Ombudsman 2011 report slams Workcover. What are your experiences with Workcover losing/misplacing your paperwork, delays in payment, etc? Please update us!

This  report and media surrounding it was damning to Workcover, but I wonder… have things changed? What are your experiences with these issues in the previous 12 months since this report was tabled in parliament by the Ombudsman?

Injured Victorian workers are facing a system in crisis, with privacy breaches, lost documents and delayed payments stemming from poor record keeping by insurance firms, according to the findings in a report by Ombudsman George Brouwer tabled in Parliament in May last year. The report slammed the performance of Worksafe and the six big insurers it authorises to manage workplace claims.

The Ombudsman’s investigation was sparked by a nearly 30 per cent increase in complaints it had received over the past three years about WorkSafe and its insurers.

The report reveals many failures in the management of Victoria’s 56,000 active workplace injury claims because of poor record keeping. Bad file maintenance, inadequate understanding of the law by managers and outdated computer systems have all contributed, the report found.

“Many of the complainants who approached my office raised concerns about having to repeatedly submit the same documentation to the agents and delays in service this was creating,” Mr Brouwer said.

In one case, an injured worker had to wait months to receive more than $20,000 in back pay, because Xchanging lost her documents and maintained only minimal records of her claim.

In another case, a worker who required a kidney transplant because of a work-related illness, and was unable to walk to the bathroom, had to wait more than a year for Gallagher Bassett to act on a claim for the costs of home modifications.

Mr Brouwer’s investigation found the agencies had manipulated incentive schemes, delayed payments to workers and mismanaged files. Insurer CGU was found to have hidden about 10,000 invoices in a locked cupboard in order to obtain lucrative WorkSafe incentive payments.  CGU has since been fined $2.8 million and ordered to repay the $2.5 million for the manipulation known as ‘gaming’, which Mr Brouwer said was “clearly improper”. Mr Brouwer’s investigation uncovered evidence that CGU staff, including managers, were manipulating the scheme, benefiting by $2.5 million before the practice was detected.

During interviews with the Ombudsman, workers from CGU admitted some files were binned if they lapsed the due date for payment, because there was no system in place for recording when the account was lodged. This meant the agent would wait for a duplicate account to arrive to process that within the allocated time period, avoiding a fine by WorkSafe and claiming a bonus payment for processing the payments on time.

“If I was a person punching accounts and I have to hit a certain level, that’s checkin in that day, and the timeliness is really thoroughly checked and it’s a tight measure…I could throw a whole batch of those in the bin, walk over to the security bin…and they’re gone,” a manager at CGU told the ombudsman.

WorkSafe has six authorised claims agents – CGU, Allianz, Gallagher Bassett, GIO (no longer an approved agent), QBE and Xchanging. WorkSafe  has committed to modernising its IT systems and holding its insurance agents to account

Allianz, CGU, Gallagher Bassett, GIO, QBE and Xchanging are the insurers WorkSafe uses to deliver services such as weekly payments and medical treatment, with the authority paying the six about $212.5 million in fees last financial year.

The report found that each insurer’s files, apart from GIO and QBE, were in inferior order, lacked contemporary notes of conversations and meetings and were secured poorly. All insurers use a computer system more than 25 years old, while managers showed ”limited or no knowledge” of the Public Records Act.

The report revealed one woman did not receive weekly payments worth more than $20,000 for 18 months until this year because Xchanging repeatedly bungled her case. It also showed 222 reported privacy breaches – including medical records emailed to the wrong address.

Former facilities manager Alex Nicholls, who dealt extensively with Allianz after suffering nervous breakdowns due to workplace bullying, said he was not surprised by the findings.

Mr Nicholls, whose son was suffering cancer at the time, said after his first breakdown forced him to leave his job in December 2009, Allianz did not return phone calls and tried to make the process as difficult as possible.

After his claim was approved, they failed to ensure he was receiving weekly compensation, leaving him without adequate payment for three months. When he suffered another breakdown last year, they again did not ensure he was receiving the right payments.

”They were atrocious,” he said. ”You are dealing with someone’s livelihood.”

Allianz did not respond to questions on these matter.

WorkCover Minister Gordon Rich-Phillips said the government was concerned by the developments but would not say if it showed the WorkSafe board was incompetent.

The Ombudsman has made sweeping recommendations to fix the problems, including annual audits of insurers’ record keeping and the introduction of a modern computer system.

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WorkSafe said in May 2011 that  it accepted the recommendations, but has anything changed? You tell us! What is your experience with these issues since that time?

13 Responses to “Ombudsman 2011 report slams Workcover. What are your experiences with Workcover losing/misplacing your paperwork, delays in payment, etc? Please update us!”

  1. aworkcovervictimsdiary received an anonymous email:

    Case managers often juggle heavy personal injury caseloads

    If you have been injured in an accident, you may find that dealing with your workcover insurance company is a less-than-pleasant experience. The process of how the insurance company handles your claim and communicate with you may seem inexplicable and bureaucratic.

    When a workcover insurance company receives a claim, the first thing that happens to the claim is that it is assigned to a case manager by territory or size.

    Case managers are busy people, and they check their files regularly in order to maintain a “diary” of their cases to try to keep them moving in a timely fashion and not keep any one waiting for too long. However, a case manager may have as many as  two hundred files going at once, which means they may only spend a few minutes per week on a typical claim and may not return your calls, emails, letters right away.

    Case managers are evaluated on the basis of: how many cases they settle within or below their authorised “amount”; how quickly they can settle / close a case; and how little money is spent in the course of settling the case.

    • are we talking about staffing issues anonymous? how is that an injured worker’s problem? It’s not our fault most case managers don’t last, can’t be fun working for a shonky system and those that do want to help don’t have the authority/resources. if the system was effective and truly interested in getting injured Australians back to work the case manager would have means to help in simply one email or one phone call and we wouldn’t have to send 5 emails or make 5 calls for every tiny issue we had. there’s the ‘heavy’ caseload… right back to the cause: ‘shonky system’.

      • Case managers are evaluated on the basis of: how many cases they settle within or below their authorised “amount”; how quickly they can settle / close a case; and how little money is spent in the course of settling the case … so I guess it is in their best twisted interests NOT to reply to injured workers, certainly not in a timely fashion, so that their collective monthly BONUS can be reached! Did you know that they have TEAM bonuses? You’re either part of the filthy system r you’re out. That’s why they are all pretty much immoral….

    • The same happens with scammy and dodgy people working in the customers’ phone support system.

      They are paid for how many calls they receive NOT for how many issues they resolve, to gain more profit they very often just hung the phone and next one please!

      And what a pity anonymous insurer’s employee spying on this blog and not revealing his real name!

  2. in regards to paper work  had conversation with insurer who claimed could not find my current workcover medical certificate and asked for it to be resent. I asked why when I had a transmission report with time and date on it she said that they dont have it. She then proceeded to give alternate number but when i attempted to send it would not go through- turns out phone number given was a private home number.

    i then attempted to contact the insurer but when i did get through my case manager and her manager were in “meetings” and this was the message for rest of day and they not contacted me since.

    with payments they are consistently late – up to 2 weeks which doesnt help my financial situation.

  3. Did you notice that WorkCover calls their case managers now “customer advisors” –  and talks about “advisory services”—- as if! The only advise I have ever received through these “services” is “go to hell”, really.

    workcovervictim3 February 22, 2012 at 3:34 pm
  4. I have been WAITING for urgent home help since the medical request was sent to Xchanging in JULY 2011.

    To date I am still WAITING.

    Some “household help appliances” were approved and “ordered” by Xchanging (in July 2011), some arrived AFTER XMAS and 2 are still outstanding.

    Because the “home help assessment” was undertaken 10 months ago, I now have to be “re-assessed” says Xchanging – thereby delaying the whole cycle and thus “legitimately” DENYING the care/help I am  legally entitled to.

    It drives me insane.

  5. You just caught me “in the act” of having to deal yet with another “if your [workcover] account payment is not received within 7 days, your details will be forwarded to our debt collectors agency for formal proceedings”

    I am sick of this – it’s almost every time – Xchanging NEVER pays for accounts in a timely manner and only AFTER I write at least 3 complaint letters and/or involve WorkSafe – GIVE ME A F*CKING BREAK.

    here is the letter/email I just sent:

    Dear Mr
    I have today received a final warning about an outstanding account (attached) for [workcover imaging] as performed on [date December 2011].
    I have submitted this account three times to Ms [former case manager], and whilst she keeps stating -in a most unfriendly manner- “that the account was paid”, this account STILL has not been paid for.
    The first time the account was submitted was via fax on [date] December 2011 (attached), the last time was via email (via Mr – see below).
    Could you please be so kind as to settle this outstanding account immediately, as the [test/image] is related to the [workcover injury] surgery and Xchanging is liable for this account (see attached email from my treater).
    It really stresses me to be told that the “debt collectors” will be involved. This is not the fist time it happens, Ms [former case manager] has in the past delayed many account payments, incl a [test] account for which I received a debt collector phone call and for which I had to involve WorkSafe.
    Could you please be so kind as to confirm that the account has been paid.
    Thank you very much
    workcovervictim3 February 22, 2012 at 2:52 pm
  6. Hi, yes, we regularly “never receive” email and expense claims. It’s what we do well.

    We know that most claimants don’t bother to follow-up and so it helps us achieve our team bonus.

    Thanks for asking suckers!

    Claim Managers Coalition February 22, 2012 at 2:46 pm