In this article we cover yet another few “buzzwords” which are guaranteed to annoy the sh*t out of virtually any workcover case manager. The supposedly “lighthearted” (but true) content was provided to us via an informal interview with a former Allianz case manager… So here we go…
Things that annoy the sh*t out of workcover case managers
1. Fibbing about never having had an injury before
Apparently, according to the former Allianz workcover case manager, there is always some distrust between an injured worker and an insurance case manager at the beginning. The reason case managers are distrustful of a “claimant” is that they wrongfully believe that many injured workers are frauds and seeking nothing more than a “free holiday”. Many case managers also believe that quite a few injured workers “make a career of claiming workers compensation benefits”, “yes really”, says our insider!
Many “claimants” also get on off on the wrong foot with a case manager and this is understandable. Many are genuinely scared of the unknown and many injured workers have heard horror stories from other injured workers, and naturally worry that they will not be entitled to certain benefits or that their claim will be rejected.
The former Allianz case manager also thinks that “most people feel that all workcover insurers “share” information on people. That is true to a point”. Case managers will – always -run through the “motions” and do an “initial but thorough background check with just about every claim they receive”. The insurer does this to protect itself against “fear of the unknown” – so they say – but in actual fact they do so to find any way possible to reject liability and compensability for a workplace injury. “This is just part of the initial claim set up”, says the former case manager. “It’s about business”.
The former Allianz case manager also tells us that honesty is her best advice. “Just because you have had an injury that that particular body part, or that you happened to have had a previous workers compensation claim, does not necessarily mean that your claim will be doomed”. The problem is that “case managers are obliged and will snoop in your past medical history and conduct thorough background research on you”. “If they find injuries or claims in your background and you have not shared those with the case manager or the insurer, it will become a big beacon on the radar”.
Her advice is to be “honest” as best you can and to report all previous injuries, no matter how insignificant. That way, they can never ever “blame” the injured worker of “hiding something”.
” Please do not drive the point home by being unable to complete a sentence without groaning in unbearable pain. I understand there is pain, but can a decent laceration, a bee sting, bruise, broken bone be that disabling? Sure everyone has their own pain threshold, and some people can deal with pain better than others deal, but again please just act f *cking normally. There are no Oscars for pain performance”!!!!!
What’s more, many case managers will deliberately sift through an injured worker’s medical reports to see whether a doctor or even an IME has in fact indicated that the pain is in proportion to the injury! If the notes indicate that the pain (as in groaning, moaning, etc) appears out of proportion (i.e the so called Waddel signs), the case managers will believe that the injured worker “is over the top” and will be less likely to believe an injured worker. You will then be flagged as a “malingerer”, she says!3. Demanding 24/7 medical attendant care
Fact is that insurers and as such case managers prefer – at all cost – to use the husband or wife as a carer for assistance with activities of daily living. Even WorkSafe Vic has guidelines about the provision of, for example, home help, whereby it insists that the husband/wife must take care of the injured worker and for free! Obviously case managers will go to great lengths to exploit the use (abuse) of the spouse as a carer, instead of bringing in outside vendor and person to do this work for them, at a cost (labour).”Much cheaper that way”, says our insider.
Some injured workers will, understandably, argue that it is not up to their full time working spouses to care for them (as a free carer) and to undertake all the household work as well as the personal care for the injured worker. Especially, given that most injured workers were in fact doing those duties (or part thereof) prior to their injuries.
According to the former Allianz case manager, “nothing will irritate the case manager more than receiving an account for 24 hrs per day, 7 day per week attendant care”. Obviously this is not reasonable or acceptable. But, saying that we believe that the spouse should not be made responsible to be made the sole non-paid carer (cleaner + attendant) for an injured spouse!
Most case managers believe that if you are not a quadriplegic, you should be able to “care for yourself” or “made to care for yourself” with things such as long handled toilet brushes, a light hoover and a long handled bathroom scrubber!
We just wonder about those injured workers living in remote or rural areas, and even those who live in cities but who are in need of specialist centres of a decent doctor, therapist, etc! How sick to judge an injured worker on mileage traveled!6. Being a “Google doctor”
More and more injure workers, understandably, will “Google” their injury and try and find out as much as they can about their type of injury, treatment and so forth.
Our insider tells us that case managers hate it when injured workers use medical terms or “talk shop” with the case manager (WTF!). Case managers feel very upset when injured workers do so, because “case managers have handled claims like yours for years and they think they know the time-frame and the improvement step to make and when they should be made” – wow, how SICK!
So again instead of this helping the scenario, it is hurting it in the long run. … WTF!
No wonder I have being treated like sh*t the minute I have talked or written about my medical condition, complications or prognosis (and I am medically trained)! And as if my uneducated case manager would know anything about the injury I suffer, hell, even my upper limb specialists has not seen this before. One of the operations he performed on me had only been done once before!!!! And that bitch even had the guts to tell my upper limb specialists that “she did not believe him and that I needed an objective medical examination”! Guess what, the objective examination consisted of an 8o year old (at least) GENERAL surgeon’s old fashioned and clue-less opinion on a mangled arm. A limb that this geezer has never ever operated on either by the way, as he deals with gall bladders, warts and stuff like that. Still his honorable “opinion” was in my favour and a far much worse prognosis was given, inevitably, given that he knew nothing about bionics.
According to our insider, there are other important words that annoy the cr*p out of case managers, and these are so-called “risk” or “risk drivers”. These are the non-injury facts that can contribute to disability and include things like obesity, diabetes, having a young child at home (being off of work decreases daycare costs), not wanting to go back to work in general, pending layoffs at the employer of the injured, smoking, etc. (WTF).
Our insider tells us that for example, if an injured worker is “fat”, the case manager will go to great length to try and blame the injury and consequences on being “fat”, rather than the other way around (fact is many injured workers will gain weight because they loose their job, hobbies, activities etc). [See previous post: case manager tells injured worker she is fat to deny benefit ]. While some risk drivers may (MAY) have a bearing on a claim (i.e drug/alcohol use), most are RIDICULOUS.
So there it is, words, and issues that annoy the sh*t out of case managers. These will never go away, and will probably increase in use as time goes on,says the former Allianz case manager. The system is heavily biased, and that is why I chose to leave and ran as fast and as far as I possibly could.
Updated 19April 2012
— COS Magazine (@COSmagazine) April 18, 2012
Thank you to The Cos Daily!!!