Doctor John Costa, National Vice President of Doctors Reform Society, had his opinion and thoughts about the workers compensation published in the Guardian (2006). In his article, Dr Costa states that the system has become a sick system. Profits of the insurance companies are booming, the stock market is booming and the private health system is awash with money while the public system and injured working people are made to starve. We are losing any sense of justice and compassion. The doctor’s role is being demeaned and doctors are at risk of becoming dupes of unscrupulous insurance agents and employers…
Workers compensation is a heartless system
NSW workers compensation: A heartless system
Dr Con Costa National Vice-President, Doctors Reform Society The Guardian 13 December, 2006There is a noticeable sharp decline in the number of people requesting a Workers Compensation Certificate following injury at work. And, if a claim does go in, doctor and patient are inevitably bombarded with telephone calls, faxes and requests for information or a medical report from the insurer and the “rehabilitation provider”. (Rehabilitation organisations are contracted to insurance companies to monitor work injury cases and “assist with work return”.)
Most notorious is the “Case Conference” [in NSW]. These are insurance company scheduled meetings in the doctor’s office meetings include the doctor, injured worker, the insurance agent and one or two people from the rehabilitation provider. The doctor’s consulting room has now become so crowded it’s hard to move or breathe – a stifling and uncomfortable atmosphere.
And Case Conferences can go on for over an hour. (Not a good situation for all the sick patients in the doctor’s waiting room who are already stuck with a long wait because of the[former] Howard Government’s GP shortage.) The patient can end up in tears, the doctor exasperated and the insurance and rehabilitation representatives calmly stating they will be back in two weeks to check on whether decisions are followed.
The doctor has no choice but to go along with this process because, when the doctor signs the bottom of the workers’ compensation certificate, the line above states: “I agree to be this worker’s Nominated Treating Doctor and to assist in his/her work return”. If the doctor does not submit to the insurance agent’s demands, including Case Conference, (or respond to the mountain of paperwork from insurer and rehabilitation provider), all payments to the injured worker, as well as treatment costs, can be cut off as well as the insurance agent refusal to accept the doctor’s medical certificates.
Injured workers are steered towards the company’s doctors at the time of injury, or, where an injured worker insists on seeing their own doctor, insurance agents and “rehabilitation providers” (paid by the insurance agents) try to dictate management of the injured worker to the treating doctor. (It is not well known but the doctor has some rights in the new legislation including the power to change the rehabilitation provider – although few doctors know about these rights and it rarely happens.)
More often than not the doctor just gives up – either complying with these outside forces or simply telling the patient to find another doctor. (Many workers are also not aware that they still have the right to choose their treating doctor – or to change treating doctor where they are not happy with the treatment – but usually too anxious to do so.)
The workcover system gone mad
Recently, a patient came to our Medical Centre because his own doctor was fed up with just such a situation. The doctor didn’t want to be involved anymore because of the harassment.
The injured worker had seen two orthopaedic surgeons – both advised arthroscopy on his injured knee. The insurance agent’s retired surgeon (a retired doctor) disagreed, so the insurers were denying liability for the simple surgery.
Another patient had been seen by a doctor at the airport and told there was “not much wrong” and to go back to work. (She later found out that, without her knowledge or permission, he had also rung the employer immediately after the initial consultation. I found out later he was also under contract to the employers at the airport.) After two or three visits she was unhappy with the doctor’s management (“he didn’t even examine me” was the complaint) and she attended at our medical centre.
After I accepted to take over her care, I was inundated with faxes and paper work and telephone calls and a long period of harassment.
The patient’s file became so big it became totally useless and I had to put it in a special filing cabinet. The same doctor at the airport now took up the role of consultant doctor to advise the employer. He continued to be sent copies of all of the medical correspondence by the employer – even though they had all been advised that she was no longer his patient.
My patient was well educated and a feisty personality. She could speak up for herself. But you could only imagine the situation for the thousands of other workers at the airport, many having less English skills and who may be more easily intimidated by the system.
But it does not stop there!!
Employers are now contracting with their own flying squads, officially called Return to Work Coordinators (RTWC) who can go out and visit the injured worker (and their doctor) as soon as the workers’ compensation claim is received – and the RTWCs have wide ranging powers sanctioned by WorkCover.
RTWCs (usually very young people just out of university who have a few years training on workforce and no medical background) contact injured worker’s doctors to discuss treatment and return to work plan.
(Rehabilitation Providers – who were employed by insurance companies to monitor claims and were originally meant to play an intermediary role between employer and injured worker – now seem to be on the outer and perhaps considered “too independent” and “too slow” by the insurance agents and employers.)
The implications of the further changes to the system were driven home to me last month when I was pressured for almost two hours in front of my patient by a RTWC and insurance Case Manager (neither of whom had any training or background in health care).
The purpose of the Case Conference appeared to be: 1) to get the doctor to agree to hand over their patient’s treatment to the insurer – “because they have allied health professionals all under the one roof”; 2) agree to upgrade the work return program at a faster rate – even though it became obvious that the employer really did not have the appropriate duties; 3) comment on two medical specialist reports obtained by the insurance agent and agree to a further meeting with the case manager and RTWC in two weeks time to check on the patients (and my) progress.
So it has come to this: a state Labor government has introduced changes to workers compensation which give WorkCover sanctioned power to insurance agents and employers to enter the doctor’s consultation room and dictate management and certification of injured workers, while making Medicare patients second class citizens in the doctor’s waiting room.
I asked the Case Manager how doctors and all the patients in the doctor’s waiting room are going to cope with this new situation? She replied that we would just have to get used to it “because this is the future and she has visited doctors all over Sydney and, to date, doctors have been willing to cooperate.”
Medicare or Managed Care
This is not just a bad situation for injured workers and their doctors. It is also what doctors and patients can expect when the insurance companies eventually take over Medicare and gain control of our health system. (Under the US private health system doctors need to ring up the insurance company to get permission before ordering tests or starting treatment and, as with the worker’s compensation system in NSW, the insurance company becomes a constant third party in the doctor-patient consultation.
Under US Managed Care you can’t just go to a casualty or emergency centre at a hospital if you feel sick – you have to ring your insurer and they may simply tell you to wait and see a doctor the next day – or direct you to a hospital all the way across town where the insurance company gets a better deal.)
This article may be six years old, but has anything changed? has anything improved? Nope! Actually Barry the Butcher has now decided to further slash benefits and to make things even harder!
In what world do we live in?
Thank you John McPhilbin, again, for sourcing this article.
Shortlink: http://aworkcovervictimsdiary.com/?p=7524
It’s all about profits and cost containment! The sad fact is the costs associated with ruined health and lives are not calculated – herein lies the moral hazard – it fronts as a caring system but operates like a calculating psychopath.
Robert Hare is a leading expert on psychopaths and here he describes how corporations display the hallmarks of psychopathy.
http://www.youtube.com/watch?v=s5hEiANG4Uk
Sounds like insurance companies and many employers?
Via twitter thanks to @grathom – check out:
The Hon. PETER PRIMROSE: I direct my question to the Minister for Finance and Services. The Premier said last week that “we will make clear in a month precisely what action we will be taking” in relation to the WorkCover scheme. Can the Minister advise the House whether the Government has already made a decision about the future of the scheme?
The Hon. Greg Donnelly: That’s a different question.
The Hon. GREG PEARCE: It is a different question, but it proves that the Hon. Peter Primrose must have been comatose for the past year, and certainly for the past couple of months. I do not know how many times I have said that the Government has decided that WorkCover must be reformed. I do know that I have said it repeatedly. I have said it in meetings with unions—and I have had some lovely meetings with unions—at which they have all agreed that the scheme needs to be reformed. Unlike members of the Opposition, who today have engaged in misrepresentation, distortion and deceit, I have been straightforward and direct.
The PRESIDENT: Order! Members will cease interjecting.
The Hon. GREG PEARCE: Unacceptable practices and unjustified costs exist in the medical, legal and associated services area. I have provided a number of examples of that and I will provide more. In one case a solicitor arranged for multiple medical assessments following an injury to a worker’s left ankle to support a claim for the highest permanent impairment lump sum payment. The solicitor made subsequent claims for permanent injury to the worker’s back, for constipation, for sexual dysfunction and for minor scarring. The scheme paid for more than 10 medical assessments for that worker. [and who would have sent this bloke to those assessments eh? we call that doctor shopping on the part of workcover insurance companies...]
The Hon. Greg Donnelly: Keep going; this is good.
The Hon. GREG PEARCE: It is.
The PRESIDENT: Order! The Minister will ignore the interjections, which are disorderly at all times.
The Hon. GREG PEARCE: The Labor Government failed to address any of these problems. In another example, more than 10 years after the original injury a worker obtained a cumulative impairment assessment of 15 per cent, which allowed him to make a work injury damages claim that his employer had been negligent. That claim cost the scheme more than $650,000, including more than $50,000 in legal costs and about $18,000 in medical investigation costs.
Unlike members opposite, I have not resorted to spin, lies, deceit and cover-up. I have been, as this Government always is, transparent and open in addressing the concerns that have been raised. I have said that the Government will reform the scheme, transparently and openly. We have the figures, which we have released, and we have the actuarial reports. We have told people about the problems and we are continuing to work through them. We are sitting down with the unions and other stakeholders in an attempt to address the problems that make this scheme unsustainable. As I have indicated previously, I would be very happy if those who have any backbone and sense of responsibility on the other side were prepared to participate in reforming the scheme. I also invite The Greens to participate.
http://www.parliament.nsw.gov.au/prod/parlment/hansart.nsf/V3Key/LC20120404035
Via Twitter thanks to @grathom -
The Hon. LUKE FOLEY: I direct my question without notice to the Minister for Finance and Services. In this House on 28 March 2012, in relation to the New South Wales workers compensation scheme, the Minister declared:
In the work injury damages space everybody gets a prize …
What prize did the mother of National Parks and Wildlife Service firefighter Bryce Laut, who died after being struck by a falling tree whilst fighting a fire in the national park west of Kempsey, receive?
The Hon. GREG PEARCE: The Leader of the Opposition in this House is trivialising and politicising this tragic death. Once again, on behalf of the Government, I express my sympathy to the Laut family. These tragic deaths are never acceptable in any shape or form—and I make that point whenever I can. But we have now reached a low point in this House with the Hon. Luke Foley seeking to trivialise and politicise a death. As I have advised the House previously, the projected deficit for the WorkCover scheme is now $4.082 billion and the cost of claims incurred but not reported that are assumed for actuarial purposes is $741 million. Those numbers serve to reinforce what I have been saying. The New South Wales Workers Compensation Scheme is a broken system and without significant improvement it is not financially sustainable.
The scheme actuary has warned that even if reforms are introduced, the scheme performance is likely to get worse before it gets better. Given the examples I have provided in previous days—which were provided to indicate deficiencies and weaknesses in the scheme—I hope that members begin to realise the disastrous state of the New South Wales Workers Compensation Scheme and the importance of reforming this broken scheme. On numerous occasions I have referred to problems and deficiencies in the scheme but I have never suggested that it was inappropriate for a family to be compensated for the death of a worker. For the Leader of the Opposition in this House to so disgracefully scrape the bottom of the barrel and trivialise and politicise a death exposes the Mark Latham of New South Wales Labor for what he is. The Hon. Luke Foley is a bullyboy with a glass jaw who has no qualms about displaying the most disgraceful behaviour.
The Hon. Amanda Fazio: Point of order: The Minister’s comments about the Leader of the Opposition in this House are out of order. The Minister is inappropriately making imputations about a member in question time. The Minister for Finance and Services should be reminded of the standing orders that apply in this House.
The PRESIDENT: Order! The Minister was making inferences about the Leader of the Opposition in this House. The Minister should be careful not to make inferences in his answers.
The Hon. GREG PEARCE: The disgraceful comments and performance of the Leader of the Opposition in this House will mark him for what he is.
http://www.parliament.nsw.gov.au/prod/parlment/hansart.nsf/V3Key/LC20120404018?open&refNavID=undefined
“Unacceptable practices and unjustified costs exist in the medical, legal and associated services area.”
None of which are the injured workers fault – yes the system is broken and doing much more damage than good. I know my own case exceeds the $500K mark. Its took 10 psychiatrists to tell insurers the same thing and then they decided my case was too hard to handle so they ignored my plight!