WorkCover: an injured worker’s perspective of a sick system

Today I am going to “speak” on behalf of injured workers on this blog.

You may ask yourself what authority I have to do so, as I am only an (ex) intensive care specialists nurse, and have no formal authority from any official injured workers group, or from any other fellow workcover victim individually…

However, I am a seriously injured worker myself and have, most unfortunately, had to experience the difficulties of negotiating the workcover system in Australia for many years, as a result of my personal injury. I have also treated and seen many workers who have been injured or made ill as a result of their employment everyday in my former employment and have done this for more than 20 years.

I have worked in the nursing field (Intensive Care, Day Surgery) for a period of 20 years, and after that spend some years working in the research field in the public health care sector. More recently, before I got the sack, I had gained qualifications as a redesign/improvement manager (lean six sigma), which ties in with the redesigning and improvement of unspeakable, politically-influenced practices adopted by large public health care organisations (including “surgical waiting lists”, “ambulance off loading and clearance times” etc). I believe that my own personal injury,combined with my own experience of the sick workover system and working at the grass roots level with workers, has given me some understanding and insight into the difficulties experienced by injured workers and that my past training in research and in redesign/improvement has given me some critical analysis skills.

During my time as an intensive care nurse and surgical nurse, I have also seen injured workers with the more serious illnesses and injuries, and the more medium to long term injured – we used to call them “the walking wounded of the workplaces“.

The experiences and the difficulties of injured worker’s perspective, from Victoria, and undoubtedly from many, if not, all other states and territories, indicate that the system of workers compensation or workcover, has failed them in a number of unacceptable and various ways.

1. Number of injured workers in Australia

Let’s just have a look at some stats on the number of workers injured or made ill in Australia. The workers compensation authorities deal with only some of these and the figures produced by them really do not reflect the total numbers of those injured in the workplace.

For example, in 2005-06, it’s officially known , from workcover compensation data, that 216000 claims were accepted. From the Bureau of Statistics however, 689000 people reported that they were injured at work during the same period.

So, the question is: why is there such a discrepancy, huh?

Obviously this means that at least 49% of economic cost is borne by the injured worker and their families! Add to that about the same percentage borne by the communities and yes that gives you the “correct figure that 3% of the cost is borne by the employer“!!!!

Even without considering the social cost and adverse effects of the workcover system, the question that begs answering is why do injured workers have no voice in decisions related to the system, and why do employers have so much?

2. Representation of injured workers

Unions (and employee organisations) represent workers generally, but there exists no injured worker association in Australia which can represent what 600-700000 injured workers specifically!

Isn’t it clear that a voice or vocal advocacy is required for injured workers?

3. Unreported workplace injuries

According of the Australian Bureau of Statistic (ABS), injuries in the workplace are under-reported because of:

4. Stigmatisation of injured workers

Stigmatisation of the injured workers occurs in the workplace, in society, in the system, in families, friends and by the community. (see our post about stigmatisation for more detailed information).  In addition to trying to cope with the difficulties of injury (or illness), workcover victims are stunned to find that support is not provided and that there is overt discrimination against them in all aspects of their lives! All this because one day, just like you, we went to work, to earn an honest living, but were injured on the job instead! Tell me, what is it that we have done wrong?

There is stigma that injured workers are not acceptable in the workplace – hence many employers will literally do everything to sack the injured worker, often starting by offering demeaning “suitable duties”.

There is stigma that injured workers are not acceptable in the community – because of the misconception that we are all frauds and “milking” the system, etc etc.

5. Concern for injured workers

There is active discrimination at all levels against injured workers in all aspects and at all stages of the injury.

Fear of loss of our jobs is realistic; fear of inability to get another job is also realistic!

The claims process also leads to complete dis-empowerment and loss of all rights.

In addition, turning to carers and treaters for assistance can sometimes lead to further conflict and despair! The attitude of quite a few GPs and specialists leads to further difficulty in increasing numbers (see below).

There is even, anecdotal, reduced acceptance by some GPs that injuries should be judged to be work-related – just because the GP cannot be “bothered” to deal with the workcover system (i.e. paperwork, unpaid reports, increased time spend with patient etc).

6. Refusal of medical care

There is a trend of increased refusal of many GPs and specialists alike to see and treat patients with work cover claims.

I have been provided consistently with anecdotes of GPs and specialists insisting the work-injured patient leave the practice, the room, threatened and derided.. Many specialists now have their own websites, where they now display, like an ad, that workcover patients are NOT welcome. I have had my own experience too – my case was reviewed by a world-renowned specialist surgeon overseas and he urged me to seek the opinion of Dr X or Y here in Australia. The overseas specialist went out of his way to personally write to Dr X and Y and to basically ‘beg’ to see me – still Dr X and Y refused to see me and did not even have the courtesy to reply to the overseas specialists personal letter! In what world do we live? If you were a doctor and you received a personal letter from the head of the American Shoulder and Elbow Association asking you to please see such as such, surely you would do so as a “collegial favour”! At the very least you would reply- but here, they play Ostrich and prefer to hide their extremely non-human policies “that will no see workcover patients”! It’s disgusting, considering that when they graduated they swore an oath! It’s worse than racism.

There is a increased unwillingness by GPs and reknowned specialists to see workcover patients – so most of us, seriously injured victims, end up with middle to low grade doctors/surgeons and don’t get the treatment we should be getting. No wonder most of us suffer many complications and do not recover “according to plan”.

How would you feel if you were seriously injured at work that you could not even get access to the best surgeons around? But, hey, fall on a footy field and the best surgeons will come running to you! Imagine your daughter or son terribly injured and needing some sophisticated risky surgical procedure? And the “good” surgeon does not want to come near your daughter/don with a pole, just because he/she happened to have sustained that injury at work due to his/her employer’s negligence?

And I am not even mentioning the refusal of workcover to pay for treatment and/or surgery here – that’s an entire chapter on it’s own.

7. Under diagnosis of occupational illness and injury

Lack of training concerning occupational illness and injury as a result of the short training period in medicine and the removal of training in occupational medicine from the clinical role in Australia, has resulted in lack of experience in GPs generally. For example, occupational asthma is one of those illnesses so under diagnosed and some figures indicate that 10% of adult asthma is work-related! This is certainly not reflected in the workcover claims! Same with repetitive strain injuries such as capal tunnel syndrome… etc/

So, if under diagnosis occurs (as it certainly appears to do), the real cost of injuries and illnesses to the worker, the community and also the employer is far greater than “estimated”.

8. Specialist refusal to treat injured workers

In addition to GPs refusing to treat people with work related injuries or illnesses, an increasing number of specialists, particularly surgeons are declining to see/treat patient with workcover compensation claims in Victoria.

In Melbourne a short survey of orthopedic surgeons recently indicated that few were willing to see work-injured patients. Apparently their rationale has mainly to do with the frustrating “red-tape” imposed by workcover agents (i.e waiting for ages to obtain permission for surgery whilst seeing their patient deteriorate), dealing with ridiculous amounts of paper work (unpaid), writing medical reports (also often unpaid) and the enormous amount of time it all takes (meaning that they could easily see 5 normal private patients in the same time it takes to deal with 1 workcover patient).

Moreover, neurosurgeons have also increasingly declined to treat work-related conditions.

GPs, Orthpedic and neurosurgeons said that there were several reasons for not wanting to see/treat workcover patients. This include:

If you consider how frustrating alone it is for us, workcover victims, to deal with the bureaucracy of the workcover insurance companies… I mean, for example your GP request you have medication X, you buy the medication,send the account to workcocer, receive a letter that the medication X won’t be paid for “becasuse there is no relationship between your injury and the medication X” (they are too stupid to look medication X up and read for themselves that although for example it is an anti-epileptic medication,it  also often used to treat nerve pain). So you go back to your doctor (another consultation at the cost of workcover for no reason) and you get a letter written like to a 5 year old explaining that medication X is needed because of Y. You send it back to workcover etc etc. Same with a request for an MRI from your surgeon, sometimes they make you wait (although the law sates that no per-approval is needed when it is prescribed by the surgeon) – it’s happened to me and where the request was stated as urgent! So you go back to the surgeon, who is now also frustrated, he needs to write another letter to get you the MRI (another waste of unpaid time), eventually you get the MRI 3 months later and then the surgeon sees that if you had had the MRI in a timely manner, chances are that the problem could have been fixed with surgery and now it’s too late and you require major surgery. A request for surgery is made and the morons make you wait 6 months and so the vicious circle goes on and on and on…

9. Return to work

There are undoubtedly great faults in the process of arranging a return to work.

The few employers who encourage RTW and voactional rehabilitation are a pleasure to work with, but unfortunately the majority of the employers see the RTW process as burdensome, not even acknowledging that their system of work lead to an the injury (or illness) in the first place! I mean, look at me, I was ASSAULTED by a patient at work because of their stupid negligent practices, and I got punished for it, not only by losing my right arm, but by – like many other injured workers- being seen by my employer (for whom I worked no less than 10 years) as an ex-worker who has to be tolerated until termination of employment can occur without an unfair dismissal claim!

Vocational rehabilitation service providers serve three masters: the workcover insurance company, the employer and the injured person. Unfortunately there is not one dedicated person who advocated for the injured worker alone and unfortunately the information gathered and garnered by the vocational rehab providers is used to further narrow the injured worker’s options, such as cessation of payments as a result of information gathered in what is often seen by injured workers as confidential information. Thus over time the vocational rehab provider has come to be seen as an adversary in an adversarial system by the injured workers. There are a huge amount of gross failures of the inexperienced vocational rehab providers and I could give many examples – in fact I could write a book with my experiences alone!

I have knowledge (from my own and fellow injured workers) of extremely careless assessments, lack of expertise of vocational rehabilitation organisations and pervasive lack of requirement to perform a risk assessment of the duties to which the injured person may return.

Funding of so called training is also restricted to minor and often totally useless short courses which are of questionable benefit. Sometimes “training” is provided just to keep the injured person long enough ‘at work’ so they can be sacked!

The worst ever rehab provider I have dealt with over the years is IPAR rehabilitation – please don’t come near them (remember you should receive a list of at least 3 choice providers).

10. Injured workers and the system of independent medical examinations

I would also like to provide a summary of injured workers’ experience with IMEs. Many injured workers are truly horrified at the attitude at the examination(s) and the content of the IME reports provided. There is common reporting from workcover victims that those IME doctors will see them for 10 minutes (if that), including psychiatric examinations. Some IMEs to not listen to patients and appear blatantly are antagonistic and arrogant. Complaints of insults, derision, rough examination or conclusion reached without adequate examination are very frequent. Most injured workers prefer to be examined by several doctors at once, such as in the case of the Medical Panel.

Again, why are injured workers treated like this? A normal person would not tolerate this, or would you? So why is it that because we got injured on the job, we deserve to be treated like scum?

Obviously a systemic change is needed concerning the role of treating doctors, payment of the treating doctors and the manner in which independent medical examinations occur.

11. Harm of the workcover system to the injured workers

There are many reports of increased difficulty of treatment of injured workers because of the complicating factors of the adverse impact of the sick workcover system on the patients.

Onset of depression is extremely common as a result of the workcover claim process – it has been reported that up to 30% of injured workers will develop depression because of the workcover system itself!!!

So, basically the whole sick workcover system is punitive towards the injured worker.

Isn’t this very much at odds with the original social nature of the workcover scheme? That is: provision for workers who are made injured or ill as a result of failure of the OHS system in the work place?

The lack of social acceptability of those who submit and persist with a workcover claim is inherently unfair. This has been expressed over and over again by all injured workers known to me ” why don’t they understand that I did my best at work and should I be treated like this“. It’s most often said or written to me “I’m just treated like a criminal“.

12. How injured workers manage outside the sick workcover system

Many injured workers avoid submission of workcover claims until all their benefits such as sick leave are used and they have no other option – so for many it’s a last resort!

I have been in the system for 7 years and when I was still (forced) to work I used to take my own sick leave when I needed surgery. I had about 7 major operations in 5-6 years, which means that I never had a hliday during that times because all my sick leave (6 weeks a year) went to my surgery and thus to my work injury. I did this just so not to have the hassle of having to go through workcover and having to deal with those sick case managers on a daily basis!

Thus,when the cost become prohibitive for individual injured workers, when all leave is used up and the job is at risk and then workers have no option but to apply for workers compensation benefits, often at a time too late to save their job(s) and at times resulting in denial of liability by insurers because of the delay.

Short term injuries such as lacerations, sprains and strains are most often not reported as the disadvantages of submitting a workcover claim outweigh the benefits. Some employers will also gladly meet the cost of short term, small injuries as to avoid an impact on their premiums. Some employers pay bonuses to all workers if no workcover claim was submitted! This of course results in nothing more than to demonise anyone who submits a claim! Return to work in such a situation or culture is most often impossible!

13. Termination of employment

Many injured workers have told me that many employers will not tolerate injuries in the workplace and view injuries as a way for workers to access leave. Many inured workers, including myself, have been terminated following a work injury. This is rife in casualised work. One true example: a person working as a window cleaner fell off his ladder which was not secured as there was no means of doing so provided. As the man lay on the floor bleeding, his boss sacked him and asked him to leave the workplace which was difficult to do for him because both his legs were broken.

Injured workers are seen as a liability and not a responsibility.

14. Social disadvantage of injured workers

The injured workers with lesser resources are those who have the worst outcomes. According to the WHO those who have lesser social and economic resources have also poorer health outcomes.

15. Financial harm to injured workers

Financial stress is very common in those injured workers submitting a workcover claim. The effect and conflict with a medium to long term claim can have disastrous financial consequences in our society.

Many injured workers are required to access special benefits for superannuation funds, borrow money, sell their houses, and many end up moving to disability payment from Centrelink (at about $200 odd for a single person). Quite a few injured workers and their families have become homeless and their is also a increase in marriage and relationship breakdowns.

Needless to say that once there is financial strain, the cost of medical treatment becomes prohibitive, and the cost of medication impossible to meet.

What also upsets me extremely is the fact that, although I was injured some 7 years ago and at the time was working as X earning Y, I continued to work for many years (5) after the accident and actually retrained (paid for my own courses), and got 3 promotions over those years, meaning that in my last job Z, I was earning almost tripple than in job X at the time of the injury. So, how come, when I eventually got sacked based on impairment and since have been certified unfit, my weekly payments are still based on my pre-injury average weekly earnings from the time of the accident? At the time of my accident I was also – unfortunately- just finishing a masters degree at uni and worked 4 days a week + 1 day a week full time uni (so they calculated the PIAWE based on 4 days a week!).

16. Legal system and injured workers

First of all isn’t it really sad that injured workers need to hire a lawyer to get what they are legally entitled to? Secondly, most lawyers work on a no win no fee basis, which means that if you have a small case (i.e. small lumpsum) you may not even be able to find representation! Consider that the workcover insurer runs lawyers at the hour,  like parking meters – if you don’t have legal representation, you are squashed. If you do have a lawyer, workcover will probably walk a little less all over you.

And then, many agree that many injured workers have their first experience of the legal system and particularly courts during the tortuous process of legal workcover claims. The process leaves many injured workers harmed and dismayed. Their wish is to obtain justice rather than monetary gain,but those that do are often sadly disappointed by the narrowing of their rights and targeted practices. The procedures for when their cases go to court can be unreasonable…

Some injured workers who also suffer a psychiatric injury may be cross examined for 3 or 4 days without respite…

It really depend on the lawyer and judge you get – one group believes in the all workers are lying and could work if they wanted to, the other group is sympathetic and may not be as critical of  ‘evidence’.