Workcover Case Managers: from Pizza Hut Team Leader to Claims Manager

Screenshot_2019-06-28 case manager

You may remember that we have – over the years- posted quite a few articles about the Workcover Case Managers (aka Claims Assessors). They often have the right to withhold treatment recommended by our own medical specialists or to over-rule evidence-based treatment based on thorough medical knowledge. Workcover Case Managers also change often, without notice. The problem becomes even more absurd in that the Workcover Case Managers do NOT have appropriate education nor qualifications, certainly not in the medical or allied medical field, yet they are given the power to deny your claim and to deny your medical and like services!

Workcover Case Managers most lack education and qualifications yet over rule medical specialists’opinions and medical treatment plans

The Workcover Claims Manager and the Workcover Claims Assessors

When an injured worker lodges a WorkCover claim, their claim gets assigned to a Case Manager to be – firstly- determined, and then to be “managed”.

We all know that many Workcover claims are pretty complex and actually demand quite a high level of medical (and legal) knowledge, not only to make a decision on whether a claim is approved but also to manage and determine appropriate medical (and like) treatment. This is even more complex when it comes to people who suffer from a psychological injury.

Given the level of “power” given to these  so-called Case Managers ( and as such decision-makers) and the impact their decisions can and do have upon an injured worker’s physical and/or mental health and their livelihood, we surely would expect nothing less than that these decisions are made by appropriately qualified case managers/claims assessors.

Appropriately Qualified

“Appropriately qualified” has been defined as “…having the qualifications, experience or standing appropriate to perform the function…” (Acts Interpretation Act 1954).

Sadly, many case managers/claims assessors are NOT appropriately qualified, and we – the injured/ill workers – are at their “unqualified” mercy. We have to rely on these unqualified workcover employees to make a decision on whether or not our work cover claim is accepted, and we rely on them to accept the medical (and like) treatment plans that our own treating specialists recommend. Because workcover case managers are no appropriately qualified, certainly not in the medical (nor legal) field, many injured workers actually suffer immensely at their hands.

Workcover Case Managers / Claims Assessors Educations, Qualifications and Experience

Out of sheer curiosity, we had a look at some Workcover case managers and/or claims representatives online, using LinkedIn as to view their “profiles”, several showing their education, qualifications, and work experience.

We were shocked (and that is an understatement) to find a pretty much consistent lack of appropriate education, qualifications and/or experience of workcover case managers.

Here are some examples we found:

  1. Claims representative #1 ( working for Workcover QLD): completed high school in 2010/ worked as a Team Leader for Pizza Hut and KFC, worked as a Team Leader at Coles, worked in a casino (games dealer). Started work at Workcover QLD in 2014.
  2. Case Manager #2 (working for workcover QLD): worked as a waitress at a Hotel (room dining attendant). Works for Workcover QLD since 2011. Studied Cert III in commercial cookery and has a diploma in Hospitality.
  3. Case Manager #3 (Workcover QLD) – employed at Workcover QLD since 2005, overseeing and approving decisions made by claims representatives. Her resume shows she was a Dancer at QLD Ballet and a Pilates instructor. She has a Cert IV Polestar Pilates.
  4. Claims Representative #4 (Workcover VIC since 2015): Finished High School in 2007, worked as a Personal Assistant to Managing Director/Accounts Payable/Receivable/Sales and Invoicing Officer at Natural Vitality Australia and in Crewing and Travel Co-ordinator/Drilling Operations Administrator at Weatherford Drilling. Qualifications –Cert III Business Administration.
  5. Case Manager #5 (Workcover QLD 2015): Office Administrator and Property Manager at Harcourts. No qualifications.
  6. Case Manager #6 (Workcover VIC 2014): Assistant Manager at Hungry Jacks. Store Manager at Cotton On Group. Counter Manager/Beauty Therapist at a Day Spa. Internal Sales Representative at Solomon Security and Blinds.
  7. Claims Officer #7 (Workcover QLD 2014): worked as a Credit Officer at BGW Group. No qualifications

HELLOOOOOOOOO!!!!

So, obviously our main concern is that it appears that many WorkCover employees, from claims representatives, case managers and similar “decision-makers” are not appropriately qualified, nor have any appropriate experience, yet they are allowed to make “life and death” decisions regarding injured workers claims, injured workers’medical treatment (including surgery), make decisions regarding psychological injuries (eg what is or is not reasonable management action etc)!

Workcover employees appear to get employed (by WorkCover insurers) with no particular or specific training, no tertiary qualifications, experience or expertise in the medical field, nor in management theory (eg in work environments).

So, let us rephrase this again, how on earth is it possible, let alone ethical or acceptable that WorkCover insurers authorise uneducated employees (case managers etc) to assess and manage complex work injuries and illnesses, and are allowed to assess complex matters such as whether the actions of particular people towards a particular worker in a particular context in a particular organization with particular policies and procedures in a particular industry are ‘reasonable’ (eg in the case of some psychological injuries).

Is it a wonder injured workers face ridiculous and – at times – outrageous obstacles from their assigned case manager(s)? Repeated nonsensical questions are asked, “additional information” is sought, the act (law) is often inappropriately referred to, injured workers are sent to independent medical examiners with no knowledge or expertise or qualifications in the field of injured workers particular injuries (eg. they will send you to a general surgeon to assess a complex orthopedic matter, or to an orthopedic surgeon to assess a neurological injury, etc etc). Case Managers routinely deny or cease medical treatment, playing Russian Roulette with the lives of injured and ill workers. Injured workers with, for example, osteomyelitis (infected bones) have their therapeutic and suppressive antibiotic treatments ceased at a whim, only to become septic! Others have their time-sensitive surgeries denied and end up permanently impaired; rightful psychological injury claims are denied and so much more!

It certainly appears that WorkCover Claims Representatives or Case Managers are not qualified “investigators”, and it is alleged that they receive a 2-week in-house training course before being authorized to make major decisions with regards to an injured worker’s eligibility for compensation or entitled medical and like services/ benefits.

In our injured opinion, this is totally unacceptable that WorkCover case managers have the responsibility for assessing and managing injured/ill workers claims that will potentially often affect an injured worker for the rest of their lives!