Although a very short article, this painfully ‘funny’ story sums up what workcover really is about. Phil, a pensioned injured worker, who needs joint replacements, uses a walking stick. He needed to have his walking stick replaced… check out workcover Victoria’s response and the mind numbing process Phil had to go through…
Take a stick to workcover Victoria
Phil is a disabled pensioner and Victorian WorkCover pays most of his medical bills.
Phil uses a fold-up walking stick, but they wear at the joints and have to be replaced.
“I rang WorkCover to inquire about a new one and was told I needed proof, so I said my brother is an engineer and he would examine it.
“They said a doctor had to approve the condition of the stick, so they paid for a trip to a doctor.
“The doctor said he knew nothing about walking sticks, but after being charged $150 plus his normal fee for the visit, he said he’d let them know that I needed a new one.
“I now have a new $19.90 walking stick.
This story makes me think of a previous article we wrote about surveillance and case managers – some case managers will request an IME (independent medical examiner) to assess the “wear and tear” of for example your prescribed crutches or walking stick/cane, for the sole purpose of gathering so called ‘evidence’ on whether you are really “using” those devices and whether you “really” need them. How SICK!
A few months ago, an injured worker shared his story about the end cost of a pair of thongs – a simple $10-20 pair of thongs, prescribed and reasonable for his injury was denied at all cost by his insurer. The matter went to conciliation and in the end the total cost of the pair of thongs exceeded $3000 just in conciliation fees (incl. the cost of a dozen medical reports)!
Reflecting back on my own claim, I can’t help but wonder why workcover (Xchanging in my case) happily forks out thousands of dollars in an attempt to deny me legitimate,prescribed and medically reasonable entitlements such as basic home help, personal care, taxi transport to medical appointments etc. Consider for example that Xchanging paid $7500 (at least) in an attempt deny me basic home care – about $2500 was spent on Conciliation (incl. the cost of all medical reports) and a flat fee of $5000 was spent on the Medical Panel. Now, think how much home help $7500 could have bought me (or any other injured worker in dire need of this service)?
Needless to say that my case for basic home help was rapidly awarded at ACCS, however the whole process took me over 11 months. And whilst I was awarded 2 hours per fortnight home help at Conciliation, I felt that this was not nearly enough for a severely disabled person like myself. So, there was no option for the Conciliator than to refer the matter to the Medical Panel and ask the question on whether I could (please) have 2 hours of home help per week rather than 2 hours per fortnight. A Medical Panel referral costs the insurer a flat fee of $5000 and this does NOT include the cost of all medical reports.
I am unsure how the actuaries work out profit versus loss, but I imagine that by denying and stalling legit entitlements to injured workers, they rely on a certain percentage of those injured workers to literally give up their pursuit for (legit) entitlements – SSS – Stall, Starve, Settle concept. Wear injured workers down, bully, harass, intimidate them, use endless “paperwork”, demoralise them, don’t inform them of their rights, then starve them (literally – cut off benefits) and eventually, for those that still have the energy to fight, “settle” for half the legit entitlement (i.e at conciliation) or else, continue the fight (i.e. Medical Panel or court).
A few tips
Our advice is simple and that is not to give up any of your legitimate entitlements, no matter how “small”. KICK BUTT and pursue your rights. If you feel you can’t handle the stress of it all, seek help and support. For example, many injured workers appoint an ‘advocate‘ to deal with it all (this can be a family member, friend, even your psychologist, a professional workcover advocate or your law firm).
You can also request that all correspondence is made in writing and sent to your [advocate, doctor, lawyer] and that no contact is made directly with you. (see our tips collection for sample letters).
We also advise you to use the service of WorkCover Assist [if you are located in Victoria]. These ‘consultants’ are extremely well trained and versed in the legislation and will fight to the death for your rights at conciliation.