If you have a WorkCover claim, and the WorkCover insurer has made a decision that you don’t agree with, it is important that you know that you are allowed to challenge this decision. This can include denial of medical and like treatment, even denial of requested surgery. In this article you will find some useful resources to help speed up the decision-making process, as well as dispute and complaints avenues.
Surveillance is still an accepted tactic in the workcover world, especially in longer-term and more complex cases, including in cases of mental injury/illness. Workcover insurers still try to convince the public that surveillance controls fraud. But for genuinely injured workers, surveillance tactics can cut off rightful benefits and, worse, also cause humiliation and paranoia to the injured worker’s pain, disability, and lost income and joy of life.
Further to the recent article by ABC Investigative Journalist, Pat McGrath about an injured worker who has taken the unusual step of prosecuting her case manager (EML) for its failure to determine her claim for compensation as and when required under the WIMA, it has come to our attention that the New South Wales Workers Compensation Independent Review Office (WIRO) has published on their website that they “bring to your attention that on 29 November 2018, the Supreme Court of NSW (per McCallum J) declined to grant prohibition to Employers Mutual Limited (EML) in respect of a Court Attendance Notice (CAN) that was issued by the Local Court of NSW upon an application by an injured worker : Employers Mutual Limited v Julie Ann Heise and the Local Court of New South Wales – 2018/356687. Her Honour’s judgment has not yet been published, but her decision provides authority for the proposition that SIRA does not hold a monopoly regarding the prosecution of offences under the WIMA.
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.
As we have stated a zillion times, independent medical examiners (IMEs) are not always perfect. Sometimes the IME doctor will make mistakes, these could be genuine mistakes and oversights based on, for example, very selective and outdated “material” your case manager sends to the IME doctor. But unfortunately some IMEs are outright biased, some more than others. So what do you do if you feel your IME report is incorrect, or is missing important information, or has partial “mistakes” and/or “oversights”?
We have recently been contacted by a couple of seriously injured workers regarding their workcover injury permanent impairment claim. Most are confused about the process and many are quite shocked at the low monetary value put on their case/injury. Some don’t know whether they should accept the lump sum, or take their case to conciliation (and/or a medical panel). Perhaps it’s time we summarised the permanent impairment claim process in order for injured workers to better understand the process and what to expect.
For many injured workers, many medical professionals and even personal injury lawyers, there is quite a bit of scepticism about the workcover system’s use (or abuse) of “expert witnesses” including the (over)use of Independent Medical Assessors. It has been alleged that workcover expert witnesses and the like are not always there to share informed, evidence-based insights or opinions, but rather to “spin” evidence as required (by the insurer).
These days, just about everything we do on social media can have a big effect on our offline, private lives. We see increased cases of, for example, social media defamation; workers who have been sacked thanks to inappropriate Facebook rants, inured workers who have posted pictures of themselves, even to people who have had their homes robbed after mentioning on FB pages that they were away! The internet is a private investigator that never sleeps!
We recently received a pretty alarming email from a bewildered injured worker, who – unfortunately- was sent to Dr X. This doctor is still practicing and appears to live in Australia in QLD and is allegedly used as FIFO “independent medical examiner”.