A letter arrives, addressed to your attorney or to you. A company you have never heard of says it has been retained by your employer to provide “telephonic case management,” that a registered nurse has been assigned to your file, and that the nurse would like your permission to call you and discuss your medical treatment. Sometimes there is no letter at all and the phone simply rings.
The letter is polite, and the person on the other end usually is too. That is not the question. The question is what this is, whether you have to participate, and what it costs you if you do.
The short version
A nurse case manager is not your nurse. Nothing in the Workers’ Compensation Law requires you to speak with one, and declining is not a violation of anything. But the law does require you to do certain other things, and those are worth knowing so you do not confuse the two and refuse something you actually have to do.
Who the nurse actually works for
A nurse case manager is a registered nurse employed by a case management vendor. The vendor is under contract to your employer or, far more often, to the insurance carrier or third-party administrator handling your claim. The nurse is paid by that side of the case and reports to it.
That does not make the nurse dishonest. It does mean a few things are true at once:
- The nurse is not treating you. There is no doctor-patient or nurse-patient relationship, and nothing you say is a protected treatment confidence.
- Everything you say can end up in the carrier’s file, in a report, and eventually in front of a Workers’ Compensation Law Judge.
- The nurse cannot authorize treatment, deny treatment, start your checks or stop them. Those decisions are made by the carrier and the Board.
- A suggestion about where to treat is a suggestion from the carrier’s side of the case. You choose your own authorized provider, and the carrier does not get to pick your doctor.
The friendly call asking how you are feeling and whether you are getting out of the house is not small talk in the way it sounds. “I’m doing much better” and “I drove my daughter to school this week” are statements about your condition and your function, and that is the material a disability finding is built out of.
Do you have to talk to them?
No.
There is no provision of the Workers’ Compensation Law, and no Board regulation, that makes speaking with a carrier’s nurse case manager a condition of receiving benefits. There is no penalty written anywhere for declining. Where the Legislature wanted cooperation to be mandatory, it said so and attached a consequence — which is exactly why the absence of any such provision here is meaningful.
Notice, too, what the letter itself is doing. It is asking permission. Under the Board’s own Communication Guidelines, once a Form OC-400 notice of retainer has been filed, the employer or carrier’s attorney may not communicate directly with a represented claimant about the case and must go through the claimant’s attorney — the rule against contacting a represented party, which the Board cites as 22 NYCRR § 1200.33(a) (Rule 4.2). A nurse is not a lawyer and is not bound by that rule. So the vendor writes and asks. The request is a courtesy, and a courtesy can be declined.
We handle workers’ compensation claims for injured workers throughout the five boroughs and across New York State. Call 718.701.2776 or 800.310.5520. Consultations are free. If we don’t recover money for you, we don’t get paid.
What you actually do have to do
This is the part people get wrong in the other direction, and it is more expensive than talking to a nurse.
You have to attend the independent medical examination. Workers’ Compensation Law § 19 provides that an injured employee claiming or entitled to compensation shall submit to such physical examination as the Chair or the Board may require, and that “[p]roceedings shall be suspended and no compensation shall be payable for any period during which the employee may refuse to submit to examination.” Missing IMEs is one of the fastest ways to stop your own checks.
You are not defenseless at that exam. Board Rule 12 NYCRR § 300.2 requires that you get at least seven business days’ notice of a scheduled IME. It also provides that you may be accompanied to the examination by an individual or individuals of your own choosing, and that you may videotape or otherwise record it — an examiner may not refuse to perform the exam because you intend to record.
You have to testify when the case requires it, at a hearing or a deposition, and you have to tell the truth. What happens when a claimant is found to have misrepresented something is a serious subject on its own.
Your medical reports go to the carrier either way. Your treating provider files reports into the Board system, and the carrier receives them. You do not need to hand-deliver your condition to a nurse for the other side to know how you are doing.
Can the nurse call your doctor, or sit in on your appointment?
This is where the real stakes are, and where New York has actual rules rather than etiquette.
Workers’ Compensation Law § 13-a(6) makes it a misdemeanor for any person to interfere with an injured employee’s selection of an authorized treating physician, or to improperly influence or attempt to improperly influence the medical opinion of any physician who has treated or examined the injured employee. Board Rule 12 NYCRR § 325-8.5(a) says the same thing and spells out who it reaches: no employer, insurer, carrier, self-insured employer or any of their agents. A vendor under contract to the carrier is an agent.
The statute contains one narrow carve-out, and it is worth reading closely. It is not interference or improper influence if, in the presence of the injured employee’s physician, the employer, carrier or agent recommends or provides information about rehabilitation services. That is the lane. It is a narrow one, and it is conditioned on the doctor being there.
The Board has addressed contact with treating providers twice, in Subject No. 046-124 (2003) and again in Subject No. 046-1749 (March 21, 2025). Read together, they say this: parties and their representatives may communicate with a treating provider in good faith, and a claimant cannot forbid it. But contact must be limited to relevant inquiries about condition and treatment, questions may not be leading or suggest the desired answer, all communication should be in writing and sent to the other side at the same time, and — in the Board’s words in the 2025 bulletin — ex parte verbal communications “should always be avoided.”
There are teeth behind that. Evidence obtained through contact made without notice to the other side may be precluded, and the Appellate Division has repeatedly upheld the Board when it gave such evidence no weight — in Matter of Goutermout v County of Oswego, 194 AD3d 1333 (2021), and in Matter of Powers v State Material Mason Supply, 202 AD3d 1265 (2022), where a treating physician’s testimony was found incredible after a letter to him was not copied to the other side. Both of those cases involved a claimant’s attorney. The rule cuts both ways, which is precisely why it is worth enforcing when it runs the other direction.
So: a nurse case manager who wants to speak with your treating doctor is not automatically doing something improper. A nurse case manager who is calling your doctor’s office, going back into the exam room, discussing your work capacity with your surgeon and putting none of it in writing to your attorney is operating in exactly the space these rules were written about.
Whether anyone comes into your examination room is, in the first instance, between you and your doctor. You can say no. Many physicians’ offices will decline on their own once asked.
When a case manager is actually useful
Not every one of these is a trap, and pretending otherwise is not honest. A case manager with a direct line to the adjuster can sometimes get a surgical authorization moving, get durable medical equipment delivered, or unstick a request that has been sitting. If your treatment has genuinely stalled, that is worth something.
The point is not that the nurse is your enemy. The point is that the nurse is not neutral, and the decision about whether and how to engage should be made by you and your attorney with that in mind — not made for you by whoever calls first. If the goal is to get a delayed authorization approved, there are deadlines the carrier is already under, and a missed one is worth more than a phone call.
Three things not to do
- Do not sign a blanket medical authorization. The carrier is entitled to records relating to your claim, and it already receives your treating provider’s reports through the Board. A broad HIPAA authorization reaches further than that. The Board’s own guidance is that disclosure of provider information not directly related to the claim requires a HIPAA compliant authorization — which is another way of saying that signing one is how the other side gets material it otherwise could not have.
- Do not give a recorded statement because a nurse asks for one. That is a claims function, not a medical one.
- Do not manage the call by being agreeable. People minimize their pain to nurses. It is a reflex, and it reads on paper as a claimant who is doing fine.
What to do instead
If a nurse case manager calls you, you do not need to be rude and you do not need to argue. Take the name, the company and the phone number, say that your attorney handles communications about your claim, and end the call politely. Then call your attorney and hand over the name and number.
If the letter came to your attorney, it is already where it belongs. The answer may be a flat no, or it may be a yes on conditions — questions in writing, no discussion of work status, causation or settlement, nothing without your attorney’s office copied. That is a judgment call about your particular claim, and it is the kind of call that should be made deliberately.
If you already spoke to one
It is not a catastrophe and it is not unfixable. Tell your attorney what was discussed, as close to word for word as you can remember, and when. If the nurse has been speaking with your treating doctor, that is the thread worth pulling, because the Board’s rules on how that contact must be documented are on your side.
Frequently asked questions
Will my benefits be cut off if I refuse to talk to the nurse case manager?
There is no provision in the Workers’ Compensation Law that authorizes suspending benefits because a claimant declined to speak with a carrier’s nurse case manager. Compare Workers’ Compensation Law § 19, which expressly suspends compensation for a refusal to submit to a required physical examination. The law says what it means when it wants cooperation.
Can the nurse come into the room during my doctor’s appointment?
Only if you and your physician allow it. It is your medical appointment. Many offices will refuse on their own, and you can ask that anyone who is not part of your care wait outside.
Is a nurse case manager the same as an IME doctor?
No, and the difference matters. An independent medical examination is a formal step under Workers’ Compensation Law § 137 and 12 NYCRR § 300.2, with notice requirements, a written report filed with the Board, and the right to cross-examine the examiner. A case manager call is none of those things — no notice rules, no filed report you can test, no cross-examination.
Why did the letter go to my lawyer instead of me?
Because a well-run vendor knows that contact with a represented claimant is expected to go through counsel, and because it wants a record that it asked. Asking is the correct thing to do. It is also an acknowledgment that the answer might be no.
The nurse says she just wants to help me get my surgery approved. Is that real?
Sometimes, yes. It is also true that the carrier is already under fixed deadlines to respond to a treatment request, and those deadlines do not depend on anyone’s goodwill. If treatment is stalled, the first question is whether a deadline has already been missed.
I am not represented. Does any of this change?
The rules on improper influence and on documenting contact with your treating doctor apply whether or not you have a lawyer. What changes is that nobody is reading the file for you, and nobody is on the other end of that phone call but you.
If you got one of these letters
Bring it in, or read it to us over the phone. It takes a few minutes to tell you what the vendor is, what it is likely to want, and whether there is any reason in your particular claim to say yes. Call 718.701.2776 or 800.310.5520.
This page describes New York law in general terms and discusses published appellate decisions and Board guidance. It is not legal advice about your claim, and reading it does not make us your attorneys.
