Surviving WorkCover: some more tips

A while  ago I posted an article called “survival guide for injured workers“, which contains quite a few handy tips and information about entitlements etc. Further to that article, here are a few more handy tips and tricks on how to survive workcover, mainly directed at long-term and/or permanently injured ‘workers’.

If you suffer a permanent work injury, or an injury which has long-term effects, it can have a major effect on your quality of life. Dealing with your injury and its effects can be extremely stressful. Negotiating your way around a very complex WorkCover system, dealing with your employer, the WorkCover agent, rehabilitation agents, doctors, “independent” medical examiners and, at times even lawyers can be mind boggling!

 

1. Maximise your recovery

Your highest priority should be to maximise the extent of your physical and psychological recovery. And for that high quality medical treatment is essential! WorkCover must pay for all reasonable treatment costs. This includes psychology treatment/counseling! (Just ask your GP for a referral and WorkCover must pay for the reasonable cost).The most critical issue is to make sure that you are getting the best quality medical treatment possible. So do your research first and seek out a reputable doctor/specialist/physio/psychologist/psychiatrist that is willing to take on WorkCover patients (although quite a few refuse to treat workcover patients, this is unfortunately an ethical matter which we cannot influence; although saying that, I have personally managed to be accepted by two highly reputable specialist (1 pain specialist and 1 orthopedic specialist) who do not normally take workcover patients, by writing directly to them and making a case).

Dealing with busy medical practitioners and specialists can be very difficult but it is important that you are able to discuss carefully all the treatment options that might be available to you and the various advantages of each option. If you feel that you do not get the opportunity to discuss these matters freely with your doctor there are a few things you can try to do.

  • When you book an appointment specifically ask the doctor’s receptionist for a long consultation so you will have an opportunity to discuss these matters. WorkCover will cover the extra cost of the consultation for this purpose. Also, from experience, to avoid grumpiness from my specialist surgeon, I always ensure I am booked in as the last patient of the day (in case workcover paperwork is involved – I mean, you know what it’s like…)
  • It often helps to make a note (write down) of all your questions  before your appointment so you don’t forget what you had to ask/discuss. Also please don’t feel ashamed in bringing out the list of questions at the consultation and working through them. It will actually save time (as you will not be distracted or side-tracked).
  • If you are consulting specialists and they recommend serious treatment such as surgery, discuss this with your treating GP and discuss the possibility of obtaining a second opinion before you commit to surgery. You are fully entitled to obtain a second opinion under WorkCover. Also, remember that you  have the right to obtain medical treatment from the medical practitioner of your choice, and that you can change to another treater whenever you like too.

Ensure  that your doctor is prepared to deal with WorkCover as this can be very important in making sure your entitlements continue to be paid smoothly. If you are a long-term patient of the practice this is usually no problem.

Some doctor’s surgeries have notices which make clear that they do not deal with WorkCover.

Other doctors may communicate some ‘irritation’ or ‘grumpiness’, to you about having to deal with WorkCover. This is because payment of medical accounts by WorkCover can sometimes be slow. They also have to spend a lot of time withyou or time  preparing certificates and writing reports for WorkCover, for which they usually are not paid. So, being irritated with having to deal with WorkCover is perfectly understandable!

Some doctors also become worried about the (slight) possibility that they may be called to give evidence in your WorkCover case.  If you think that your doctor is showing too much ‘irritation’ or frustration, try to have a frank chat about workcover and explain for example what you have to deal with on a daily basis, and ask the dotor if there is anything you can do to help (i.e. by booking long appointments, by being the last patient, perhaps by having an additional phone consultation, perhaps paying upfront (if you can) and claiming back…). But don’t sever your relationship with the doctor, unless you can find an equally reputable doctor who is willing to take workcover.

2. Really understand your WorkCover entitlements

You certainly will have to make many very important decisions about your future. In order to make the right decisions it will be critical to understand as much as you possible about the structure of WorkCover benefits, and even how they interact with your other employment entitlements and your superannuation.

WorkCover is an extremely complex system! The Act of Parliament which governs WorkCover alone is several hundred pages long!  Trying to understand just what WorkCover does and does not provide is really important. Fortunately there are many good and free resources available to help you understand the system.

A good starting point is this blog/ website which contains most frequently asked questions about WorkCover entitlements, as well as frequently asked questions, and a whole resources section where you can find Acts and regulations, Links, Contact, Articles etc . Obviously, and especially if your injury is likely to have permanent effects,  you will need to talk to a lawyer who is an expert in the area. It is never too soon to have a free confidential discussion – even if nothing needs to be done at this time. I personally recommend Shine Lawyers, but that’s your decision.

Other resources are available to you include the  WorkSafe website which contains a very detailed publication called the Online Claims Manual. This contains detailed instructions from WorkCover to its agents on how to handle claims. It also includes very detailed information about the calculation and payment of WorkCover benefits. Remember this information is written from WorkCover’s perspective only. Nonetheless this can be a useful resource for people who want detailed information. Also just have a look below at the “blogroll” for a list of useful informative links.

3.Assess your future work capacity

One of the most difficult areas which you will experience with WorkCover is the question assessing your future work capacity and dealing with issues of rehabilitation and potential return to work. You must always remember that WorkCover will do whatever it takes to get you back to work, at whatever cost, even if your doctor and specialists say you are not fit for work. It’s a matter of liability for the workcover insurance and potentially a massive economic loss damages claim can be awarded to you.

In theory, the WorkCover system is “strongly committed to rehabilitating claimants and providing assistance to enable a return to work” (see above). Rehabilitation, however, means different things to different parties. Some employers are genuinely committed to rehabilitation and a proper,appropriate return to work; however the majority, have no genuine interest in returning an injured worker to meaningful work and so provide only minimal assistance ” to keep WorkCover happy” until they can officially sack you (after 12 months), or will make a case of ‘constructive dismissal’ and make false allegations such as that you are not performing well etc. These employers are usually easy to identify, they use phrases like “we don’t have light duties” or “don’t come back without a full clearance certificate”. Other employers will only make  meaningless and demeaning work available. Unfortunately, in these cases, a return to work can be like a ‘guerilla warfare’ which is, ultimately, aimed at squeezing the injured person out of the workplace. Just browse through some of the comments posted on this blog and you will see for yourself that many injured victims have been unfairly sacked. It also happened to me (after no less that 10 years employment, and even a renewed contract 1 week prior my last surgery based on an excellent performance review). In many cases you can make a claim for unfair or unlawful dismissal or discrimination. But you really need to seek proper legal advice because many of these laws will or may interfere with your potential common law damages claim. For example, should you proceed with an unfair dismissal you may well be reinstated (do you really want to work for an employer that treats injured workers like that?) or you may get a few months salary, that’s it. On the other hand, a sacking may be a goldmine in a case of a damages claim for economic loss because, hey, here your employer (and thus workcover) tells you that you can’t work, see what I am saying…

4.Try to deal well with WorkCover and your Case Manager

 

When you deal with the WorkCover system, the WorkCover insurance company, your claims manager etc., this can have a significant effect on your claim and on your stress levels. Always Keep good records and try to develop a good relationship (where possible!!!!) with your case manager.

  • It is extremely important you to keep good records/notes. For example, if you wish to claim travel expenses you need to be  able to produce details of all your trips to and from the doctors you saw, so keeping a log and the receipts for parking, tram, train fares etc will make life easier. Another example, If there is an argument about your weekly payments because WorkCover alleges that you are not looking for work, keeping a record of all your attempts to obtain work can put you in a much more favourable position (i.e. interviews, phone calles, CVs mailed out etc).
  • Always refer to your claim number when you contact WorkCover . Find out the name of your case manager (sometimes they change like underwear! ) and ask to speak to them direct. If you have a discussion with any other person, always make a note of their name and extension number/email. It can be very frustrating to deal with multiple people over the same issue and to have to repeatedly explain the issue. I personally -and from experience- always and only communicate in writing because I have noted that they will often completely twist and misrepresent/document you conversation.
  • Keep your own copy of all important documents. For example, when you receive a certificate of incapacity, the original should be provided to your employer. It is most useful for you to send a copy to your WorkCover agent and to retain a copy for your own records. This will help to overcome any (and often) delays in making payments to you.
  • When submitting your medical certificates ensure that you complete the section on the back of the certificate about your work activities.  After many years off work, it has happened once or twice to me that I forgot to sign the back of the form because I was in hospital having surgery, and still those bastards would not process the certificate, not pay me, and send the certificate back to me (imagine the delays). It is also useful to try and ensure that your certificates expire on a Saturday or Sunday to make it easier for WorkCover or your employer to calculate your weekly entitlement. This enables weekly benefits to be paid in whole weeks. It still amazes me how often I will receive a different amount each fortnight!!!
  • Try to develop and maintain a “constructive”, “collaborative” working relationship with your WorkCover case manager. The case manager will have to make important decisions about your entitlements. Having a good relationship will be to your advantage. Sometimes the decisions that a claims manager makes can be very frustrating. Losing your cool can backfire as you will run the risk of being labelled as difficult or as suffering from a psychological problem. However, you are entitled to request and receive an explanation of a case manager’s decision and to discuss the decision freely with them, but it is important to ‘keep your cool’. I must admit, I currently (for the past 2 years) have a case manager from hell and I think she is vindictive. I have not been able to keep “my cool” and stopped talking to her after only 1 week. She was then issued with a restraining order by my solicitor which she breached after 3-4 months, when she started emailing me up to 5 times a day. I even asked her nicely and then not so nicely to stop emailing me which she ignored. I have told her on many occasions that I believe that she is compounding my depression and PTSD. More recently she has be requested by my treating psychologist NOT to email or phone me ever again and that all correspondence needs to be in writing via post and that all letters will be opened by the psychologist. My case manager is a nutter. The things she has told and written to me via email are really disturbing. Those things include: that I do not need to see a psychologist or a psychiatrist because I can talk to her (I had just been illegally sacked and was suicidal at the time, no kidding), when she was told that my injury had catastrophically deteriorated (and the surgeon even requested major surgery, home help, taxi etc), she said that she was NOT interested in my physical condition but only wanted me to be psychiatrically assessed,and, hold your breath, that the reason for the assessment was to assess my fitness to engage in rehab and to return to work!!! When taxi travel was requested on physical grounds, she wrote to me (email) that in order to make a decision for taxi travel I needed to be assessed by an independent shrink… etc etc.(also see the post “my case manager is making me sick)
  • If you disagree with a decision, you can indicate to them that you understand that they have to work within guidelines. You can ask them to identify their superior (aka Team Leader) and request to discuss the matter with them. If you still disagree with the decision, you should dispute the decision by referring the matter to conciliation. Many WorkCover decisions are overturned at conciliation. It is also very important that they provide you with a rejection letter. It is illegal just to email you (or tell you) that they won’t pay for this or that!
  • Should you wish to contact WorkSafe to lodge a complaint about any aspect of the service that WorkCover insurance company has provided to you, you can do so via their email address which is service_division@worksafe.vic.gov.au. WorkSafe is actually pretty good and they are very friendly.
  • If you believe that your claim has been seriously mishandled, of course you can complain to the State Ombudsman. This can be a major step so it is important to ensure that your attempts to resolve the issue through other channels have failed. Note: I have been told by a WorkSafe insider that may complaints to the Ombudsman get passed onto WorkSafe – so perhaps first contact WorkSafe and see whether they can help you first.

5. Obtain legal advice sooner rather than later

When you suffer a permanent work injury, it is likely to have many impacts on you, and not only financial effects.It is very important that you obtain proper legal advice with an experienced personal (workcover) injury lawyer so that you can be prepared for some of the issues that may arise as your condition and case progresses. If you don’t have a lawyer, and are looking for one, I personally recommend Shine lawyers. (no strings attached, I do not benefit in any way, shape of form by “advertising” rest assured!) Do your research, for there are quite a few sharks out there that are preying on vulnerable victims like us and I actually know of a few fellow injured workers who have been left in DEBT after having received their ‘compensation’!!!! If that is not fully sick!!! Be very very careful indeed.

I changed over from one law firm to another …. so that is possible to and if your are not happy with your current lawyer, or smell a rat, look around and perhaps check out Shine.

Hope all this helps 😉

If you have any other thoughts, or tips, please share them below! Thanks 😉



This post has been seen 781 times.

4 Responses to “Surviving WorkCover: some more tips”

  1. I congratulate you on a very well written and thought out post. You have provided some very valuable advice there.

    Thumb up 0 Thumb down 0

  2. Thanks for the compliments,but most importantly, I am glad that you are getting something out of it! Thanks again 😉

    Thumb up 0 Thumb down 0

  3. the information posted was a great help very clear advise , however i was woundering if you could help with my situation. iam on stress leave , i have just done a mediation and it is was concluded the workplace was unsafe  for me to return to work , due to the boss being the bully . so therefor the employer cannot give me suitable duites to return to work and i will not be returning there.so how do i exit from the employer, i cannot resign, can they terminate me? or does the case manger organise with this with my employer to terminate me.it is a black hole to get information , please can you help? many thanks .

    Thumb up 0 Thumb down 0

    • Hi Marie

      I am sorry to learn of your ordeal!

      Assuming that you live in Victoria, and that you went to Conciliation (ACCS) I believe that:

      – you need to read this article:http://workcovervictimsdiary.com/2011/10/return-to-work-explained/

      – your employer has a duty of care for you for a period of 12 months from the date of your injury (and cannot sack you as such)

      – If there are no suitable duties available within the company (i.e. different boss etc), your employer and workcover have a duty to offer you NES = New Employer Services. This means that you will receive “occupational rehab”, including a vocational assessment. If you have a capacity to work (certificate) the occupational rehab (under workcover) will source new employment for you/with you and you will be allowed to stay on your weekly payments until such a time as you have a new job.

      – We have dedicated a blog post to you : http://workcovervictimsdiary.com/2012/02/workcover-rehab-and-termination-issues/ 😉

      It may be worth looking at the online claims manual (return to work) , the FAQ what if you can’t return to your job, as well as go through the relevant legislation.

      If you have a union, it is well worth getting in touch with them. Also with your lawyer (if you have one).

      Hope this helps 😉

      Good luck and please keep us posted!

      Thumb up 0 Thumb down 0