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Who they actually are
A nurse case manager is hired and paid by the claims administratorClaims administrator / adjuster The person handling your claim for the insurer or self-insured employer.. They may be pleasant, competent, and helpful. They are also not your nurse, they do not owe you confidentiality, and what you say to them can reach the adjuster and the file.
They will usually be introduced as being there to help coordinate your care. Sometimes that is exactly what they do — scheduling, chasing authorizations, unsticking a stalled referral. Those are real problems and a good case manager solves them.
What to watch for
Attending the appointment and speaking to the doctor without you. The conversation in the hallway is not in your medical record, but its effects are.
Steering the discussion toward work status. A release to modified duty written after a conversation you were not part of is a common story.
Framing your recovery optimistically to the physician. “She’s been doing great” said by a third party carries weight the same sentence would not carry from the adjuster.
What you can do
You can decline to have them in the exam room. There is no statute compelling you to allow a third party into your examination, and a physician cannot be required to permit it either. Saying “I’d prefer to see the doctor alone” is a complete answer and does not need to be justified or apologized for.
Say it to the doctor’s office too, not only to the nurse. The office controls who is in the room.
Ask for anything they communicate in writing. A case manager acting in good faith will have no problem with that.
Keep working with them on the logistics. Declining the exam room is not declining help with an authorization.
The larger point
The record is the case. Permanent disabilityPD Permanent Disability. Compensation for lasting impairment. A different and much lower weekly rate — 2026 maximum $290/week. is decided by what the reports say, and reports are written from what the physician understood. Anything that shapes the physician’s understanding without you in the conversation is shaping your case.
That is also why the first thing you tell any provider matters so much, and why an inaccurate history in an early note is worth correcting immediately rather than later. How to read the report your whole case is built on.
Related things that also work for the carrier
A “field” nurse who wants to visit your home. Same analysis, higher stakes. A vocational counselor calling to talk about your job. What that’s about. Someone asking for a recorded statement. That one, decline until you’ve talked to someone.
Doctors, exams, and records
Who examines you, who chooses, and what the report has to say.
Sources
Labor Code § 4600 (the employer’s obligation to provide treatment, and the employee’s right to be treated by a physician)§ 4600(f), (g) (interpreters — certified at examinations, qualified at treatment)§ 5710(b)(5) (depositions)§ 5811(b)(2) (hearings)8 CCR § 9785 (the primary treating physician’s role and reporting duties). No provision of the Labor Code or the regulations gives a claims administrator’s nurse case manager a right to be present during an examination.
General information about California law, not legal advice about your case.
Reviewed by Jamey Teitell, Partner & Trial Attorney · Last reviewed
Law Offices of Solov & Teitell, APC · (213) 380-9310
Printed from https://www.solovteitell.com/answers/theres-a-nurse-at-my-appointments/ · Last reviewed