In many workers' compensation cases, the insurance adjuster will assign a registered nurse to be the Nurse Case Manager for the claim. This person is supposedly working for the benefit of the claimant to make sure that they get all of the proper medical treatment. However, they are hired and paid by the insurance company so their duty is not to the injured worker; it's to the insurance company. They, for the most part, are managing the case to make sure that their financial exposure is as limited as it can be. That means paying you less, authorizing less medical treatment, and pushing you to less costly treatment (even if that's not the best for your condition).
There are exceptions to the rule and some Nurse Case Managers are advocating for the client, but these are very few and far between.
In addition to having a Nurse Case Manager, some insurance companies will also hire a prescription drug management company such as the one referenced in this article. We have seen prescription cards being issued to our clients that are not activated. We have also seen prescription cards promised to clients that don't come. It's unfortunate, but true. Some medications are pain-management related and some are prescribed to deal with a certain condition. Most of the time, medication needs to be taken regularly and there are physical consequences to having a medication lapse. Workers' comp insurance adjusters don't seem to understand this. Instead they cause interruptions in medical treatment of all kinds: physical therapy, routine doctors' appointments, and medications.
The New York Times conducted a study showing that the price of prescription drugs is at the top of the healthcare concerns for consumers. According to this article, the less expensive choices for prescription drugs are also more addictive. In an environment where healthcare is more expensive and opioids very addictive, we are seeing companies like OptumRx suggest the more addictive options in order to manage their own costs.
As legitimate and serious on-the-job injuries often require surgery, injured workers need pain management for their medical condition, and that often includes opioid medications. As a result, many are at risk for long-term opioid use and addiction: the workers' comp insurance company should be doing everything it can to prevent (or lessen the risk) of this happening. Why? Obviously, that's best for the injured worker, but it also costs the insurance company less in the long run. If you become addicted to opioids from a work injury, the workers' comp insurance company owns it. We've had people go through expensive detox treatments and facilities, paid for by workers' comp.
If you have been assigned a nurse case manager or a prescription drug company and aren't sure of your rights about your medical care or benefits, give us a call today at 202-393-3320. You can speak with a real person today for no cost and no obligation and we'll get you some great information that can help you through the difficult, complicated, insurance system of workers' comp.