then that would also be a time to consider assigning it,” she says. “Examples include a complication that was not anticipated or a surgery that has been recommended, and you want to make sure that the post-op recovery goes smoothly.”
A nurse case manager can be helpful if the patient has a psychiatric issue because he or she can communicate directly with the treating physicians and the patient, she says. They also can be helpful with parties who are not cooperative with medical treatment, which will drag out the claim. The case manager can schedule appointments and also notify the injured worker and the counsel, she says.
“When you’ve got a lot of moving parts because maybe you have a number of different body parts involved, they can really focus the treatment early on with the right type of physicians to get appropriate treatment and earlier resolution of the claim,” Martin says. “They can help, sometimes, with ruling out causation and complaints that the employees have that they think are related to the accident. They can’t act as a lawyer, obviously, but a lot of times, in those post-appointment conversations and meetings that the nurse case manager will have with the treating physician, they can explore those causation issues and that can help eliminate body parts that should not be covered.”
Research has shown that assigning nurse case management early in a claim results in better outcomes, Martin says, with some showing that an average of about $6,100 was shaved off of medical and indemnity costs on workers’ compensation claims where a nurse was involved. Another study found 18% lower medical costs and 26% lower overall claim costs.
“I know from just practical experience that the claims tend to go more smoothly and move along more efficiently to a resolution point when there is a nurse,” she says. “Our clients and risk managers are overburdened with files. It helps them to get things accomplished, keep things moving, get things to a resolution point sooner, because they’ve got help with the medical treatment.”
Patients sometimes welcome the inclusion of a nurse case manager, but it usually is better received when there is no lawyer involved on their side, Martin says. The less sophisticated injured worker usually will be happy to have that help with the medical appointments and understanding care plans, she says. “But sometimes, the injured workers just do not trust because they think, ‘Oh, you’re working for the insurance company,’ which the nurse is, but the nurse also has ethical obligations to do what’s best for the patient and report everything to the patient as well, so there is transparency,” she says. “What I see once an attorney is representing the employee is they do not want to agree to it.”
In some states, the employee and the attorney do not have to agree to the nurse case management, provided certain rules are followed. In Georgia, for instance, the nurse does have to give notification of the appointments and their intention to be present at the appointment and meet with the doctor afterwards, Martin explains. The nurse has to report to everyone — the claimant, the attorney, the defense counsel, the adjuster, the employer.
Some risk managers balk at the cost, Martin says.
“They see it as an added cost to the file. But I think if you can offset the cost of the nurse case manager by getting the claim resolved more quickly and for less, then you’re probably coming out ahead in the long term,” Martin says. “I think some clients feel like they can manage everything without help from a nurse, and some probably can, but, particularly when it’s more complicated medical issues or issues of causation and preexisting conditions, nurses are particularly helpful with that.”
Source
- Marion Martin, JD, Partner, Swift Currie, Atlanta. Telephone: (404) 888-6143. Email: [email protected].
Greg Freeman has worked with Relias Media and its predecessor companies since 1989, moving from assistant staff writer to executive editor before becoming a freelance writer. He has been the editor of Healthcare Risk Management since 1992 and provides research and content for other Relias Media products. In addition to his work with Relias Media, Greg provides other freelance writing services and is the author of seven narrative nonfiction books on wartime experiences and other historical events.
Risk managers should consider using nurse case managers for workers’ compensation cases, even though there can be an additional cost.
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