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Thursday, March 17, 2011

Field Nurse

Today, I want to talk about what it means when a field nurse is assigned to your case. I've heard from a lot of claimant's how a field nurse seems to march in and take over as if they're the new boss. I've heard horror stories of Privacy Act violations and intimidation. The field nurse may tell you that you and your physician's have to do what they say and/or ask...or else...but this is not true. Unlike Vocational Rehabilitation where you must cooperate, your cooperation with the field nurse intervention program is voluntary.

Once the field nurse is assigned to you, you can track any payments made to the nurse from OWCP on the billing page of the ACS site if you want. You can find the ACS site on the "Links" page.

The field nurse will likely provide you with some sort of consent or release form. Most of these releases are so broad, they can entitle the nurse to your medical records from birth and are not specific only to your OWCP claims. I've seen some that even release financial information as well. I can't think of anyone who wants to sign something like that.

If  your field nurse supplies you with a release to sign and you find the release the nurse gives you too broad, you can type up a release of your own. Your release can limit the nurse to medical documents that pertain ONLY to your OWCP case. You can name specific physician's who have permission to release your records. You can put time limits on the release. The field nurse is assigned to your case for 120 days from the date of OWCP's referral. The CE may authorize an additional 30 days if need be. So your release should expire 150 days from the date of your referral. I've put an example of a release on the "How To" page. If your field nurse doesn't like it, too bad. You've provided a release for the records that pertain to your OWCP claim, which is all the nurse should be interested in.

I also suggest you type something up for your physician(s) that states no medical records are to be released without your express written permission. You should also explain to your physician(s) that s/he does not have to speak to the nurse or allow the nurse into the exam room without your permission. Doctor patient confidentiality applies when dealing with an OWCP field nurse unless you provide a signed release. If your doctor is the nervous type, explain that although the nurse may appear to be in charge, it is in fact the physician that still calls the shots in his own office.

I suggest you bring a tape recorder to any meeting with the field nurse. That way there's no confusion later as to who said what and you have documentation should the nurse's report state the events other than they actually happened. You will not automatically receive copies of your field nurse's reports, but you can get them by requesting copies of your file (see the "How To" page).

In a September 2010 case appealed to the ECAB; http://www.dol.gov/ecab/decisions/2010/Sep/10-0485.htm the Office reduced the claimant's compensation to zero for failure to cooperate with field nurse services. The Board stated the role of the Office filed nurse, as described in its procedures, is to attempt to "identify light or limited duty for the claimant" at the employing establishment, with the goal of reemlpoyment in the previous position.

The Office's procedures contemplate that such activities do not constitute vocational rehabilitation, but may result in a referral to a vocational rehabilitation specialist for a formal vocational rehabilitation plan.

The Board concluded that the claimant's failure to return a consent form did not impede efforts toward job placement, but delayed the field nurse's ability to communicate with claimant's physician. The Board reversed the Office's decision.

In the appeal of http://www.dol.gov/ecab/decisions/2006/Dec/06-0777.htm the Office advised the claimant that she had been assigned a case management nurse. The nurse was assigned to monitor claimant's medical status and progress, assist in coordinating the medical aspects of her care and facilitating the flow of information concerning her treatment.

The Board noted there was no referral for vocational rehabilitation, but a referral for nurse intervention to work with claimant on medical management to facilitate her return to work. The Board found that the field nurse's activities were limited to the role set forth in Office procedures, i.e., of attempting to return claimant to work and providing medical management services, a preliminary reemployment effort.

The Board determined this did not constitute non-cooperation with vocational rehabilitation and the Office did not meet its burden to suspend claimant's compensation. The Board reversed the Office's decision.

Another very similar case can be found at: http://www.dol.gov/ecab/decisions/2008/Jun/08-0528.htm

As with any other medical personnel assigned by OWCP, research the nurse. Does s/he have a valid certification? Are there any ECAB decisions regarding the nurse? Any red flags?

Information on field nurses can be found in the FECA Manuals at;

Part 2 at 2-600-8
Part 2 at 2-0811
Part 3 at 3-0201-3
Part 3 at 3-0201-7
Part 3 at 3-0202-1

You can find parts one and two of the FECA Manuals on the "Links" page.

15 comments:

  1. Wow! I am glad I came across this information. During one of my post surgery appointments, the field nurse invited herself into the exam room. I'm in the medical field and wondered if this was some type of HIPPA violation. I was very uncomfortable with this and will not allow this to happen again.

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  3. Field Nurses are supposed to be there to expedite your recovery process. Is it O if a nurse handles paperwork in front of you to the doctor and denies you a copy and even take a look at this paperwork.
    Is it OK isf the doctor wants to set a next appointment in 2 weeks, and the Field Nurse says: "there's no need to come back until the date of surgery" and the doctor follows her suggestion while I am at home accruing more and more frustration.
    Can the FN superceed the doctor's opinion, or original suggestion?

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  4. No the field nurse's opinion is the opinion of a NURSE not a physician. Your physician needs to understand that s/he is still the physician. If s/he believes additional appointments, tests, etc...are required, then they're required. Physician trumps nurse everytime.

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    1. Thank you very much ... what a mess !!!

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  5. My Dr increased my restriction limits on my last visit, however my employer is not allowing this and instead is taking me away from my normal position to work in another area I am not qualified for. Can my employer do this? I contacted the FN and she is no help. I told her I intend to see my Dr again and she claims I can't see him before my next scheduled appointment which isn't until mid September. Is she allowed to keep me from seeing my Dr? Also I would like a copy of my information from the FN and I went to the "How to" page but not certain where that letter form is. Any help would be fantastic! Thanks!

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    1. You have to get that from OWCP. Go to the "How To" page and use the request a copy of your file letter.

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  6. I obtained a copy of my OWCP file, and to my total surprise I found that the Field Nurse openly (because I can't give her the benefit of doubt even when I wish I could)lied. What can I do about it, because what she stated (which I can prove is wrong), had triggered numerous leter from my employer requesting SECOP and other things. FYI I have seen 3 doctors and all of them were consisted that my ilness is work related. Can I request to have someone have the Field Nurse review her false statements? Thank you!

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  7. I would write a letter to OWCP and and list out the inaccuracies your nurse gave OWCP. If you can prove it, make sure you send that proof alone with your letter. OWCP may or may not review the nurse's statements, but at least you'll have something in the file if anything happens because of what the nurse said.

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  8. I was unable to go to one of my doctors visit and my field nurse scheduled an appointment for me so that this could fall within her schedule. Can she do this?

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  9. She can do it but you don't have to adhere to it. The field nurse is voluntary, you don't have to have her on your case at all. You can talk to your doctor and tell them the nurse doesn't schedule your appointments...you do and they should only schedule appointments that you make for yourself.

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  10. Do you have to sign the medical release that that Nurse Case Manager forwards you? Was assigned a NCM after my Spinal Cord Stimulator Trail. She called me and was under the assumption that I had never returned to work since my initial injury in 2006 (I have had two laminectomy's, a multilevel spinal fusion, multiple failed attempts at epidural injections and am now in the process of getting a spinal cord stimulator implant). This women was clues and frankly rude and hostile when I told her not only was had I returned to work after every surgery, it was indeed my goal to get better and remain at work. I guess I don't know why she was been assigned to my case and what right she was to my medical information?

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  11. If you read the article, you'll see that the field nurse is voluntary not mandatory. You do not have to sign a medical release and you do not have to cooperate with the field nurse.

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  12. JEsse ...I recently DID NOT sign the nurse waiver and when she called to ask why?..i simply told her , I don't want to sign that and she said tht federal compensation is Involuntary contrary to what I've been told..I'm guessing she is lying but I was more concerned about retribution by the claims examiner.Can he suspend my case for Not cooperating with her ? thanks

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  13. If this is a field nurse and not a vocational rehab counselor, the nurse is lying and there is nothing OWCP can do to suspend your benefits.

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