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Do I have to allow a nurse who works for workers comp to attend my doctor appts with me?

San Mateo, CA |

I have a workers comp claim that is about a year old. I don't have a lawyer and sought advice early on and he basically told me I didn't need one.
The insurance company where my workers comp is through is now demanding that a nurse be present with me at all my doctors appointments. I feel this is a privacy issue. The doctors office sends reports of my visits, isn't that enough??

Attorney Answers 6

  1. The doctor patient relationship is confidential and NO you do not have to allow an insurance company paid nurse in to the doctor's visit. Not only is this your time with the doctor to privately tell the doctor of your concerns, but also, the insurance company "nurses" have a way of shifting the event around in the insurance company's favor.

    I must caution you that I practice in 2 states, but not CA. You need a CA workers compensation attorney for a number of reasons.

    Workers compensation attorneys do not charge for an initial consultation and most fees are paid directly by the insurance company. An attorney representing you has a duty to pursue all benefits due to you. Insurance company claims adjusters are not going to notify you as to all of the benefits to which you are entitled. Their interest is to close the file as early and efficiently – to them – as possible.

    Presenting and recovering from a workers compensation claim requires more documentation than probably any other type of personal injury claim. The requirement to submit documentation is ongoing until the claim is over.

    This answer is provided for informational purposes only. Actual legal advice can only be provided in an office consultation by an attorney licensed in your jurisdiction, with experience in the area of law in which your concern lies.

  2. No, you don't have to allow the workers' comp nurse to be in the room with you and your doctor. You say that you were told you didn't need an attorney. I would get a second opinion. It's almost always a good idea to have someone representing you against the insurance company. Feel free to give me a call if you have further questions. I'm an Illinois workers' comp attorney, but I can recommend a colleague in your area if you would like a referral. 1-800-807-9530. Good luck.

  3. If this were a Federal Workers' Compensation Case, you could decline to allow the OWCP's rehabilitation nurse to attend, but the Office could suspend your compensation benefits on the grounds that you were not cooperating. It might be better for you to get your physician to say that he or she does not permit outside persons to attend the appointment.

  4. You do NOT have to allow an insurance company's nurse to attend an evaluation between you and your physician. However, if the insurance company wants to retain a nurse to follow up with your doctor before or after the appointment, it is allowed to do so.

  5. You should always retain the services of a workers' compensation attorney. Since most workers' compensation cases are done on contingency, it does not cost you anything.

    Remember your employer has the workers compensation carrier, nurse case managers, investigators, adjusters, supervisors, in house counsel and maybe even the physicians looking out for their interests. Even with an attorney the deck is stacked in favor of the employer/carrier and their unlimited resources. This is self evident as you can see from the carrier's demand that a nurse be present with you at all my doctors appointments.

    You cannot prevent the nurse from talking with the physician, but you and the attorney that you are going to retain should not allow the nurse to be present in the room for your examination. The nurse is simply a specialized conduit of information for the carrier.

  6. Absolutely not. They are agents of the insurance company. Their mail purpose is help reduce the value of your claim. By Federal HIPPA Law, you can prohibit them from being in the room with you and your doctor. As such, you must inform the doctor that you refuse the outside nurse's presence in the examination room.