Navigating the work accident war zone: tactics used by workcover agents

Did you know that the day you were injured you entered a war zone with the workcover insurance industry!

Workcover insurance claims managers, including case managers will use any means necessary to pay out as little as possible, even on legitimate claims that involve serious injuries.

Workcover insurance claims managers receive extensive training on how to save the insurance company money, and not necessarily on how to examine a claim and pay a fair settlement.

Many workcover insurance companies reward their case managers and claims managers with bonuses or promotions based on how much money that person saves the company rather than how many claims are resolved.

The claims manager/case manager accomplishes this in many ways:

  • Using Delay tactics: The case manager is a master of using delay tactics to wear people down. He knows that many people will at some point throw up their hands and say “enough!” and finally accept the workcover insurance company’s last offer just to be over and done with the whole stressful process.
  • Requesting Unnecessary Information: Another method is when the case manager makes repeated requests for “documentation” even if the information will have little or no bearing on benefit to be approved or the amount that will be offered in “settlement”. Repeated requests for unnecessary documentation can easily frustrate people and wear them down so they’re more likely to accept a lower benefit or settlement offer.
  • Disputing the Medical Treatment: Another way the case manager will try to minimise your claim is to dispute or question your need for medical treatment, despite having no medical training! (and even if the treatment is prescribed by their own doctor!). Often it does not matter to the case manager that your treatment has been recommended by a reputable  physician or specialist. A “triple play” is very common with doctors’ requests for medical tests such as MRIs. The insurance case manager delays response to the doctors office’s request for approval, then requests “documentation from the doctor” and then the case manager says the MRI is not necessary. Six months later, you finally get the MRI and the correct treatment. What has the delay cost you? A slow medical recovery, lots of pain, financial stress and possibly the loss of your job!
  • Failing to Advise an Injured Worker of All His Benefits or Any of his Obligations. The case manager doesn’t have to tell you that certain types of benefits even exist! I have never known in my 7 years on workcover  a case manager to freely give this information. What is worse than not getting “fully made whole” is to lose your benefits altogether, i.e. because of time limits!
  • Acting as Your Friend. There are times when the case manager from hell will try to “befriend” you and make it appear that she is watching out for your interests when in fact she is not. Sometime the case manager will give you advice about the type or frequency of your medical treatment, and then decide later on not to pay for the treatment because it is “excessive.” The worst is directing you to change physicians to a “company doctor.” (i.e. a doctor who is more easily persuaded to state nothing is wrong with you and certify you fit for work.)
  • Making False Promises. There are times when the case manager will make promises to you that he or she knows can’t be met. For example, I know of a fellow workcover victim who was promised that the workcover  insurance company would pay for her to go to TAFE course. This went on for months until the injured worker was resigning her light duty position and retiring to attend the full time TAFE courses. The problem was that the injured worker didn’t find out about the insurance company’s decision  not to pay for the classes until she had resigned!

Real examples of dirty workcover tactics

My specialist orthopedic surgeon recently requested a high reslution MRI. Whilst no prior-approval is required for an MRI if it is requested by a specialist, I needed to have a letter addressed to the radiology clinic detailing that the MRI would be paid for by workcover (they refuse – rightly- to undertake any MRIs without prior approval). A week alter I still did not have that 2 word letter.My treating GP sent a fax to my case manager stating that PROMPT approval was needed as I was in terrible pain and the MRI was deemed urgent. Well, it took my case manager 28 days (almost 1 month!) to write me that 2 word letter for the radiology clinic.

My treating specialist orthopedic surgeon recently requested I undergo extensive blood tests as part of an investigation for an infection in my injured limb. The request was filled out by the specilialist surgeon and the slip detailed that the reason for the test was to look for an infection because a (limb) scan had showed some suspicious spots. The case manager from hell refused to pay for the blood tests (amounting to $432) because it was her opinion that the blood test had nothing to do with my injury. It eventually took over 2 months and several “debt collector”letters to have that bill paid. For Christ’s sake!

A very reputable pain specialist/anesthetist had prescribed me an anti-epileptic drug which is also used to treat nerve pain. The case manager again refused to pay for the drug stating that it had nothing to do with my injury. She was well aware that I had suffered a serious nerve injury during the previous [limb] surgery, and for which liability was accepted! In the end it took several visits to my pain specialist and GP to get additional unnecessary documentation (at workcover’s cost) and after 65 days the drug was paid for. Meantime I was struggling to pay for the expensive drug, being poor as hell!

 

These are just a few of the tactics that the workcover insurance industry uses to badger and wear down injured victims so that less money is paid out.

And to a large extent, the industry has been successful!

The workcover insurance industry will do everything possible to withhold fair settlements and deny valid claims until you convince them that you are ready, willing and able to go the limit. But do not be discouraged. You CAN achieve fair compensation for your injuries and beat the insurance industry at their own game. But it may take time and lots of effort.

Hang in!

 

 

 

One Response to “Navigating the work accident war zone: tactics used by workcover agents”

  1. You have to wonder how they sleep at night (On those expensive beds they buy with the bonus cheques they receive by stopping our treatment)

    R soles