Don’t become the victim of a workcover insurer “Doctor Shopping”

If you have been injured at work and have made a claim, expect the workover insurance company to require you to see one of their doctors for examination. These doctor reviews are also called independent medical examinations

This of itself is not a problem…in fact it is quite reasonable for the workcover insurer to have you examined by one of its doctors before it agrees to pay your claim or, sometimes, to continue to pay your weekly payments or for “reasonable and like medical services”.

When Workcover goes doctor shopping

What is unreasonable, however, is when the workcover insurance company doesn’t like its own doctors’ opinion and it arranges for you to be seen by yet another of its doctors.

Although the law is very vague and states that the workcover insurance can send you to an independent medical examination from time to time or at reasonable intervals, most lawyers agree that this means about one (1) IME per year on average. When you believe that workcover is requesting you to attend too many IME’s, you can reasonably refuse to attend an examination, but you need to contact your lawyers (or WorkSafe) just to make sure – because the law also states that if you unreasonably refuse to attend an IME, they can cut off your weekly payments.

Some insurers will continue this process until they receive a doctor’s opinion they can rely on to refuse to pay your claim or benefit..we know this as “doctor shopping“.

Don’t wait to contact Worksafe or your lawyer before you have already attended numerous doctors for the workcover insurer…and the damage has been done!

Don’t let this happen to you… if an insurance company contacts you for the purpose of attending yet another one of its doctors for examination, contact WorkSafe or your lawyer  immediately and they’ll let you know if you are required to attend the appointment.
You may also be interested in our post on how you can best prepare and protect yourself during an independent medical examination.

In my own case Xchanging (workcover insurance) went on a massive shopping spree

Over a period of 14 months I was sent to no less than 5 independent medical examinations AND one (1) vocational assessment AND two (2) medical panels!!!

July 2010: IME Shrink A

opinion part 1 (click to enlarge)

 

opinion (part 2)

 

July 2010: General Surgeon

Note: whilst I have a very serious and extremely complex orthopedic injury to the upper limb, which by the way also involved transplants, it is quite strange that the insurance company does not send me to at least an orthopedic surgeon! A general surgeon mainly deals with internal organs, mainly bowel (guts), gallbladder, appendix and small stuff such as warts!

Opinion (part 1)

Whilst this geezer (excuse my language – hey he was at least 80 years old, deaf and short of breath!) was reasonable, you can see his bias towards the insurance in the 3rd paragraph. He writes that whilst my wrist and hand (should be entire arm, wrist, hand and fingers) were cool and cyanotic (=blue), he feels that this is due to the arm being held dependent and not because of the RSD (aka CRPS) or a vascular problem. Now the fool gives himself away already cos in paragrpah 2 he writes that I use the sling for great lengths of time (always actually) and therefore my elbow has become stiff (movement only at 30 degrees) – so if my arm is kept in a sling (also at the time of the assessment) how come my hand and wrist were cold and blue? Prick!!!! Also, more importantly the insurance company had of course not sent him my pain specialist’s reports – where I am clearly diagnosed with SEVERE RSD/CRPS but they also omitted the surgical report that I had had an EMERGENCY decompression for a blocked subclavian artery (just above the clavicle in the neck) because of that shoulder injury. You see what I mean – typical ‘whore’s report” indeed.

opinion (part 2)

The geezer goes on to state that “I am confident to return to work” – (oh yeah? since when) – but that I have a semi-useless member, which should read useless and he goes on to write that this arm needs to be fused… Whatever.

opinion (part 3)

So, now the geezer writes that I “have a GROSSLY PAINFUL, UNSTABLE RIGHT SHOULDER”… OK, that’s correct – now you tell me that I am confident that I can work with this? He may have forgotten (not in his report though) that I got the sack a few weeks earlier because of my “impairment”…

opinion (part 4)

What’s it gonna be mate, fit for work or not – here he writes that I am currently unfit but earlier on he said that I was confident to return to work.

December 2010: Shrink IME B

Note: interestingly workcover does NOT send me back to IME shrink A, although he clearly requested in his report I be re-assessed 3 months later – this is already proof of doctor shopping !

opinion (part 1)

This shrink was a nutter and a real hired gun. She had no respect whatsoever for my physical injury, which by then had deteriorated to such an extent that further major surgery had been requested. The entire back of the shoulder ruptured as well as the rotator cuff! Volunteer work – you fu*cking mad or what.

She was the cow who wrote that the cause of my depression was because my mom and dad had not visited – for christ’s sake!

So, I am certified unfit (legally) by my GP, specialits orthopedic surgeon, IME shrink A, the Geezer (above), even this cow writes that “she is incapacitated for work BUT”… but I have to undertake volunteer work… yeah – up yours 😉

August 2011 : Shrink IME C

Note: workcover wanted to send me back to shrink B but I blatantly refused to see that cow ever again – she was extremely rude and some of the things she dared to write about me were such a big fat fabrications — anyway, my lawyer got onto it and I was allowed to see shrink C instead.

opinion (part 1)

This shrink was really really nice and by far the best IME I have ever come across – decent and HONEST. I have even send him a thank you card.

opinion (part 2)

 

opinion (part 3)

See how workcover tried it on here by asking about “the other factors affecting my recovery”? (the story about my parents not visiting). They are just vultures, pond scum and should be ASHAMED of themselves.

opinion (part 4)

Thanks IME – and PISS OFF workcover – gimme a f**king break!

September 2011: General Orthopedic Surgeon

Finally, wow, couldn’t believe it, they were sending me to an orthopedic surgeon! First time ever in 7 years! Workcover still lied though, for in their request letter they wrote to me that this orthopedic surgeon was an UPPER LIMB orthopedic surgeon – well he’s NOT (I checked with the AMA!). This doctor by the way is at least 86 years old. It is important that you also know that they send me to this guy also for an “independent surgical opinion”. Now the insurer did NOT send the previous surgical reports to him (they only sent 1 shrink report!) and, in addition, this man, however “nice” he was, does not operate on shoulders. On top of that I was to attend the medical panel 3 days later for an impairment assessment and for that I signed my surgeries away! I agreed (and it is my wish) that I would not have any further surgery for the foreseeable future! How dare they ask for a surgical opinion under those circumstances?

Graduated in 1955 excuse me!

 

opinion (part 1)

 

Opinion (part 2)

 

pinion (part 3)

 

So, tell me, what is it that they want from me for God’s sake? How many independent examinations must I undergo?  I am starting to feel like some wild animal in a zoo!

How many times does the wokcover insurance need to read “HE/SHE IS UNFIT FOR WORK /HE/SHE HAS NO CURRENT WORK CAPACITY”???? before they will accept it? And that’s just IME’s – we’re not even mentioning my own treater’s letters, reports, requests for major surgery, explanation of catastrophic deterioration of the shoulder etc.

4 Responses to “Don’t become the victim of a workcover insurer “Doctor Shopping””

  1. The goverment should decrease the legaslation.
    Put professional trained staff @ 1st contact.

    Don’t have JNR staff at such a stressful position.
    Agency just stand over them.. Arn’t they a joke..
    Simple logic — bring back the C E S ..

    Tidy the system up..
    There tripping over there bullshit.

  2. Whats the change of a stress claim Against WC qld..

    First claim – now a googled DIY EXPERT.
    – Workplace / labour hire / medical
    – Workcover LAW in your face and they pull this stunt. WTF.

    Workcover lose the plot

    – 20 day limit reached,

    – Claim boy says —
    $3000.00 common law accept in mail..
    -Sorry taken so long Blah BLAH BLAH…
    – Letter sent day before afternoon.

    – i asked about faxing it, how long till $$$ in bank..

    – Call back next day, state no letter..

    – Claim Boy – goes what letter, no decision been made.

    All medical (GP) say soft tissue RT hip – no work – injury and worker description ok.
    – Pushed for MRI but WC qld, was too messy.. INSANE

    Soft tissue HIP. woke up tuesday morning.. Its was fuked.. Couldnt walk on it.. It locks up, Cant sleep – it would lock up with sleep Rollovers.
    Agency, claim desk boy, his supervisor, WC injury specialman-

    1ts not a work injury..
    Ha. first claim and it leads too a now argue with your law..

    – Did the reasearch, due too not getting a straaigh answer.

    – Claim boy always lost with details.. I called 3 times a week.
    __ First claim — Newbee..

    Health & Safety
    – Awkward body postures place joints away from their natural position (such as a bent back, a bent wrist or arms raised above the head). Awkward postures require more muscular effort to do a job, leading to fatigue and potential injury.

    I state-
    — Notch Machine – had to lean forward, pressing movable foot pedal. Very Repetive

    Health & safety
    – Fixed or static postures can also be harmful because they keep part or the whole body in the same position for a long time (such as standing on a process line or bending the back to lay concrete).

    – Pre Assemble – with rubber & mohair (stand still work), at a work table.

    Then the job agency are a rouge company.. He’s GONE..

    GOOD LUCK WITH YOUR system review WC qld.
    I might email the minister for justice.
    __ YOU GUYS ARE SICK –> its a AWESOME LEARN..

    FUK

  3. Seems to me that Xchanging needs to be stripped of its license to operate in Victoria.

    • The question is how do they justify spending $5000 on IME’s, some of whom would undoubtedly laughed at in a court of law? But when I ask for $40 worth of home help, it is DENIED to me, or 1 hour massage to help alleviate agonising spasms worth $25 it is DENIED to me and so is a 20 min physio session (in fact all phsysio got TERMINATED) – whilst all reports are pretty consistent in 1 thing and that is that I am pretty “fu**ked” physically (+secondary depression).

      Thank you, workcover (aka cover-up-works)

      workcovervictim October 15, 2011 at 2:27 pm