In a recent Appeal Decision, Winn v. Sunopta Food Ingredients, the Iowa Workers’ Compensation Commissioner held that a nurse case manager is not protected from a deposition nor can an employer refuse to provide her/his reports or records. In the Decision, the Workers’ Compensation Commissioner rejected the employer’s claim that a nurse case manager is part of the “defense team” and information generated by the nurse case manager is protected as work product (in the same manner that the employer attorney’s records, reports, etc. are protected from disclosure). In so ruling, the Workers’ Compensation Commissioner cited the Iowa Code (85.27(2)) which requires the employer/insurance carrier to release all information which it has concerning the employee’s physical or mental condition – the information shall be made available upon request. The Workers’ Compensation Commissioner stated that it is apparent a nurse case manager will have information concerning the employee’s physical or mental condition relative to the claim. The recited Code section does not exempt the nurse case manager from disclosure. A nurse case manager assigned to manage or oversee medical care is a well-recognized claim management practice. Such individuals are foremost nurses and therefore have a nurse–patient relationship with the employee for whom they are charged with providing care. That relationship has strict ethical implications for the nurse as to her/his relationship with the employee. This Decision provides support for the proposition that a nurse case manager cannot be excluded from examination or evaluation by an authorized physician, but that issue is not addressed in this ruling.
The importance of this ruling is that nurse case managers must use care to ensure their writings are limited to only facts. The records must not contain any editorial comments. Records should be prepared factually, but with the anticipation they will be seen by the employee and his/her attorney. Nothing written by a nurse case manager is confidential. All documents authored by the nurse case manager are discoverable by the employee’s attorney.