WorkCover Case Manager will use the “shakedown” tactic
This post follows up on yesterdays’ rather popular post…I’m using the word “shakedown” here, because to me it means the arbitrary termination of work cover, coverage, benefits, treatment, etc to see what will happen. Shake the tree – see who falls out. This sort of treatment is foisted especially on chronic pain “of unknown cause” of workcover and road traffic accident (TAC) victims . I feel this is a major human rights violation. Obviously the “unknown cause” stems from the denial and refusal from the workcover insurer’s case manager to approve for the necessary medical tests to diagnose the cause of the pain,e.g such as a slipped or an herniated disc!
What must be understood is that most chronic pain workcover victims in a rehabilitation program will admit they would go back to work if they were starving. Many of them HAVE been FORCED to go back because the non-medically trained case manager has denied them the diagnostic tests, treatment and have threatened them to cease their weekly payments should they not return to work! And, the worst thing of all is, that many are forced to return to the same job that CAUSED the injury (e.g the back pain – the slipped disc, or the carpal tunnel or the shoulder injury)!
The suffering would be, and IS immense but they would, HAVE (to) do it. This natural response to poverty is used by case managers to prove the subject wasn’t really too sick to work!!! This is remarkably similar to a surveillance technique used where pain subjects are offered a generous amount of money to help move a TV (and secretly videotaped doing so; or where they are literally scared or startled out of their wits to show them “jumping”!)
Here are a few real cases of workcover case manager shake-down tactics
Case manager’s medical knowledge is very limited to non-existent but they can make sweeping decisions that have major impact on the injured worker!
An example was an injured worker whose doctor and physiotherapist, (who was unable to do a Functional assessment because the subject was in so much pain), both wrote that the subject was in too much pain to go back to work. The case manager decided on her own to cut said injured worker off because a specialist, working for the insurer, made some remark about how the patient should be “boarded” – a remark which could mean anything. This said specialist did not even touch the patient in doing an assessment. This injured gentleman had a young child and wife to feed. He had no money and lived in a small rented flat. When hist specialist saw him, he phoned said case manager, (bypassing the answering machine and going directly to the manager). When asked why the said case manager made said decision, the case manager started to talk so loudly that the specialist had to point out to her that she was getting out of hand. Then the case manager said that under the circumstances she couldn’t talk to the doctor because things were getting heated (though it was the doctor -specialist- who had to tell the caseworker to relax). The specialist then concluded by pointing out she had just committed a human rights violation.
The worst shake-down (Workcover) case I have heard of had to be a 43-year-old gentleman with a previous back operation, but MRI evidence of a disc protrusion with compression of a nerve root (done within two weeks)– no doubt severe neuropathic pain. He had been unable to work for over a year and he was not a candidate for surgery. He had a heart condition and was on blood thinners. He was told he had to report for rehab or would be cut off. Now as the act is, the insurer had to find a program suitable for the subject so his “program” was static standing and sitting for extended periods. There is no evidence that this is valid treatment – there would be no efficacy in this at all. It amounted to torture, but one of the rehab centers was willing to do it for the continued support and money they got from the insurer. At the same time, the subject was suffering from a bad prostate infection and was up every hour to urinate. He still had to report for “rehab” in the morning; the case was if he was not medically fit then his disability was no longer workcover’s concern and he would be cut off. He found he was getting snappy to the personnel. After angry complaints to the insurer’s case manager, he was eventually allowed to stop this program. He was dead a week later. He stood days of this torture because he loved his young daughter so much that he would do anything for her- and now she will have to grow up without a dad.
And then, if I just look at my own miserable case – where over a period of 6 years I had to endure no less than 7 major arm/shoulder operations with many complications (including a cardiac arrest during one one the surgeries),yet everytime the case manager would FORCE me back to the SAME job without the medically requested, reasonable ergonomic aids. I had NO choice either, I HAD to work, I mean I got to eat, pay the rent, the bills. And what happened? The injury got worse and worse and worse, because I was FORCED to use the arm repetitively, until the arm/shoulder really fell into pieces, until my employer sacked me, … and I am now left without the use my my dominant arm and hand at a fairly young age. The only thing that could help short term is a reverse prosthesis (the thing is so buggered that I can’t even get a normal prosthesis)…. but these prostheses have a very short life-span and then what? All this because the case manager was too stupid to see further than the monthly carrot on her stick, all this because workcover was too greedy to allow me time off to heal,all that because workcover didn’t give a shit what type of work I was doing as long as I was back at work. They have destroyed me, my life, and in a way they have also destroyed themselves – saving what $500 and now facing a massive payout for a young person’s severe permanent impairment, pain and suffering and a life of economic loss.
Yet everyday I get emails and letters to let me know that -AFTER A CAREFUL AND THOROUGH REVIEW- I am denied household help, physiotherapy, taxi transport, massage, any-fu*king-thing. Their cockroach brains don’t think! The more I try to wash dishes, the more I try to make my bed, hoover the floor, mop, hang onto swerving busses and trams, the MORE I INJURE myself, the MORE painkillers I need, the MORE consultations I need (pain specialist, GP, surgeon), the more MRI’s I need (because I rupture more tendons etc), the MORE IT’LL FU**ING COSTS THEM!!!!
These tactics are foisted on sick workcover victims who are in no position to say no. Some of the above tactis are really human rights violations. Some are worse than that. And why? Because we got injured at work!!!
Someone has to go in and clean house and supervise this “institution” so these human rights violations never happen again.
Just an after note: I was cut off physiotherapy 2 years ago “because my injury was not improving” – hahaha! Of course the injury was not improving, for they forced me to work until the entire shoulder broke into pieces, I mean if you don’t have ligaments and tendons, how can it “fix” itself? But what the cockroach failed to see (beside her monthly $$$ bonus for saving $ physio) is that when you stop physio on a buggered shoulder/arm, you make it WORSE. The remaining ‘good’ structures start failing and shrinking, and now my elbow has also locked at 30 degrees (stiff because of wearing the sling permanently) and my little finger is permanently clawed (nerve injury) … Guess what – when I’ll have the final impairment assessment those additional “injuries” (wasted shoulder/arm muscles; clawed finger; stiff elbow) will ADD UP! But unfortunately for me,as a person, it does not help for no amount of money could ever replace my arm, my freedom, my life….
Think about it this way: the insurance company employs “number crunchers” and “risk assessors/managers”. So, let’s say for the 100 injured people they “shake out of the tree”, 80 will be literally cut off and not reinstated (injured workers ARE poor and don’t have the $ to hire lawyers etc to fight every single case of injustice). So the insurance makes a huge profit on those 80 victims who were cut off by any means possible (even by human rights violation, malpractice etc). The 20 remaining victims (if that) who will be left severely maimed for the rest of their lives because of the ill-treatment/mismanagement of their claims will be paid out their due compensation (minus of course the bias from the hired guns). If you add up the numbers, the insurance will still overall have made a huge profit, in-spite of those 20 victims needing compensation – see what I mean. To them it is nothing more than a business and you are nothing more than a number in the overall scheme of things.
Private comment.
I am EXTREMELY grateful for the tips, thank you from the bottom of my heart
Private comment.
Thank you, thank you
Indeed!
I’ve had thirteen years of hell, major back surgery and twice they have contacted two Physio’s to not only cut my treatment but also terminate my claim.
I’m not allowed to see a surgeon even though a recent CT scan is showing the surgical implant is impacting the nerve.
They caused this injury but will never admit it.
I am at a loss as what to do because everyone I talk to gives me the run around.
I’m so sick of continually having to look for a new Doctor, Physio or surgeon because if they support my treatment they are either not paid, asked to cut back or I’m not allowed to see them.
They force you to jump off a bridge
I’ve had no wages for eight years
I’ve had to pay for my own medication for 5 years
Any treatment they approve they delay
I’m not allowed to see my doctor for Workcover
Not allowed to see my surgeon
after ringing my Physio in 2009 I’m with a new one and they did it again I will now need to see a a third in 2 years.
They stall all payments, reports that makes you feel like scum when you see your treaters, I’m sure they say under their breath
Oh no not him again because of all the crap they go through
One physic I was seeing years ago would hear only how they would hold up everything in our sessions and one day when she was treating me she said “you….I’m not even getting paid for you!” my god your suppose to be treating me not add to my trouble…. Why would you put this on a patient instead of chasing the money yourself
Of course I never saw her again
One day the hydrotherapy department of a private hospital came to me to show me the bill to treat me was not paid for 14 months. She showed me how many invoices that they sent and resent and resent.
They have many ways to hinder our treatment and make us feel like crap out there.
That is indeed their only goal: ” to make you feel like crap out there” – so that you GIVE IT ALL UP! Think about it! They want to drive us to DESPERATION so we quit and abandon what little we have left to us in terms of “benefits”. It’s a win-win for them and if they have a 100 people like that, it all adds up to a nice little fortune for them, you see.
Try to hang in and nag them to death – complain to worksafe for everything, your insurer has to respond to you in writing, and believe me, after a while they will start giving in just to get rid of your complaints – it’s nothing more than a “try-on” of their part – suss out how strong you are and what you’ll do. Use strong words in your letters, use exerpts of the Act, threaten that you’ll address the matter with the Ombudsman, with your local member of parliament or that you’ll go to the media.
In fact, I’ll write some sample demand letters and will post them shortly.
Thinking of you
Private comment.
I’ll set up the fund raising tomorrow and we’ll see where it will take us – cross fingers. If you are at all able, it would help to write a few lines about yourself and your situation for the appeal (perhaps email me on workcovervictim@iinet.com.au). If all my readers could donate $2, we could easily get $280 for the MRI… Let’s HOPE. xxx
Private comment.
Private comment.
As I see it the horse has bolted. Workcover commenced as a good way to service injured workers. That’s what they preached to us in the beginnning. On paper it looked like a good deal for both employer and employee. I’ve been on both sides of this scheme. As a small business owner I have had to pay out the massive premiums demanded by Workcover. Then after closing my business I returned to the workforce as an employee to be injured at work. I’m telling you I’ve been screwed both ways. This system only makes money for the government and their insurance company banking buddies. The gap between the wealthy, powerful and average Australian is widening to a chasim when this level of obvious cruelty and abuse is administered, then ignored. There was a regime around in the forties that treated the disabled with a similar contempt. Minus a gas chamber. If the government is truly for Australians stop the abuse! Have the backbone to pull these insurance companies into line.