When I first started practicing law in Florida, nurse case managers did not get involved in cases. Instead, adjusters communicated with the doctors about treatment needs. The adjusters did not attend the medical appointments, bill by the hour or charge their bill as a medical cost. Administrative costs should not be included as medical expenses, they should be fees paid by the insurance company.
Not only do injured workers suffer because of this tactic, the employers of Florida pay increased premiums because of these mislabeled “medical costs.” The insurance industry includes all these expenses in the total losses, causing the employer to face increases in rate base calculations. This is not fair to employers, injured workers or the citizens of Florida. When the legislature is given inaccurate data, it is nearly impossible for them to properly evaluate whether changes to the law are necessary. If we cut the fees to physicians or cut access to medical care for injured workers, the injured workers will end up receiving state benefits. The taxpayers of the State of Florida should not end up picking up the tab for an injury that occurred in the workplace, and for which an employer paid insurance premiums.
The big question is: Are nurse case managers really necessary in workers compensation claims? The insurance industry has the sole authority to select doctors and authorize care. They should trust the doctors that they choose to provide quality care without the oversight of a nurse case manager — a position that does not require a physician license. If the insurance company does not trust the doctor to treat the injured worker properly, then it should not authorize the doctor in the first place. The intent of the law is to assure the quick and efficient delivery of disability and medical benefits to an injured worker. However, by adding this extra layer of administration between the adjuster and the doctor, the process of delivering medical benefits to injured workers is hampered.
The legislature and our insurance commissioner need to examine what is being included in the “medical costs” before cutting medical expenses. Unfortunately, there is no legislation pending to reduce the cost of nurse case management fees, though I think it’s time for legislature to pass a bill decreeing that the cost of nurse case management cannot be included in the rate base calculations of employers as a way of cutting “medical costs.”
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