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.
For any injured worker the prospect of having to undergo an Independent Medical Examination (IME) causes a lot of apprehension and fear. But for those workers who have suffered a psych injury at work ( in particular a primary psych injury) attending an IME can cause even more trepidation!
Here is (yet another) rather typical empty content letter from Mr Robin Scott, the current Victorian Minister for WorkCover…kindly shared by an injured worker.
According to the Latrobe Valley Express,the (new) Victorian Ombudsman, Deborah Glass, welcomes ‘good’ whinges, including whinges (complaints) about WorkVover Vic (WorkSafe Vic), and is pushing for changes in legislation, in a bid to encourage more complaints. So guys, let’s bring on the workcover complaints!
The workcover case manager’s job is to save the workcover insurance company money, period.
Many case managers get bonuses and ‘special’ recognition for saving their workcover insurance company money. And, you guessed it, the only way to save money is by stalling and denying claims and by paying the least amount possible. In this article we’ll give you some tips on how to deal with a non-responsive case manager.
Most workcover authorities state on their websites something along the lines that Independent Medical Examiners (IMEs) should provide unbiased, accurate and comprehensive information and be carried out with dignity and respect for the injured worker.Although injured workers have reportedly experienced poor IME assessments we are surprised how few formal complaints are filed.
According to WorkSafe Victoria (now called the Victorian WorkCover Authority) they take all independent medical examiner (IME) complaints seriously. They claim to review and respond to each complaint received from an injured worker. Outlined in this post is the complaints handling process for IMEs, as well as the IME Service Standards and their “Declaration”…
When injured on the job, many workers may be surprised to learn that workcover insurance companies routinely stop payments or deny many workers comp benefits.Whilst we have previously written about common tactics used by insurance companies to minimise workers compensation payouts, this article focuses on manipulation of information, power, or a communication process to deny a benefit, in this case household help.
It is important to remember that our employers, and often all too many politicians, workcover insurers and especially the media portray our workcover system as some sort of undeserved benefit (or even a free “holiday”) that all deceptive injured workers abuse.
Workcover is portrayed by the media as an undeserved benefit
Let’s refer back to some excellent comments made by injured workers, regarding workcover and the media. As injured worker “EFFEDUPNOW” asked , [has] anyone really tried to get this [workcover abuse, stories] in the media?
The answer is simple: yes… but the media is not interested!
The media bias
A typical national prime time television show airs shows on workcover fraud, usually opening very dramatically with footage of for example an old man working on a farm and a lawyer interviewing that same old man. And it goes something along the following lines:
Announcer: This is [programme] Wednesday, March 20th, 2014. Tonight. It’s a crime that takes money out of your pocket, it starts with a lie.
(Unidentified Lawyer) : Are you able to lift anything?
Injured old man: A cup.
Lawyer: A cup?
Injured old man: This is how I am.
Announcer: Think he’s a broken old man? Here’s what hidden cameras showed he was really doing while collecting money from you.
Maybe an IME: The man can grip. I see the legs working, I see the arms working.
Unidentified Lawyer: When you first saw that videotape of him throwing that bale of hay, what was your reaction?
Insurer maybe: I was mad.
Announcer: injured old man, with lies, ripoffs and videotape
One of the many incendiary messages in such sensationalised TV show is in the announcer’s very first line when the viewer is informed that (in this example) “money is taken right out of their pocket.” Seconds later, the announcer again informs viewers that the supposedly injured man was throwing hay bales “while collecting money from you.”
Interestingly money does not mysteriously float out of viewer’s pockets as portrayed by the sensationalized lead into such frequent TV segments!
First, money paid to workcover claims, including alleged fraudulent ones, comes directly from insurance industry profits. Only after dipping into insurer profits does the cost get passed onto employers purchasing workcover insurance (premiums). Then, the costs are spread over the entire group of mandatory policyholders; costs are not charged back to each employer dollar for dollar with their workers’ injuries. If employer premiums do increase, the employer pays for it by one or more of the following ways: taking it out of the company profits; reducing wages; and passing it on to consumers. For the smaller number of companies that choose to self-insure, they pay the claims directly rather than pay premiums for workcover insurance. Then, and only then, does it come out of the general public’s pocket IF the public chooses to purchase the specific products made by companies with high workcover rates. In neither case does money flow out of unsuspecting people’s pockets as portrayed by the insurance industry. …
Such over-sensationalised shows typically fail to mention that for example (at the time), the workcover costs were only 1.something % of payroll down from a peak of 2.something% 5 years or the year before. It also routinely fails to explain that in the past 5 years or so, workers’ compensation costs to employers decreased x% as a percentage of payroll while benefits to workers declined x%.
Instead, the announcer of such sick and twister shows will state something along the lines of… “After all, workcover fraud is very common. The industry estimates it adds up to $X billion a year.” How many of you have heard this $X billion claim before, which Unions, and even Lawyers will explain and defend.
Such allegations have absolutely no relationship to fact but are based on ‘attitudes’ and ‘perceptions’ about fraud (when for example respondents say they ‘know’ of someone supposedly on workcover even though s/he might be capable of working). Similar fabricated claims put workcover fraud at for example 20% of the total of all claims in (a state); the truth is however that suspected fraud that year, is for example three-tenths of one percent!
Anyway whether the true fraud rate is less than one-percent or as high as two-percent, it is hardly “quite common”, duh! (Off to my Soap Box).
The myth of workcover fraud
In recent years, the insurance industry’s focus on cheaters and malingerers helped push through state workers’ compensation reform, a profitable cost-cutting campaign supported by outrage over alleged abuse of the system. The problem, however, is that the fraud image is false for the vast majority of workcover cases.
Studies show that only 1 to 2 percent of workcover claims are fraudulent.
Certainly, the tens of thousands of workers killed every year were hardly aiming for a free ride on their employer’s tab!
The presumption is constantly that fraud in our workcover schemes lies with the injured workers. This is fuelled by media portrayal of ‘cheats’ in the system and the presentation of material in the public domain by employer groups, politicians (at election time) and insurers. The evidence, however, is to the contrary. The incidence and cost of fraud in the workers’ compensation schemes lie predominantly with employers and to some extent service providers.
The detection of fraud in Australian workers’ compensation schemes is focused on the more easily identifiable fraud, that of the injured worker. Employer and service provider fraud is much harder to detect and there is less incentive to eliminate such conduct as a result of the structure of the various schemes.
The pressures of injured workers being suspected as a fraud really do not assist recovery.
“Despite the claims of the insurance industry, employer groups and workers’ compensation authorities that rorts and fraud by injured workers are widespread, all official inquiries into the various workers’ compensation schemes in Australia in the last 20 years have found no cogent evidence to support claims of widespread fraud, malingering or malpractice.” (1)
How can injured workers address the media bias
We believe that the only way to address the media with regards to workcover is to write a commentary on for example each single sensationalised TV show/programme of newspaper article!
Sample letter to Media
Dear [Media Stinger],
Approximately [2 weeks ago], you broadcasted a report on fraud by an injured worker in [State]. I frankly don’t know whether or not this injured worker in fact committed fraud. I have no sympathy for injured workers who defraud the workcover [insurance] system. But what is astonishing to me is that your report/show focused on what is acknowledged by the vast majority of academic experts to be, by far, the source of the lowest amount of fraud in the workcover system. In every study that has been done on fraud in workcover, employer, insurer, and service provider fraud are found to be a dramatically greater problem than injured workers’ fraud. At a time when injured workers throughout this nation are suffering enormously from “deform” of the system driven primarily by insurance providers, your report/show/article gave a seriously skewed presentation on the problems with the system.
I certainly don’t believe you have a serious interest in what is happening to injured workers [like me], but if by chance you do, I urge you to take a look at for example [the recommendations that were made by the xxxx (an administration not particularly sympathetic to workers), then have your staff compare those recommendations to today’s reality for injured workers. We should really be deeply ashamed of what we are doing to injured workers throughout this nation.
[Or take for example my situation… explain your story…]
I wish I did not feel cynical about sending you this letter/e-mail. I am sorry that you have bitten the insurance industry bait, hook, line and sinker!
More workcover sample letters can be found under our Useful Stuff.
Workers’ compensation is hardly the gold mine insurers, politicians and the media portray it as. Fat lawsuits and big settlements are usually completely out of the question.
When a workcovervictimsdiary tells distraught families who just lost someone in a workplace fatality that they cannot sue the employer, they are shocked.When we tell incapacitated workers that they can not obtain compensation by means of a pathetic lumpsum or common law, they are shocked.
Sometimes it takes lawyer(s) to tell these families and injured workers the same thing until they believe it! We’ve had families and severely injured workers go to 3 or 4 lawyers until they would accept it…. depending on how angry they are.The bottom line is that in all but the most willfully negligent circumstances, injured/ill workers and their families cannot sue their employer for killing them/making them injured or ill.
[Post dictated by workcovervictim and manually transcribed on behalf of WCV]
Imagine being a hard-working Australian with a family of three or four and a job that perhaps just barely supports them. Now, imagine you are injured at work in an accident or incident and through no fault of your own, or through the sheer negligence of your employer. You are suddenly forced to survive without any income while your employer’s workcover insurance carrier attempts to determine if you were really, really “injured at work.” Hey, it could well be that you suffered from ‘old age’ degeneration, or worse, the insurer may try and blame your injury on a ‘pre-existing’ condition, after all you may have fallen off your rocking horse when you were 5 years old.