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Is it legal for RNs who work for an insurance company to review medical information and records to determine if it supports a person's disability?

Friday May 16, 2014
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Question:

Dear Nancy,

I work for a disability insurance company and we review medical information and records to determine if it supports the disability. Our management is working on a process for the RN to be the person to determine the physical restrictions and limitations. My RN colleagues and I are not comfortable with this, and we do not believe it is something an RN legally can do.

Abigail



Dear Nancy replies:

Dear Abigail,

Without much more detail, it is difficult to comment on what is meant by "determining the physical restrictions and limitations.Ē If the process that is being developed is for the RN alone to provide a medical diagnosis as to an individual's condition and its restrictions, it does not sound like it is within the scope of the RN practice.

Some general comments to think about could be helpful. RNs in rehabilitation nursing can, and do, provide assessments, develop care plans and evaluate patients in a rehabilitation program, certainly in relation to the patient's ability to complete activities of daily living, the family dynamics (especially in regard to the family's emotional support of the patient), and other areas of the patient's ability to overcome whatever physical and/or mental limitations the patient experiences. Advanced practice nurses in rehabilitation nursing can order specific treatments and medications needed by the disabled patient as well.

The nurse practice act and its rules in the state where you work can be helpful in obtaining specifics about what an RN's scope of practice is and also what is possible for an APN's practice. You and your nurse colleagues may want to consider setting up a consultation with a nurse attorney or other attorney in your state who specifically can provide input into your roles at the company.

It also would be helpful to review the Association of Rehabilitation Nurses' website at (www.rehabnurs.org) to see if there is any information available that could be useful. The website has position statements and white papers such as the Advanced Practice in Rehabilitation Nursing (2014) and The Appropriate Inclusion of Rehabilitation Nurses Whenever Rehabilitation is Provided (1996). This association also has a certification program, and completing it might help increase your expertise in making decisions about how a patient's "medical" supports his or her disability.

Remember, too, rehabilitation nurses are always team players, working with others on a healthcare team to determine what is best for the patient. In your situation, a team approach would seem to be an essential component of the determinations you make as well.

Sincerely,
Nancy




Nancy J. Brent, RN, MS, JD, is an attorney in private practice in Wilmette, Ill. This information is for educational purposes only and is not intended as legal or any other advice. The reader is encouraged to seek the advice of an attorney or other professional when an opinion is needed.