Browsing through more submissions I came across this classic statement of fact:
The Case Managers, employed by the Insurer, and the Return to Work Coordinators have the right to withhold treatment recommended by specialists, or to over-rule evidence based treatment based on thorough medical knowledge.
Bravo to Professional Health Partners P/L for telling it like it is. You can tell from their ‘General Overview’ that they are not impressed. Join the CLUB!
The current scheme is unwieldy, expensive, inefficient and not meeting the needs of the employers or the injured workers.
It does not meet the needs of the medical professionals trying to restore injured workers to good health and to provide an expeditious return to the work-place.
The Scheme currently has many Insurance Companies working under the umbrella of Workcover.
Each Insurance Company has its own bureaucracy, from Boards of Management to frontline office staff. They work through Case Managers (who typically have no formal medical training) and return to work coordinators. These typically work for a third party Company, and also seldom have any formal medical training. The Case Managers, employed by the Insurer, and the Return to Work Coordinators have the right to withhold treatment recommended by specialists, or to over-rule evidence based treatment based on thorough medical knowledge.
The problem becomes more absurd in that the Insurer, Case Manager or Return to Work Coordinators often change, without notice.
The Insurance Company changes with amalgamations and takeovers, or when employers change Insurers, the Case Managers seem to change within Companies without reason and it would appear that if the Return to Work Coordinator works too diligently on behalf of the injured worker then the Insurance Company replaces them with someone who works more in accord with the wish of the
Advice from the most senior Medical Staff in the country can be overruled by Case Managers, and often Orthopaedic or Neurosurgery is delayed or never done on the whim of a Case Manager “who decides that it is not necessary.”
Insurers regularly use Medical Advisers that are known to provide reports favourable to the Insurer. These appear to be used to prevent reasonable care to injured workers, especially if the injury is complex, or has been ongoing for a significant period. They are often flown in to an area from afar, see a large number of people in a short period of time and then leave the region. Alternatively patients are directed to travel inordinate distances for a consultation, with all reports and
radiology. They are usually advised “I am performing this examination on behalf of the Insurer and I am unable to discuss any of my findings with you.”
In the event of an adverse report this does not allow the injured worker to contest the statements effectively.
It would appear that many medium sized businesses choose to pay the fees for injured workers themselves, rather than transferring the cost to the Insurance Company because the long-term penalty to the Company’s premium is much more than meeting the cost themselves.
This seems to be a ridiculous situation, but certainly it would fit with the Workcover objective of cost containment.
Insurance Case Managers and Return to Work Coordinators have a policy of returning injured workers to a work-place, even when it is impractical. A person who works as a heavy labourer in a sawmill or a coal mine is unlikely to be able to be gainfully employed in those positions with a serious injury, yet that is exactly what is attempted. When this fails, there is often a statement in relation to retraining. But the retraining is often unrealistic. A hard working saw-miller is unlikely to be able to cope with retraining as a computer technician or as an
office worker but these seem to be the first options considered.
I have been notified twice in the last fortnight that injured workers have been advised that they should seek retraining at their own expense and that on commencement of retraining they will be transferred to Centrelink payments, and their compensation would cease.
This is hardly motivation for an injured worker to attempt rehabilitation along a new career path.