Key takeaways:
When a serious workplace injury happens, the kind that involves surgery, specialists, or months of recovery, a lot of people enter the picture: Doctors, claims representatives, employers, attorneys. But one role often gets the least explanation and does some of the most important work: The nurse case manager.
Becky Goodyear is a Senior On-site Nurse Case Manager at MEM. She works directly with catastrophically injured employees, helping them navigate complex claims from the acute phase through recovery and return to work. On this episode of the WorkSAFE Podcast, she walked through what that work looks like and why it matters more than most employers realize.
The medical coordinator behind a catastrophic claim
Ask most employers what a nurse case manager does, and you’ll get a vague answer at best. Goodyear explained it simply: She’s a nurse who manages the medical side of a claim.
On-site nurse case managers like Goodyear handle a mix of claims, from simple fractures to catastrophic injuries, but typically focus on the catastrophic end of that range, where coordination is most needed. In practice, that means:
- Obtaining treatment plans from every doctor involved and keeping care moving forward
- Attending appointments with the injured worker so their questions get answered
- Visiting catastrophic patients and their families in the hospital, often before discharge, to explain next steps
- Coordinating rehab placement based on the level of care needed
- Working with vendors on home modifications and equipment, like a wheelchair ramp, before the employee goes home
💡 Pro tip: The sooner a nurse case manager gets involved, the more of this can happen proactively instead of reactively. Goodyear is often assigned to catastrophic cases while the patient is still in the hospital, which gives her a head start on coordinating what comes next.
Why coordination matters more on catastrophic claims
Catastrophic (CAT) claims rarely involve a single injury or a single doctor. Severe incidents often involve fractures, brain injuries, loss of a limb, or paralysis. And frequently, two or more of these show up together, with several specialists treating different parts of the same person. Without someone coordinating that care, things fall through the cracks.
➡️ Here’s an example: Goodyear described a patient with two broken arms and a broken leg who started having outbursts in the hospital, and staff said he couldn’t move to rehab until his behavior improved. When Goodyear visited, she found bulky bandages up past his elbows, leaving him unable to feed himself or use the bathroom. She advocated for a shorter cast on his healing wrist to help him regain some function.
“Once he was put in a less restrictive cast, he felt better because he could finally somewhat use his hand,” Goodyear said.
That one adjustment changed how he engaged with his own recovery. Multiply that kind of catch across dozens of appointments on a single claim, and the value of having one person tracking the full picture becomes clear.
Thinking beyond the local network
Sometimes the right care isn’t down the street. Goodyear’s job is knowing when to look further and having the relationships to make it happen.
| Patient situation | Default path | What Goodyear did instead |
| Brain injury with peripheral vision complications | Wait and monitor | Referred to ophthalmology at St. Louis University Hospital, a department that doesn’t typically see work comp patients |
| Brain injury, leg fracture, Spanish-speaking patient | Local rehab facility | Recommended Shirley Ryan AbilityLab in Chicago, a specialized rehab hospital, with an interpreter and facility liaison supporting the family |
| Spinal cord injury (patient was a physician) | Local rehab facility | Advocated for Shirley Ryan AbilityLab given the severity and his profession; he returned to full-duty work with minor limitations |
“With my expertise in handling workers compensation cases now for 26 years as a nurse case manager, I know of these resources,” Goodyear said. Without that experience directing the decision, none of these patients would have landed where they needed to be.
📍 Read next: Catastrophic Workplace Injuries: How Employers Can Prepare >
Supporting the family, not just the patient
A catastrophic injury doesn’t only affect the person who was hurt. When a patient is in the ICU, sometimes unconscious, Goodyear’s attention shifts to the family: Explaining the work comp process, connecting them with the claims rep, and reassuring them that medical bills will be covered.
“I make sure that they have my contact information and answer any questions that I can to help alleviate their fear for what comes next,” she said.
That support continues well past discharge. Goodyear stays engaged with patients until they’re released from every provider on their treatment team, whether that means returning to full duty or adjusting to a new normal after a life-changing injury.
The value of in-house case management
Not every carrier handles nurse case management the same way. Many multiline carriers, which write many different lines of insurance, only bring in dedicated case management for their highest-severity claims, if at all. MEM keeps nurse case management in-house rather than outsourcing it, ensuring the same level of coordination for any claim that needs it.
Goodyear has worked for outsourced case management companies in the past. The difference, she said, comes down to trust and speed. Working directly for the carrier means adjusters and employers already know her judgment and act on her recommendations without delay.
“I don’t always have to wait for the adjuster to approve something because we’ve probably already discussed it, and I’m anticipating that next step,” she said. That real-time coordination, built on established relationships rather than case-by-case introductions, keeps treatment moving instead of stalling approvals.
📍 Read next: Work Comp Claims Management: How MEM Handles Claims Start to Finish >
What employers should do in the first 24 to 48 hours
Goodyear’s advice for employers facing a catastrophic injury for the first time is straightforward:
- Report the claim right away. The sooner it’s reported, the sooner a claims rep can assign a nurse case manager, ideally the same day or the day after the injury.
- Lean on your carrier’s expertise on where to direct care. Every state has different rules about who can direct treatment, but a nurse case manager can help ensure the employee sees the right provider.
- Check in with the injured worker. Goodyear said the most common complaint she hears from injured workers is that their employer never reached out after the injury. “If an employee still feels valued despite their injury, they recover faster,” she said.
Want to be prepared before a workplace injury happens? This kit walks through what to do in those critical first hours.
⏬ Download: Claims Management Kit >
Good coordination doesn’t happen by accident
None of the coordination Goodyear described happens on its own. It happens because a carrier builds it into how claims are handled from day one: Reporting fast, assigning the right person immediately, and staying connected to the employee and family through every phase of recovery.
Want to see what this kind of support looks like in practice? Watch: Nurse Case Managers: Guiding You Through Your Medical Care >
Frequently asked questions: Nurse case managers
What does a nurse case manager do on a workers compensation claim?
A nurse case manager coordinates the medical aspects of a claim, obtaining treatment plans from all involved doctors, attending appointments with the injured worker, and ensuring care continues to move forward. On catastrophic claims, this often includes hospital visits, rehab placement, and coordinating home modifications before the employee is discharged.
When is a nurse case manager assigned to a claim?
A nurse case manager can be assigned as soon as a representative accepts a claim, and on catastrophic cases, that’s often while the patient is still in the hospital. The sooner a nurse case manager gets involved, the more they can coordinate proactively instead of catching problems after the fact.
What counts as a catastrophic workers compensation claim?
Catastrophic, or CAT, claims typically involve severe fractures, brain injuries, loss of a limb, paralysis, or some combination of these. These cases usually require follow-up with multiple specialists, which makes coordination between providers especially important.
Does MEM outsource nurse case management?
No. MEM keeps nurse case management in-house rather than contracting it out to a separate case management company. This gives nurse case managers established relationships with claims reps and employers, which speeds up treatment approvals since recommendations don’t need a new introduction each time.
Can a nurse case manager help find specialized care outside the local area?
Yes. When local providers can’t offer the level of care a case needs, a nurse case manager can draw on relationships with specialized facilities and providers elsewhere, including out-of-network specialists who don’t typically treat work comp patients. This kind of coordination can shorten recovery time and improve outcomes in complex cases.
What should an employer do in the first 24 to 48 hours after a catastrophic injury?
Report the claim right away so a representative can assign a nurse case manager the same day or the next day. Employers should also lean on their carrier’s expertise about where to direct care, since rules vary by state, and check in personally with the injured worker.
How does a nurse case manager support an injured worker’s family?
When a patient is in the ICU or unconscious, a nurse case manager often shifts focus to the family, explaining the work comp process, connecting them with the claims rep, and reassuring them that medical bills will be covered. This support continues as a consistent point of contact throughout the claim.
How long does a nurse case manager stay involved in a claim?
A nurse case manager typically stays engaged until the injured worker is released from every provider on their treatment team, whether that means a full return to work or adjusting to a new normal after a life-changing injury.