The Downside of Nurse Case Managers and Managed Care in Ohio Workers’ Compensation

We are coming to the end of National Nurse Case Management Week.  And as a friend of many people who are case managers in other areas of endeavor, they can be invaluable.  And to all who perform that job, happy Nurse Case Management Week.  But if you are dealing with Ohio’s Workers’ Compensation system, let me give you a different view.  

If you’ve been injured at work in Ohio, chances are you’ve met a nurse case manager or dealt with your employer’s Managed Care Organization (MCO). On the surface, they may seem helpful—someone to “coordinate care” and “streamline your treatment.” But here’s the truth: their loyalty isn’t to you. It’s to the employer and the system designed to control costs.

Here are a few things every worker should know:

You have every right to refuse nurse case management. You are legally not required to deal with them.  Why don’t we recommend them, well let me count the ways.

Not your advocate:  A nurse case manager may attend your doctor’s appointments, but their role is to report back to the employer and Managed Care Organization (MCO), not to fight for your best medical outcome.  And you can make them wait until you have had time to talk to your doctor without them. 

Managing costs, not care is their mandate. MCOs are rewarded for keeping claims “efficient,” which often means limiting or denying treatment rather than supporting recovery. A quick and inexpensive return to work is their goal, emphasis on the inexpensive, prevent costs to the employer at all costs.

Another issue is added pressure. Many injured workers feel rushed back to work or pushed into treatments that fit the employer’s goals, not the worker’s needs. And the same is true about doctors.  And even more so when there is a person at every doctor’s appointment pushing both of you. 

Complicated communication. With extra people in the room, it can be difficult for you and your doctor to have an honest, private conversation about your health. And you deserve that. 

That doesn’t mean every nurse case manager or MCO employee is unkind. But the system puts them in a position where their priorities and your best interests don’t always line up.

At the Law Offices of Kurt M. Young, LLC, we’ve spent over three decades helping Ohio’s working families navigate these obstacles. Our job is to make sure your medical care is run by your doctors and your legal rights come first.

   If you’ve been hurt on the job and feel the system is working against you, contact us at 419-244-7885 or visit www.kmylaw.com