by Alissa C. Atkins, Esq.
The State Board revised Rule 200.2 regarding medical case management, and the changes became effective last month. The revision was prompted by the McRae case, which pertained to contact of authorized treating physicians by defense counsel. However, as a result of reviewing all issues pertaining to medical case management and contacting doctors, the Board revised its rule to indicate that in non-catastrophic claims, employers and insurers may voluntarily use qualified medical case managers to provide telephonic or medical case field management services. When providing case management services, the employer/insurer are responsible for payment. If the case manager needs to attend a medical appointment, consent of the claimant is required to be obtained in writing. Consent can be withdrawn at any time, and the claimant must be informed in writing that consent can be refused.
On a positive note, the employee does not have to give consent for the case manager to contact the treating physician “for the purposes of assessing, planning, implementing and evaluating the options and services required to affect a cure or provide relief.” The case manager is also allowed to assist in the approval of job descriptions in accordance with the WC-240 process.
Finally, please note that the rule does not apply to a direct employee of the insurer, a third party administrator, or the employer, or to any attorney who represents a party, as long as their specific role is identified to the doctor. This rule changes the nurse case manager role to an extent by requiring written permission of the claimant to attend medical appointments. However, it also clarifies that the employer/insurer can have case managers providing both telephonic and field case management without the permission of the claimant. This should resolve any confusion not only on the part of claimants’ attorneys, but also physicians who question their legal ability to speak with third party case managers, as long as the case managers are properly qualified via certification or licensure through Board Rule 200.1(I)(A).