Who is your workcover case manager

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The only reason workcover case managers are employed is to help the Agent (aka the insurance company) to make money, or save money – as that is what all insurance companies do. They wouldn’t be in the business of providing “workcover insurance” to employers, if they weren’t a business. The whole idea is to make profits. Period. Below are a couple of their most common “dirty” tactics.

Who is your workcover case manager

The workcover Case Manager is simply your representative of the workcover insurance company/ Agents (eg. Allianz, CGU, EML, Gallagher Basset, Xchanging) that communicates directly with you in the first instance. They “manage you workcover claim”, and regularly change as well. In some other countries Case Managers are called “Adjusters”. If you think about this, simply the term “adjuster”means that their job is to “adjust” your workcover claim costs to save as much money as possible.

Case Managers try to save or make money by managing your workcover claim

There are several ways your case manager will try and save or make money for its employer – The Agent (workcover insuer).

The most common tactic to save or make money for the Agent (insurer) is by trying to delay and deny your legitimate workcover claim in the first place. Although case managers (and the like) often do not have any appropriate qualifications they are alleged to receive a 2 week in-house training course where they essentially learn how to minimise the benefits you should get. This can include weekly pay, and medical and like treatment. Think about it, the less rightful workcover benefits you receive, the more they save money and allow their employer (insurance agent) to make money.

Many Case Managers are also overworked and manage allegedly 200 workcover claim each, so it can be hard to get in touch with them, and most don’t even know who you are and what you have gone through or are going through. In fact you are just a number – that’s the reason why, when you contact your case manager, you have to give your claim number (no name!)

It’s very important to understand that workcover case managers are NOT your friend (ever), even if they pretend to “care”about you. Some will go as far as to pretend they are your friend and convince you of inappropriate things such as “you don’t need to see a clinical psychologist… you can talk to me”

Tips to deal with your workcover case manager

Here is a list of the most common ‘dirty’ tactics used by workcover case managers:

  1. Misrepresenting the FULL workcover benefits you can receive as an injured or ill worker under the workcover law – this is a huge one. Because workcover case managers know many injured workers don’t have a lawyer (certainly not in the beginning), they make it seem like you can’t get certain benefits when they know you can, or they never tell you about the workcover benefits you are entitled to. Recently a case manager told an injured worker, who had moved interstate, that he could no longer receive any medical and like treatment as all treatment and medications would need to be prescribed by a worksafe VIC approved service provider! WRONG! You can get medical and like treatment precribed by a doctor in another state. The only problem may be things like home help, as the law states the service provider needs to be registered as a worksafe VIC provider (but this does not apply for any doctor or surgeon, medicaltion and even surgery). Another case manager told a very seriously injured worker that she would need to repay the helicopter, every blood transfusion, every surgery etc – OMG! (see screenshot)
  2. Protecting you (the injured worker) and providing for you (and your family) IS NOT not the workcover agent’s and it’s case managers’ job. Providing you with the much needed education about the workcover law in your state and the benefits you are entitled too IS NOT their problem. As an injured worker you may not even know what to ask for, and they definitely won’t tell you. Examples include that they will not tell you that you can receive home help, garden help, have reasonable changes/modifications made to your home or car, receive assistive and ergonomic devices/tools (eg. shower stool, bath rail, electric can opener, etc) that you can obtain taxi travel to an from medical appointments, that all your medication for your injury can be reimbursed, that you are totally entitled to seek treatment in a private hospital, even attend a private hospital emergency department. So it is very important that you look up the workcover authority website in your state (eg. Worksafe Vic for Victoria) and actually read all you can to begin to understand what you are entitled to. You really need to know what you’re entitled to and how to obtain it.
  3. Workcover Case Managers will deliberately not return your calls or emails – Not hearing back? Called 20 times? Still not hearing back? emailed 3 times, still no response?  It’s a common dirty tactic to make you totally frustrated. They do this for the sole purpose to delay and deny your medical treatment and other benefits. Sometimes they will acknowledge or reply to an email but mislead you, or stall the answer by stating things like “I have just requested further information/clarification from your treating doctor…” But in actual fact never did even request it! We highly advice all injured workers to only communicate in WRITING with their case manager(s), email is fine. At least that way you have a RECORD, and can refer to previous correspondence. There are some apps that allow you to obtain a read receipt, and we highly recommend this too so that they common excuses of “not having received your email etc” does not stand. If that doesn’t work, by all means cc your lawyer/lawfirm into the email, or even the Ombudsman. If things are just out of hand and extremely frustrating/stressful, please direct your case manager – in writing – to only correspond with your treating doctor (GP, Psych, anybody), or your lawyer!
  4.  Advising you not to get a lawyer – this one we see so often and can be the most damaging too! If you have a more serious injury (eg more than a simple sprain or simple fcatrured arm) it makes it a lot easier for your case manager to take advantage of you if they know you don’t know the applicable workcover law and don’t know what benefits you are entitled to, and how much “settlement”you deserve. Your case manager will NOT give all you rightfully deserve under the workcover law if you don’t have a lawyer. Again, this can be anything from not informing you that you can dispute a permanent impairment assessment by an IME, it could be ceasing your entitled weekly pay for no valid reason, denying you treatment etc. We always recommend that any more serously injured worker engages a no win no fee lawyer as soon as possible. We highly recommend Zaparas lawyers.
  5. Workcover case managers will insist to speak with your doctor, or worse, insist they attend your appointment! This is a NO NO!  We so often hear from injured workers that their workcover case manager often calls their treating doctors and even their treating specialists (i.e. specialised surgeons, specialised pain doctors, psychiatrists etc). We also hear a lot from injured workers in states that appoint “nurse case managers”, that they insist on attending injured workers’ medical appointments, claiming they have the injured worker’s “best” interest at heart. Many ignorant injured workers also allow their rehab service provider to attend their medical appointments. Injured workers should never ever allow this! Because the case manager does this to influence and pressure your treating doctor(s) to force you to return to work (prematurely), downgrade your injury, even change the description of your injury and go as far as pressure them to change your medication or medical treatment plan. Simply tell your treating doctors (i.e. GP, Surgeon,Pain doctor, Psychologist, Psychiatrist, Physio etc) that you feel it is a violation of your PRIVATE doctor-patient relationship. Also, make sure you write a letter to your case manager requesting s/he explicitly refrains from contacting your treating doctors by telephone, and that you refuse anybody from the insurance company (i.e nurse case manager, rehab provider) to attend your medical examinations/appointments, highlighting privacy breach.

Now that you know some of the common diry tactics, tricks and strategies workcover cas managers use against you, we hope you will be ready for them. You may not realise it, but your case manager is only there to work AGAINST you literally from the moment you get injured at work. Don’t get fooled, don’t make these mistakes! If you’ve been more seriously injured or made ill at work, get all the information you can before trying to handle or manage your claim by yourself. Best is to engage a good personal injury lawyer with expertise in workcover.

The best way to protect yourself is to know the workcover system, and have someone fighting on your side!

You can find many more enlightening articles about workcover case managers on our site.