Archive | September, 2011

Surviving WorkCover: some more tips

A while  ago I posted an article called “survival guide for injured workers“, which contains quite a few handy tips and information about entitlements etc. Further to that article, here are a few more handy tips and tricks on how to survive workcover, mainly directed at long-term and/or permanently injured ‘workers’.

If you suffer a permanent work injury, or an injury which has long-term effects, it can have a major effect on your quality of life. Dealing with your injury and its effects can be extremely stressful. Negotiating your way around a very complex WorkCover system, dealing with your employer, the WorkCover agent, rehabilitation agents, doctors, “independent” medical examiners and, at times even lawyers can be mind boggling!

 

1. Maximise your recovery

Your highest priority should be to maximise the extent of your physical and psychological recovery. And for that high quality medical treatment is essential! WorkCover must pay for all reasonable treatment costs. This includes psychology treatment/counseling! (Just ask your GP for a referral and WorkCover must pay for the reasonable cost).The most critical issue is to make sure that you are getting the best quality medical treatment possible. So do your research first and seek out a reputable doctor/specialist/physio/psychologist/psychiatrist that is willing to take on WorkCover patients (although quite a few refuse to treat workcover patients, this is unfortunately an ethical matter which we cannot influence; although saying that, I have personally managed to be accepted by two highly reputable specialist (1 pain specialist and 1 orthopedic specialist) who do not normally take workcover patients, by writing directly to them and making a case).

Dealing with busy medical practitioners and specialists can be very difficult but it is important that you are able to discuss carefully all the treatment options that might be available to you and the various advantages of each option. If you feel that you do not get the opportunity to discuss these matters freely with your doctor there are a few things you can try to do.

  • When you book an appointment specifically ask the doctor’s receptionist for a long consultation so you will have an opportunity to discuss these matters. WorkCover will cover the extra cost of the consultation for this purpose. Also, from experience, to avoid grumpiness from my specialist surgeon, I always ensure I am booked in as the last patient of the day (in case workcover paperwork is involved – I mean, you know what it’s like…)
  • It often helps to make a note (write down) of all your questions  before your appointment so you don’t forget what you had to ask/discuss. Also please don’t feel ashamed in bringing out the list of questions at the consultation and working through them. It will actually save time (as you will not be distracted or side-tracked).
  • If you are consulting specialists and they recommend serious treatment such as surgery, discuss this with your treating GP and discuss the possibility of obtaining a second opinion before you commit to surgery. You are fully entitled to obtain a second opinion under WorkCover. Also, remember that you  have the right to obtain medical treatment from the medical practitioner of your choice, and that you can change to another treater whenever you like too.

Ensure  that your doctor is prepared to deal with WorkCover as this can be very important in making sure your entitlements continue to be paid smoothly. If you are a long-term patient of the practice this is usually no problem.

Some doctor’s surgeries have notices which make clear that they do not deal with WorkCover.

Other doctors may communicate some ‘irritation’ or ‘grumpiness’, to you about having to deal with WorkCover. This is because payment of medical accounts by WorkCover can sometimes be slow. They also have to spend a lot of time withyou or time  preparing certificates and writing reports for WorkCover, for which they usually are not paid. So, being irritated with having to deal with WorkCover is perfectly understandable!

Some doctors also become worried about the (slight) possibility that they may be called to give evidence in your WorkCover case.  If you think that your doctor is showing too much ‘irritation’ or frustration, try to have a frank chat about workcover and explain for example what you have to deal with on a daily basis, and ask the dotor if there is anything you can do to help (i.e. by booking long appointments, by being the last patient, perhaps by having an additional phone consultation, perhaps paying upfront (if you can) and claiming back…). But don’t sever your relationship with the doctor, unless you can find an equally reputable doctor who is willing to take workcover.

2. Really understand your WorkCover entitlements

You certainly will have to make many very important decisions about your future. In order to make the right decisions it will be critical to understand as much as you possible about the structure of WorkCover benefits, and even how they interact with your other employment entitlements and your superannuation.

WorkCover is an extremely complex system! The Act of Parliament which governs WorkCover alone is several hundred pages long!  Trying to understand just what WorkCover does and does not provide is really important. Fortunately there are many good and free resources available to help you understand the system.

A good starting point is this blog/ website which contains most frequently asked questions about WorkCover entitlements, as well as frequently asked questions, and a whole resources section where you can find Acts and regulations, Links, Contact, Articles etc . Obviously, and especially if your injury is likely to have permanent effects,  you will need to talk to a lawyer who is an expert in the area. It is never too soon to have a free confidential discussion – even if nothing needs to be done at this time. I personally recommend Shine Lawyers, but that’s your decision.

Other resources are available to you include the  WorkSafe website which contains a very detailed publication called the Online Claims Manual. This contains detailed instructions from WorkCover to its agents on how to handle claims. It also includes very detailed information about the calculation and payment of WorkCover benefits. Remember this information is written from WorkCover’s perspective only. Nonetheless this can be a useful resource for people who want detailed information. Also just have a look below at the “blogroll” for a list of useful informative links.

3.Assess your future work capacity

One of the most difficult areas which you will experience with WorkCover is the question assessing your future work capacity and dealing with issues of rehabilitation and potential return to work. You must always remember that WorkCover will do whatever it takes to get you back to work, at whatever cost, even if your doctor and specialists say you are not fit for work. It’s a matter of liability for the workcover insurance and potentially a massive economic loss damages claim can be awarded to you.

In theory, the WorkCover system is “strongly committed to rehabilitating claimants and providing assistance to enable a return to work” (see above). Rehabilitation, however, means different things to different parties. Some employers are genuinely committed to rehabilitation and a proper,appropriate return to work; however the majority, have no genuine interest in returning an injured worker to meaningful work and so provide only minimal assistance ” to keep WorkCover happy” until they can officially sack you (after 12 months), or will make a case of ‘constructive dismissal’ and make false allegations such as that you are not performing well etc. These employers are usually easy to identify, they use phrases like “we don’t have light duties” or “don’t come back without a full clearance certificate”. Other employers will only make  meaningless and demeaning work available. Unfortunately, in these cases, a return to work can be like a ‘guerilla warfare’ which is, ultimately, aimed at squeezing the injured person out of the workplace. Just browse through some of the comments posted on this blog and you will see for yourself that many injured victims have been unfairly sacked. It also happened to me (after no less that 10 years employment, and even a renewed contract 1 week prior my last surgery based on an excellent performance review). In many cases you can make a claim for unfair or unlawful dismissal or discrimination. But you really need to seek proper legal advice because many of these laws will or may interfere with your potential common law damages claim. For example, should you proceed with an unfair dismissal you may well be reinstated (do you really want to work for an employer that treats injured workers like that?) or you may get a few months salary, that’s it. On the other hand, a sacking may be a goldmine in a case of a damages claim for economic loss because, hey, here your employer (and thus workcover) tells you that you can’t work, see what I am saying…

4.Try to deal well with WorkCover and your Case Manager

 

When you deal with the WorkCover system, the WorkCover insurance company, your claims manager etc., this can have a significant effect on your claim and on your stress levels. Always Keep good records and try to develop a good relationship (where possible!!!!) with your case manager.

  • It is extremely important you to keep good records/notes. For example, if you wish to claim travel expenses you need to be  able to produce details of all your trips to and from the doctors you saw, so keeping a log and the receipts for parking, tram, train fares etc will make life easier. Another example, If there is an argument about your weekly payments because WorkCover alleges that you are not looking for work, keeping a record of all your attempts to obtain work can put you in a much more favourable position (i.e. interviews, phone calles, CVs mailed out etc).
  • Always refer to your claim number when you contact WorkCover . Find out the name of your case manager (sometimes they change like underwear! ) and ask to speak to them direct. If you have a discussion with any other person, always make a note of their name and extension number/email. It can be very frustrating to deal with multiple people over the same issue and to have to repeatedly explain the issue. I personally -and from experience- always and only communicate in writing because I have noted that they will often completely twist and misrepresent/document you conversation.
  • Keep your own copy of all important documents. For example, when you receive a certificate of incapacity, the original should be provided to your employer. It is most useful for you to send a copy to your WorkCover agent and to retain a copy for your own records. This will help to overcome any (and often) delays in making payments to you.
  • When submitting your medical certificates ensure that you complete the section on the back of the certificate about your work activities.  After many years off work, it has happened once or twice to me that I forgot to sign the back of the form because I was in hospital having surgery, and still those bastards would not process the certificate, not pay me, and send the certificate back to me (imagine the delays). It is also useful to try and ensure that your certificates expire on a Saturday or Sunday to make it easier for WorkCover or your employer to calculate your weekly entitlement. This enables weekly benefits to be paid in whole weeks. It still amazes me how often I will receive a different amount each fortnight!!!
  • Try to develop and maintain a “constructive”, “collaborative” working relationship with your WorkCover case manager. The case manager will have to make important decisions about your entitlements. Having a good relationship will be to your advantage. Sometimes the decisions that a claims manager makes can be very frustrating. Losing your cool can backfire as you will run the risk of being labelled as difficult or as suffering from a psychological problem. However, you are entitled to request and receive an explanation of a case manager’s decision and to discuss the decision freely with them, but it is important to ‘keep your cool’. I must admit, I currently (for the past 2 years) have a case manager from hell and I think she is vindictive. I have not been able to keep “my cool” and stopped talking to her after only 1 week. She was then issued with a restraining order by my solicitor which she breached after 3-4 months, when she started emailing me up to 5 times a day. I even asked her nicely and then not so nicely to stop emailing me which she ignored. I have told her on many occasions that I believe that she is compounding my depression and PTSD. More recently she has be requested by my treating psychologist NOT to email or phone me ever again and that all correspondence needs to be in writing via post and that all letters will be opened by the psychologist. My case manager is a nutter. The things she has told and written to me via email are really disturbing. Those things include: that I do not need to see a psychologist or a psychiatrist because I can talk to her (I had just been illegally sacked and was suicidal at the time, no kidding), when she was told that my injury had catastrophically deteriorated (and the surgeon even requested major surgery, home help, taxi etc), she said that she was NOT interested in my physical condition but only wanted me to be psychiatrically assessed,and, hold your breath, that the reason for the assessment was to assess my fitness to engage in rehab and to return to work!!! When taxi travel was requested on physical grounds, she wrote to me (email) that in order to make a decision for taxi travel I needed to be assessed by an independent shrink… etc etc.(also see the post “my case manager is making me sick)
  • If you disagree with a decision, you can indicate to them that you understand that they have to work within guidelines. You can ask them to identify their superior (aka Team Leader) and request to discuss the matter with them. If you still disagree with the decision, you should dispute the decision by referring the matter to conciliation. Many WorkCover decisions are overturned at conciliation. It is also very important that they provide you with a rejection letter. It is illegal just to email you (or tell you) that they won’t pay for this or that!
  • Should you wish to contact WorkSafe to lodge a complaint about any aspect of the service that WorkCover insurance company has provided to you, you can do so via their email address which is service_division@worksafe.vic.gov.au. WorkSafe is actually pretty good and they are very friendly.
  • If you believe that your claim has been seriously mishandled, of course you can complain to the State Ombudsman. This can be a major step so it is important to ensure that your attempts to resolve the issue through other channels have failed. Note: I have been told by a WorkSafe insider that may complaints to the Ombudsman get passed onto WorkSafe – so perhaps first contact WorkSafe and see whether they can help you first.

5. Obtain legal advice sooner rather than later

When you suffer a permanent work injury, it is likely to have many impacts on you, and not only financial effects.It is very important that you obtain proper legal advice with an experienced personal (workcover) injury lawyer so that you can be prepared for some of the issues that may arise as your condition and case progresses. If you don’t have a lawyer, and are looking for one, I personally recommend Shine lawyers. (no strings attached, I do not benefit in any way, shape of form by “advertising” rest assured!) Do your research, for there are quite a few sharks out there that are preying on vulnerable victims like us and I actually know of a few fellow injured workers who have been left in DEBT after having received their ‘compensation’!!!! If that is not fully sick!!! Be very very careful indeed.

I changed over from one law firm to another …. so that is possible to and if your are not happy with your current lawyer, or smell a rat, look around and perhaps check out Shine.

Hope all this helps 😉

If you have any other thoughts, or tips, please share them below! Thanks 😉

WorkCover will do anything to mitigate liability for your work injury

A few days ago I posted a story about WorkCover’s incompetency in action. The issue basically revolved (and still revolves) around the refusal of the workcover insurance to pay for a prescribed (by my treating specialist orthopedic surgeon) radioactive Gallium scan to further investigate a suspected bone infection (aka chronic osteomyelitis) in the site of injury (shoulder joint).

The Gallium scan is fairly standard  nuclear scan that specifically looks for old, chronic infections in the bone(s). The test was prescribed following a suspicious MRI of the shoulder joint done in August and following a grossly abnormal (positive) bone scan showing marked increased tracer uptake in the shoulder (both humeral head and glenoid (socket)).

A Gallium scan is read in conjunction with a bone scan.

Now, as I explained in my previous post, at the time that my surgeon prescribed the Gallium scan, I happened to also have developed a “reddened and tender” right ring finger (without trauma – spontaneous). It is very important that you know that I have NEVER had a “reddened & tender R ring finger” before that (except 11 years ago when I lost the tip of that finger horse riding), and that I even attended the medical panel a week prior to the prescribed Gallium scan, for the purpose of a final impairment assessment and there is NO mention of a “reddened” finger anywhere in the examination report, right (so here we have evidence).

Unfortunately perhaps, my specialist orthopedic surgeon was a tad worried about that finger in the overall context of a suspected shoulder bone infection (which may spread) and he decided to have the hand x-rayed just to be safe. Unfortunately, perhaps, he also prescribed the hand x-ray (to look at the ‘reddened & tender R ring finger” ) on the SAME form as the Gallium body scan to look for the shoulder bone infection.

Needless to say that the WorkCover insurance (the uneducated, non-medically trained case manager) JUMPED on the “reddened & tender” finger to incorrectly ASSUME that the Gallium body scan was prescribed for the finger and not for the shoulder!!! The prescription form however clearly states:

  1. R hand x-ray: reddened & tender R ring finger : ? infection
  2. Gallium body scan: multiple previous shoulder surgeries with known shoulder infection 6 years ago [date of injury], ongoing pain, ? chronic infection

In addition,whilst I have been trying to explain nicely and then not so nicely to my case manager, that the Gallium scan is solely prescribed for the shoulder infection, my case manager LIED to me and stated in an email (the day before the Gallium scan was due) that they [workcover insurance] would not pay for the Xray of the finger (which I can understand and which I have paid for myself) but that they will also not pay for the Gallium scan BECA– USE, so she lies, she stated that she had spoken to my treating shoulder specialist surgeon who had apparently told her that “the gallium scan had been prescribed for my finger and my finger was not work-related”.

When I inquired with my shoulder surgeon, he clearly told me that he had NOT received a call from the case manager. And that, of course, the Gallium nuclear body scan is prescribed to look for a bone infection in the shoulder only. He also told me that because the Gallium scan only “sees” OLD infections it would not even be capable of picking up a new finger infection, if that finger were infected.

So, I emailed -now bewildered – my case manager and urged her to contact my surgeon and/or my GP and ask them if the Gallium scan is prescribed for the shoulder (and not ask any other twisted questions). She refused and DENIED the gallium scan and the transport to the scan, and maintained INCORRECTLY that she (they) believed (as insinuated) that the finger is responsible for the shoulder (site of injury) infection and not the other way round!!!!

xray results R hand/finger (click to enlarge)

I then emailed this donkey (case manager) the official results of the finger/hand x-ray (which is entirely NORMAL).

I also emailed her the results of the bone scan of the shoulder, which explicitly states that there is abnormal marked uptake in the  shoulder (site of injury) AND that the rest of the skeleton is normal.(So NO EXC– USE to blame even any other site for an  infection in that shoulder!).

bone scan result (click to enlarge)

So, why is the WorkCover insurance company STILL denying me the Gallium scan? But they did pay for the bone scan and the blood tests and the MRI? Well… the answer is easy… It is nothing more than a disgusting way for the workcover insurance company to try at all cost to mitigate liability for my injury!!!

Workcover will do anything to mitigate “liability” for your injury

They know that I have a very serious injury with a high level of permanent impairment and a potential significant amount of compensation attached to it. So, any (unethical) opportunity to find an excuse to mitigate liability is aggressively pursued. Unfortunately for them (and fortunately for me) the Xray of the finger was completely normal, God it could have been just a bloody mozzy-bite or a spider bite that caused the ‘reddened & tender” finger, but in the context of a possible chronic osteomyelitis this needed to be of course X-rayed to be on the safe side.

Those bloody sharks will do anything (read ANYTHING) to find an excuse, however PATHETIC, to deny you [a benefit] and/or to put a case that they are not liable for a complication of your serious injury!

So,be VERY VERY CAREFUL what you tell them and how additional, perhaps unrelated tests are prescribed!

The lessons we learned was that it would probably been best had the surgeon used two (2) different prescription forms for a) the X-ray of the R hand/finger and b) for the Gallium body scan for the shoulder. Obviously you have to remember that your case manager is not medically trained and cannot read a form nor differentiate between two different tests. And as I said they will do anything to mitigate liability. That’s is why they will often also dig into your personal medical history to try and find something that they can use against you, no matter how insignificant.

 

Check out the disclaimer used by Xchanging in all their email correspondence

It has recently come to my attention that WorkCover insurance carrier Xchanging uses quite a nifty disclaimer in all their email correspondence with injured workers; check this out:

Disclaimer used by workcover insurer Xchanging in all their email correspondence

“The information contained in this Email and any attached files (“Email”) is strictly private and confidential. This Email should be read by the intended recipient only. If you are not the intended recipient of this Email or if you believe this is an unsolicited Email, please immediately notify the sender by replying to this Email or contact a representative from Xchanging on +61 3 9947 3000 and promptly destroy this Email and any copies of this Email. Only the intended recipient of this Email may use, reproduce, disclose or distribute the information contained in this Email with Xchanging’s permission. If you are not the intended recipient, you are strictly prohibited from using, reproducing, disclosing or distributing the information contained in this Email. Xchanging does not represent, warrant or guarantee that the integrity of this Email has been maintained or that the communication is free of errors, virus or interference. Xchanging advises that this Email should be scanned to detect viruses. Xchanging accepts no liability for loss or damage (whether caused by negligence or not) resulting from the use of this Email. Unless the sender is expressly providing you with personal advice, any advice contained in this Email has been prepared without taking into account your objectives, financial situation or needs. Before acting on any advice in this Email, you should consider whether that advice is appropriate for your personal circumstances. If this Email contains reference to any specific financial product(s), Xchanging recommends you consider the relevant product disclosure statement or other disclosure document(s) before making any decision regarding that product.”­­

Notice that they state that they do not represent, warrant or guarantee that the integrity of the email has been maintained or that the communication is free or errors or interference…

Nice try hey! So, this means that the workcover insurance can write whatever bulls*** they like and then, for example, in a court of law, state that the email – as they state- cannot be  relied upon because it is not free from “interference”… OMG!

I suggest – and this is what I have recently done after receiving the most shocking inappropriate emails ever, to BLOCK the email sender (your case manager) and KINDLY request that all correspondence needs to be in writing and send via normal post (mail).

You need to be able to rely on certain emails (correspondence) in evidence for a complaint e.g with WorkSafe or with the Ombudsman or with the ACCS and even with Court. You cannot be careful enough, especially if your case is a complicated one and or a long one (i.e. case of serious injury,serious permanent impairment and when compensation is attached to it).

Another tip that WorkSafe kindly provided to me is that,when a workcover insurance denies you [a benefit] such a taxi transport, home help, a scan, MRI,  anything really, they MUST provide you with a WRITTEN FORMAL REJECTION LETTER. They cannot just send you an email and say that they won’t pay for this or that – this is illegal!!! Only a formal  rejection letter can be used to lodge a complaint and or a dispute resolution with the ACCS !!!!

It would be most interesting to see what other workcover insurance carriers are using in their email correspondence disclaimers (i.e. Allianz). Can anyone forward me a copy of the disclaimer and I’ll publish it – thanks 😉

 

On being on WorkCover

I don’t know if your heart will allow you to, if you will, please allow yourself to open your mouth or eyes to see all those around you that are suffering a work injury,  but try…

What it’s like to be on WorkCover? And how we feel…

Some of us have heavy hearts and our head need hands to hold them up as they have being lowered so many, many times.

Many of us are wounded and physically unable to stand but we are understood by the rest of those who understand and can sympathise when all we need is a word of hope and compassion.
Say hi to those who went to work one morning to earn a living , just like you, but got wounded instead, and who are now isolated, betrayed and have been kept waiting for years… some for many years.
We feel like our lives have become a waiting game without much support.
We have been in a waiting game that causes shame and blame to lives that are already suffering with pain.
We feel like the forgotten lost in battle and no matter how we explain the state of our circumstances  it’s as if our information is written in a different language.
We wish you could comprehend without the need to offend us or our need to defend the truth about our injuries.
We communicate but there is no one who will contemplate the fact that we have rights in this society and that we are entitled and legally owed justice.
Our struggles are about justice and our rights to have a better quality of life …better than we are offered.
We are referred and passed on to other services and agencies that place us often in even more difficulty, leaving us to struggle.
Yes, we have become victims of a system that has a policy of denial making us into rivals at odds without an end in sights.
Say hello. We are not unlike a soldier with weapons to fight in a war against injustice. Our fight is for access to a better life and justice. We fight for a better way and for respect to rise above poverty. All we have are our words and we hope we will be heard and believed.
Our war is psychological and financial as we fight for the lives of our families and ourselves. It’s a fight that gets placed under scrutiny and alleged assumptions that condemn rather than complementst the possibility that we are humans.
We are placed on trial and there isn’t any one you can rely on to promote reasonable communication to allow for accommodation or compassion.
Wounded on our jobs, we lose all that we had and are left without the ability of any earning potential in a stalemate with those who were supposed to protect us.
Some of us will never be able to be self-sufficient, ever, without assistance or the courage to fight for our rights to be heard.
Say hi to  a work  injured person. No-one knows how we could survive amidst all the alliances that oppose and have imposed the stresses of life upon us.
It’s like being continually on life support.
Many of us still have unfulfilled dreams and families that are left bewildered and sad. We will lament over the opportunities that we might have had and the chances for a better quality of life that we have lost as a consequence of our injuries.
These are the facts that are the complexities of our lives – a life that was and will never be coming back.
It’s never about being compensated for being injured; it’s always about explanations that lead to frustrations in our lives not being  taken seriously as we fight for our survival. We need a chance to be affirmed as worthy of being accepted and not rejected by prejudice; we hope for collaboration rather than frustrations.
We have had to be strong among the wrongs that complicate our lives.
Our victory is about refusing to give up and staying in the fight!
Yep, feeling pretty depressed today… how about you?

WorkCover denies taxi travel inspite of overwhelming medical evidence

What can I say but I am stunned! Today a friend of mine was denied taxi travel to and from medical appointments and treatments, which, by the way, had been officially approved in writing on 19 September. How’s that? Well, so they [the WorkCover Insurance Case Manager] tell my fellow workcover victim (who is seriously injured) that the reason for refusing the taxi transport is “because they need further medical evidence“…

Consider the following evidence in support of the taxi travel for the workcover victim

On the 26 of July the workcover victim’s treating doctor requests taxi transport:

After receiving the usual, routine run-around (read bullsh*t) from her case manager such as that there is no “clinical justification” that the workcover victim actually needs taxi transport; that there is nothing to say that the person can not drive a car (for God’s sake!); and that there is no reason that the person can’t take public transport; the workcover victim gets a second letter from her treating doctor with a clearer and more graphic explanation of the reasons why she can’t drive a car and can’t take public transport.

 

[I know the text is a bit small,so here is what it reads: “The requests provided by the GP were not really sufficient and he hasn’t actually provided clinical justification for providing taxi travel. There is nothing to say why you couldn’t still travel on public transport to appointments.” ]

Next, the case manager starts the process with the usual delay tactics and eventually writes a 2 page fax to the workcover victims treating orthopedic surgeon; who eventually even speaks to the case manager directly to explain in detail why the person needs taxi transport.

email extract from my friend's case manager

 

[“We have faxed a request to your treating surgeon to provide information with regards to taxi travel and are waiting on a response. The issue with taxi travel will be addressed in due course”.]

OK, done. Wrong. Now comes the need for the independent medical examinations, right. The first email my friend received was to say that she needed to be – hold your breath – psychiatrically assessed- in order for the case manager to make a decision whether or not my friend would be entitled to taxi transport.

email extract 17 August

[“We will make a decision once we have reviewed both the physical and psychiatric assessments”.]

The psychiatric “independent assessment” took place on 8 August 2011 and the report clearly states that:

[ Does the work-related psychiatric condition preclude the worker from travelling by means of public transport or car? If the answer is yes, please explain how. She indicated that there was considerable pain, and fear of being bumped. In my opinion, taxis are needed for her.”]

So now we have support from the shrink, good. On the 6th of September 2011 my friend is sent to an “independent”medical examination with a general Orthopedic Surgeon and he writes in his report:

[“Regarding her restricted function in the right upper limb, her dominant arm, I think the patient would be dangerous driving a car. Travelling as a passenger in a motor vehicle would be the best option. Travelling by public transport, with the jolting and jarring inherent in such transport would be a use of pain for her, and therefore I would think the appropriate form of transport for this patient is by taxi, or being driven by another person.

In general summary,this patient’s traumatic episode with reference to her right shoulder originally, has led to a high level of permanent impairment with very unfortunate results for her social, domestic and employment future, for which she had high expectations prior to the accident”.]

Note the last bit: “high level of permanent impairment”! And he clearly writes that my friend really needs a taxi.

WorkCover denies taxi travel to sriously injured worker in-spite of overwhelming medical evidence showing the need for taxi transport

So in summary here we have as medical evidence for taxi transport:

  • Treating GP
  • Treating Specialist orthopedic surgeon
  • Independent Psychiatrist
  • Independent General Orthopedic Surgeon

What the f***k more does WorkCover NEED, for God’s sake? This women is in a terrible physical state and on top of access to public transport from her house is as good as non-existent, unless you want to first walk 20 minutes, take a bus to a shopping centre, then a tram to a train station, then a train, then another tram, then walk again… and go back home. Not to mention try to carry something when your arm is hanging out of it’s socket, try using the Myky with 1 hand, try holding on when no seats are available and hey, be bumped into slightly and not so slightly by the busy, hurried crowds!!

On 19 September my injured friend thought that at last she had finally been granted taxi travel to and from her medical appointments. She received an email from her case manager stating:

email extract 19 September case manager

[“Dr…suggests that you require taxi travel and now that we have a decision regarding transport we usually book taxis at 3 monthly periods. So we will need you to indentify how many trips will be required over the 3 months period , the name and address of the treaters you will be seeing.

If you could provide this information as soon as possible so these can be organised.”]

In addition, she received a formal letter from the Cab company detailing that workcover (insurance company) had requested taxi be provided to and from medical appointments and treatments.

Today, 27 September my injured friend was told that she was no longer able to receive taxi transport – she nearly fainted. The email she received today:

[“Please be advised that [insurance company] is still awaiting medical information and I am therefore unable to approve taxi travel at this time. on receipt of the relevant information,I will provide you with further advice by email.”]

A taxi booking was requested to attend a scan for her shoulder injury tomorrow morning. This had been requested already on 19 September.

Isn’t this just outrageous? Is is a case of sheer incompetence, mistake? Or do you reckon they realise that the taxi costs are adding up and are desperate for a way out, hence they are seeking further medical evidence – but from where????

I frankly think this is absolutely disgusting and unprofessional behaviour. My friend is now stranded, beside herself, and in tears… and just can’t see how on earth she is going to get to the scan tomorrow morning (for which she already had a special injection 2 days ago) and which cannot be cancelled or postponed. She has no money to pay for a taxi. Her partner is interstate for a week and she has nobody to take her to the test. How can they be so cruel? Why did they not even tell her a day or two earlier, given that they knew she was to travel already on the 19th of September?

Shame on you WorkCover insurance company!

 

break-yo-stigma

The nature and the consequences of stigma experienced by injured workers

What is a stigma?

The stigmatised individual is seen to be a person who possesses an “undesirable difference”. Society develops ideas on what constitutes”difference” or “deviance”. (Goffman, 1963).

A stigma is linked to social inequality. It causes some groups to be devalued as it were, and others to feel that they are superior in some way.

Continue Reading…

A WorkCover delay tactic and sheer incompetence at work

The last couple of days have been HELL for me again. I need to vent!

Not only was I recently told by my treating specialist surgeon that a bone infection (chronic osteomyelitis) is suspected in my [limb joint],which would explain a series of 7 failed major surgeries, night sweats, some fever on and off, general malaise, ongoing severe pain in the [limb], suspicious looking recent MRI and, now also the development of an acutely painful, red and swollen finger in the hand (which may or may not be  a case of an infection that has spread from the [limb joint] to the finger).

What is chronic osteomyelitis?

Chronic osteomyelitis is an established bone infection that has been present for a period of months or even years. It is often seen in individuals that have sustained open (contaminated) fractures, undergone multiple orthopedic procedures or had chronic wounds.

Draining wounds that fail to heal or intermittently reopen are suspicious for the presence of an underlying chronic bone infection. Additional signs and symptoms of osetomyelitis include local pain, redness, swelling and bony instability.

A series of lab and imaging tests are available to help your physician make a diagnosis. X-rays, MRI scan and a nuclear bone scan may be requested. Blood work may be draw to look for evidence of immune activity and inflammation (WBC, ESR, C-reactive protein).

The most accurate method of verifying the presence of chronic osteomyelitis is a bone biopsy.

Chronic osteomyelits is difficult to cure but can often be successfully controlled.

The cornerstones of treatment include complete excision of unhealthy bone, well-vascularized soft tissue coverage and administration of culture specific antibiotics.

The treatment of chronic osteomyelitis includes meticulous debridement (surgical removal) of all infected bone and scar tissue. Multiple trips to the operating room are generally necessary to fully cleanse the wound prior to any reconstruction. Antibiotic beads are frequently left in the wound between cleanings where they release a high concentration of antibiotic locally,etc etc.

WorkCover INCOMPETENCE exposed

My surgeon requests diagnostic tests, which are submitted to Workcover

My treating orthopedic surgeon started of (after the recent suspicious MRI) with a request for extensive blood tests, which I had done. The tests showed a few abnormalities including a raised infection/inflammation marker and severe Vitamin D deficiency.

Next, my treating surgeon requested a Technetium bone scan. This nuclear medicine whole body bone scan is used in evaluations of various bone related pathology, such as bone infection,  for bone pain, stress fracture, nonmalignant bone lesions, or the spread of cancer to the bone.

Because my bone scan (see picture) was positive, but because a bone scan cannot really differentiate between infection and inflammation (i.e. such as severe oestoarthritis), my surgeon requested I also undergo a Gallium body scan. In infections, the gallium scan is used to look for chronic infections.

Unfortunately at the time that my surgeon prescribed the Gallium body scan for the [limb] infection, my finger also had become red, hot and swollen and looked infected, so my surgeon also added onto his radiology referral form an x-ray for that hand.

After the Gallium scan I am to take a trip to the operating room and have bone biopsies taken in the hope to find the bug that is causing the infection, so we can start treatment with the right antibiotics before replacing the entire joint.

My case manager denies me the Gallium scan and the taxi transport to attend the test

I forwarded the radiology referral form to my case manager from hell sometime last week.

My stupid case manager told me that the request needed to be “reviewed” and that she would let me know of the outcome.

I explained to her that the Gallium scan is a standard test which is done after a positive bone scan when a chronic bone infection is suspected and that I did not see  why the request would need to be ‘reviewed’. I stressed the fact that a bone infection is a very serious matter and that delaying any investigation and or treatment will come at a great cost, not only for me,but also for the workcover insurance, because the longer you have the bone infection, the harder it is to treat, the more bone needs to be cut out, the more maimed I will be, the more impaired I will be and the more the workcover insurance will have to pay.

Right… On Friday evening, at 16:45 (COB), this stupid case manager refuses to pay for the Gallium scan and for the taxi transport to attend the scanning. Note that I was to have the Gallium injected on Monday (today – and I did) and the scan itself 48 hours later (on Wednesday).

She writes in her email of Friday (COB) that she had spoken to my surgeon who had told her that my finger has nothing to do with my workcover injury and that therefore the x-ray of the HAND (to see if there is an infection) and a Gallium scan of the BODY (to look for a chronic bone infection in the shoulder (site of work injury/body) will not be paid for nor the taxi to those appointments.

So, here is an UNEDUCATED, NON-MEDICALLY trained stupid case manager making decisions on her own based on twisted information, forced opinion, plain stupidity or to just delay my treatment(s). I mean how fu***ng stupid do you have to be not to be able to differentiate between a plain x-ray of a “reddened and tender” partially amputated finger (10 years ago) and which indeed has nothing to do with the work-related injury (UNLESS of course it is a case of spread bone infection from the [original injury limb] to that finger OR it a case of advanced RSD/CRPS (which I have in that arm following original work-injury) which causes in its end stages inflammation in distal joints which lead to deformities). If none of those 2 things are responsible for the “reddened and tender” finger, of course I will happily accept liability for the cheap x-ray which I had done last week already! And my case manager fully knows that I had the x-ray done already before she sent me that stupid email on Friday evening.

How fu***ng stupid must you be to even think that:

  • a simple, cheap x-ray of a hand would take two (2) DAYS!?
  • that anyone would prescribe a nuclear radioactive Gallium body scan scan/or a complex white blood-cell labelled scan for a stupid “reddened and tender” finger? Come-on!

Can this absurd, dump case manager NOT read or what: what does it say on the referral form? Two tests. An xray and a Gallium scan, and two (2) reasons of which the reason for the Gallium body scan (or WCC scan) is “multiple R shoulder surgeries, with known infection 6 years ago ,ongoing pain (in shoulder etc), ? chronic infection

Perhaps my surgeon should have put each test on a separate form because obviously these non-educated mere clerks cannot differentiate between an x-ray and a nuclear medicine test for two different reasons.

So, this idiot (case manager) left me FURIOUS over the weekend and stranded. I went to see my GP over the weekend who told me NOT to DELAY the Gallium scan at any cost. So I had the displeasure to catch public transport (which is really not advised on doctors orders because of the way things are -very fragile), as I did not get my taxi.

So off I went this early morning, bus, tram, train and had the Gallium injection. In 48 hours time (Wednesday)I have to go back to the hospital for the scan itself because it takes 48 hours for the radioactive gallium to get to your (infected) bones.

I have written several emails to this stupid woman and cc’d to my surgeon and hope to be able rectify the issue asap. Otherwise I’m in for a case at the ACCS again…and I am tired and exhausted and just sick of having to fight all the time for what I am legally entitled to!

Interestingly the stupid, vindictive case manager from hell has been hiding all morning – I have not heard from her – whilst she tends to overwhelm me with harassing emails on a daily basis.

 

I really believe that Case Managers should be mandatory trained healthcare professionals in the first instance, i.e. hold a nursing degree or something similar. They make decisions everyday about OUR health care and treatments, on their OWN and don’t even understand what a doctor writes. This is so so scary, especially when you suffer from something severe and potentially life-threatening, like an infection or an unstable spine. Yet those donkeys have no fu***ng clue and play GOD. “I, who is uneducated, illiterate, non-medically trained, and I,who have never even seen you, decide what treatment I will approve and what not”.

Grr… I am ENRAGED!

Another recent example of my donkey’s behaviour was that “after she had spoken with my specialist orthopedic surgeon” she needed an “objective” assessment by an IME. Well donkey sent me to an 86 year old general orthopedic surgeon – I kid you not. One of donkey’s questions to the IME was what type of surgery (number eight) I should have. Well, first of all donkey must have “forgotten” that I had been sent to the Medical Panel by her colleague donkey 2 weeks earlier. You can only send someone for a permanent impairment assessment/rating when the injury is considered “stable”, which means, yes, that I signed a very legal document with my solicitor stating that it is my wish not to have further surgery for the foreseeable future given that I had undergone 7 failed massive procedures with many many complications. So, for an injury to be considered stable you are not allowed to have further surgery in the “foreseeable future”. At that time, we did not know yet that I may have chronic osteomyelitis (we only realised this at the last stage of the Panel 3 weeks later and the Panel rightly suspended the impairment assessment because of “injury not stable”).

The 86 year old IME, who never ever operated on this sort of injuries in his whole life by the way, was of the very old-fashioned opinion that I should have procedure X done (massive surgery). This procedure X has been abandoned about 20 years ago because it causes a hell of complications and is irreversible. They may in very very rare occasions perform this procedure on very old people (75+) to help alleviate pain. Isn’t that shocking? In addition the procedure involves bone-union (growing of bones together). Now consider that I have most likely osteomyelitis (if not, severe osteoarthritis) and consider, most importantly, that I have very severe Vitamin D deficiency, which includes lack of calcium and phosphate. This means that my body is totally unable to grow bone or heal a fracture… do you know what I mean? Jeezus. ..oh boy, oh boy!

The worst part undoubtedly is that I am medically trained with 20+ years experience and I know too much for my own good and so I see all these things and “opinions” and lie awake at night worried sick about my fellow workcover victims, who may not even be aware that they are misinformed, mislead or given the wrong treatment(s).

Sigh, sigh…

Dear WorkCover, dear Government

Dear WorkCover, Dear Government

You assess our permanent impairments not only with a 20-year old, unscientific AMA Guide, but you also use a Table of Maims!

You printed The Table of Maims in black and white  in your legislation, in your brochures and even online,

How much for a leg, how much for a hand, how much for an arm, a finger, how much for an eye?

In the Medieval Ages, dear WorkCover, dear Government, they used to have a Table of Maims,

You received a certain bodily maim for a certain crime,

They would cut off your hand if you stole,

Oh, what form of barbarism was that, or was it, do I hear you say?

Many a hundred years have passed,

And yet nothing has changed since those medieval, barbaric days!

Because now, when you lose a limb or a part of a limb,

YOU decide how much you pay!

With a printed Table of Maims no less,

So much for an eye, so much for a leg and so much for a hand…

Your Table of Maims almost looks like a BUTCHER’s menu

It is a true insult to us, people who happened to loose a piece of our bodies at work!

Dear WorkCover, dear Government, may I ask

How much do you pay for a Heart?

And how much for a Soul?

Whilst you surely destroyed most of our hearts and souls,

With your cover-ups, ongoing denials, and

With your selective evidence, and

With your mighty powerful delay tactics, and

By treating us like criminals from the second we were injured, and

With your greedy, fully sick WorkCover Insurance fraud tactics,

and brainwashing techniques, and

Your misleading information, forced opinions, twisted answers and bullshit

How is it, dear WorkCover, dear Government that the heart and the soul

Are not listed on your Butcher’s menu?

But, whilst you wounded my heart, and shattered my soul

put a thousand poisoned darts and twisted a bayonet in it

I still have a little piece of my heart and soul left

and I tell you what, dear WorkCover, dear Goverment

that little bit of piece is still mine

and even you, with your barbaric butcher’s Table of Maims and all

Can never take this away from me…

I hope and pray that you may become a work injury victim soon,

Failing that, that someone very close to you gets seriously hurt at work,

and that your terrible injury

will not be listed on your Table of Maims.

Your Sincerely

A WorkCover Victim

 

 

 

An interesting case of using video surveillance by workcover

Misuse of Video Surveillance by workcover insurance company

Source: Australian Lawyers Alliance Victoria

During cross-examination the defendant (= workcover insurance) played a video of the plaintiff (injured worker) walking along the street.

In his later judgement His Honour found that the video showed:

  • the injured worker (plaintiff) swinging his arms freely and jogging five to six steps
  • the injured worker (plaintiff) then turning his head almost fully to the right to wave to his wife
  • that this mobility was contrary to the injured worker’s evidence that he could not run, move his arms freely to any real extent or turn his head fully to the right side

In his judgement Higgins J noted that in the video “there were aspects which were adverse to the injured worker (plaintiff).”

After the video had been shown, counsel for the inured worker, Mr Hore-Lacey QC, made a request for further information to be provided to the injured worker (plaintiff).

Relying upon Alcoa of Australia v McKenna (2003) V.S.C.A 182, Higgins J ruled that the defendant “produce any further surveillance material which was in the possession of the defendant (the workcover insurance company) and which related to the injured worker’ss neck condition”.

In his ruling Higgins J stated this was “with a view to ensuring fairness”. It is of note that in his judgement His Honour made obiter comments indicating that it might still have been open to a court to draw an adverse inference should the defendant (the workcover insurance) have failed or refused to produce the remaining surveillance material in the absence of a ruling from His Honour.

As a result of Higgins J’s ruling the defendant provided the plaintiff (the injured worker0 with dates of surveillance and provided the second tape to the Court.

In his judgement His Honour made the following findings regarding the footage shown on the second video:

  • that the injured worker (plaintiff) was seen to place his right hand across his body and hold his neck
  • that he then used his right hand to remove a letter that he then transferred into his left hand
  • that he again placed his right arm on the left side of his neck as if in pain.

In his judgement, His Honour stated that, “the second video strengthens his [the injured worker’s] credibility and indicates restrictions in activities which he may be able to perform” and that the video “clearly supports the plaintiff’s (injured worker’s) claim” and “demonstrates significant disability”.

 

 

In his judgement Higgins J noted that “nowhere in the material is there any indication or suggestion that the vocational experts have had the opportunity prior to the hearing to view the second video, which clearly supports the plaintiff’s (injured worker’s) case, and which I would have thought would be relevant to an assessment as to whether suitable jobs exist which the plaintiff (injured worker) could perform.”

Further, Higgins J stated, “had the application not been made by Mr Hore-Lacey, the Court would not have been cognisant of a second video film which, in my view, clearly supports the plaintiff’s (injured worker’s) claim.

Put shortly, the “mischief” identified by the Court in McKenna’s case could have resulted in the Court being mislead insofar as the nature and extent of the plaintiff’s symptoms are concerned”.

Judgement Higgins J granted leave to proceed pursuant to s134AB (a) and (c). Comments It is therefore worthwhile in all s134AB applications pursuant to the Accident Compensation Act (and s93 applications pursuant to the Transport Accident Act) to seek full production of video surveillance material in cases where the Defendant seeks to rely upon such surveillance.

It is also worthwhile bearing mind the obligations imposed on the VWA pursuant to section 134 AB, that is, to provide all material in the defendant’s (the workcover insurance company) possession and upon which it intends to rely as part of the response material rejecting serious injury.

Tim Tobin SC has recently persuaded Judge Smallwood to refuse to allow video surveillance to be played to the court in circumstances where the surveillance log but not the tapes were supplied as part of the 134AB response material.

Thanks God for a great Judge in this case. But OMG, isn’t it just sickening to what length workcover insurance companies will go to deny genuinely injured workers what they are legally entitled to? How can these people sleep at night?

You may also be interested in reading my previous post about workcover and private investigators: the truth and see to what length workcover insurance companies and private investigators go to capture those ‘famous, damning 10 second video shots” of genuinely injured victims.

AMA-guilelines-unfair

The current workcover system for impairment rating is not fair at all

The current workcover system for impairment rating is not fair at all. If you have read the previous post about “claiming compensation for pain and suffering” you may well have realised that our current workcover legal system is not set up as fairly as you first thought!
It is only when you or someone close to you is a victim of a workplace accident that you actually discover the VIC (and most other state) Government is denying you of a lumpsum and of the common law right of access to justice for any pain and suffering endured.

Continue Reading…