WorkCover terminates payments – conciliation or medical panel?

We received an email from an injured worker overnight stating that after he had been sent to an independent medical exam (IME), his workcover insurer called him and cancelled his payments and all expenses on the basis of the IME’s opinion that his injury was not work related. The injured worker’s sollicitor advised him that the next step would be conciliation but the injured worker wonders whether it would be better to go to the Medical Panel to dispute liability….

WorkCover terminates payments – conciliation or medical panel?

The injured worker’s story and question: his own words

Recently I had an IME.  Today I get called advising my workcover is getting cancelled payments & all expenses because it was the opinion of the IME that as I have not bee n at work for 6 months that it is now not an injury from work!!

I tore the tendons in both my arms my orthopaedic surgeon wants autologous blood injections & if no success then surgery.

Is it really the opinion of the medical world that if u sit on your butt for 6 months they magically mend & re grow ? because they don’t.

I don’t know what the best step for me is next my solicitor thinks my best bet is conciliation but I was told it would probably be easier to go to the medical board/panel.  I really have no idea. Friends tell me one thing my solicitor well his assistant as even tho I ring him only she rings back & my union tell me another thing!!

Please any information or advise or somewhere I can get another opinion from would be great I just want them to pay for my treatment & if still unsuccessful surgery but I also need to still be paid I can’t help support my family from thin air
To answer your question: your sollicitor is correct and you now need to lodge a dispute with the Accident Compensation Conciliation Service (ACCS). You have 60 days to do so. The conciliator may be able to resolve the dispute or decide to refer the matter to a Medical Panel or to issue you with a Genuine Certificate of Dispute allowing you to pursue the matter in a Court of law. We strongly advise you to also use the free service of WorkCover Assist for Conciliation.

If I do not agree with decisions made by my Insurance Agent, how are disputes with WorkCover resolved?

When you sustain an injury at work, you can make a workcover claim. The workcover insurance company of your employer (e.g Allianz, Xchanging, Gallagher-Bassett, CGU, QBE etc) is then (or shall I say SHOULD then) be responsible to pay for ALL your reasonable and necessary medical and related expenses, as well as your lost wages (if you can’t work).

However, more often than not the workcover insurer will refuse to accept your claim in the first instance, or will often refuse to pay for certain necessary and deemed reasonable medical and related expenses or weekly payments which you and your treating doctors believe you are entitled to.

The Accident Compensation Act (the law which covers work injury claims in Victoria) states that the first step in resolving the dispute is to go to conciliation at the Accident Compensation Conciliation Service (ACCS)

With  proper guidance most disputes with WorkCover should be resolved without a court hearing. As the injured worker’s sollicitor correctly stated, [almost] all disputes are initially referred to the Accident Compensation Conciliation Service, which will attempt to resolve a dispute in an informal manner.In the above case, the dispute will revolve around “liability” for the injury, that is: whether it is work related or whether work was a substantial contributing factor.

It is necessary to lodge an application for conciliation. You have 60 days to lodge a dispute form and ask for Conciliation.

Lawyers are usually not permitted to appear at most conciliation hearings sometimes they can if for example the matter is about liability of injury), but two excellent and free advocacy services are available to assist you.

Union Assist is an advocacy service for union members and WorkCover Assist is a formidable free service able to help all other employees. If you are unhappy with the outcome of conciliation, you are able to pursue your claim by court action. If the Conciliator is able to rule at the conciliation they will issue with a certificate of outcome.

If you are unhappy with the outcome of conciliation, you are able to pursue your claim by court, however court should be a last resort.

How many reports can I obtain from my doctors for conciliation?

As many as you see reasonable, to address your case. So, basically get as many supportive medical reports from your treating doctors (including Physio, Rehab, Psychologist etc) as you possibly can!

Can I seek for my dispute to go to a Medical Panel?

Referring a matter to the Medical Panel is one of the ways in which a dispute with WorkCover can be resolved. A matter can be referred to the Medical Panel by a Conciliator at the Accident Compensation Conciliation Service. (a matter can also be referred to the Panel by a court and by an impairment benefits Officer at the request of a claimant who is disputing their percentage permanent impairment rating.)

A conciliator will usually refer a matter to a Medical Panel if it is a ‘medical question‘ as defined by the WorkCover legislation. Where there is a major factual dispute, this issue may often not be referred to the Medical Panel as it is more difficult for the Panel to decide factual disputes.This is a complex issue. A decision of the Medical Panel is  binding on the parties and a court is generally required to follow its decision.

Can I appeal the decision of a Medical Panel?

The decision of the Medical Panel can only be appealed on very narrow grounds. It is only possible to appeal the decision if the Panel has made legal error. It is not possible to appeal the decision of a Panel solely on the basis that it came to the wrong conclusion.

Learn more

Hope this helps and good luck to you, mate – keep us posted!
Note: if you have a question about your workcover claim, please post it under “need help with your workcover claim

 

Shortlink: http://workcovervictimsdiary.com/?p=9411

 

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Money Not People
Guest
The purpose of IME’s is for the doctor to find information and to use that against you in favour of the insurer so they dont have to pay your claim.  The IME doctor is not there to provide an unbiased assessment of your injury. The IME doctors role is to find/concoct/invent information which they can use to prove that the insurance company’s policy holder (your employer) is not to blame for your injury, hence the insurance company doesnt have to pay you a cent for your injury. EG.  You are a 50 year old man who fell at work while… Read more »
ithurts
Guest

@moneynotpeople – these are the kind of facts/stories that need to be shown to the media – this is blatant abuse of power that shows the real story – money over what is right for the injured worker. Stories of injured workers who are in no shape (legal education or physically capable) to argue against the insurers who may not be lawyers, but they sure have more experience with Workcover tactics than an injured worker.

Money Not People
Guest
@WorkCover Victim  – I have also heard that the Conciliators in the last year issued about 90 notices of “unarguable cases” in Victoria out of some 6,000+ Conciliation cases.  The unarguable case test is such a low test burden that the insurer’s decision (usually to terminate payments etc) is overturned by the conciliator because it is so flawed. The insurers however are allowed to appeal the conciliator’s decision to the Magistrate’s Court and out of the 90 odd notices, 100% were appealed to the Magistrates Court with the insurer arguing they at least had an “arguable case” – a very… Read more »
Money Not People
Guest

@WorkCover Victim  – I usually save up 3 or 4 gripes and submit an application for Conciliation ever 4 months or so and the conference never happens because the insurer knows they have stuffed up, again !  The Conciliators are toothless anyway.  Their “decisions” are always open to legal challenge which the insurers do all the time.  Conciliators cant “make” either party agree to anything and despite whatever the Conciliator says, the insurer just say “case maintained” so the matter proceeds to the Medical Panel which is where the insurer wants to get you in the first place.

Money Not People
Guest

@WorkCoverVictim, just wondering, do you know if lodging a request for Conciliation counts against a Claims Manager by their company? I have had a prick of a Claims Manager the last year and have lodged some 20 odd Conciliation requests in that time basically for incompetence and have each one settled before the conference in my favour.  Just curious if this would be monitored by the insurer’s technical manager?

Money Not People
Guest

Annie, ask for their view as to why a second IME is needed in writing and immediately lodge a request for Conciliation with the ACCS.  I have found that 9 out of 10 times when you are right, the insurer never goes to conciliation and withdraws before the day.

Bashed and bullied
Guest
Ask your case manager to send you a copy of the WorkCover guidelines in relation to the use of IMEs they are supposed to follow these guidelines so if they are not then immediately make a complaint to their supervisor and WorkCover. I don’t know what state you are in but that is how it works in NSW. The NSW WorkCover Independent Review Officer (WIRO) can take your complaints and as well CAS 131050 can help you. if you are in another state still ask your CM to supply a copy of the guidelines to you so you know your… Read more »
Carol
Guest

If Allianz is involved then they will not follow legislation unless you complain to Workcover and even then good luck.

Case managers and their supervisors at Allianz give themselves bonuses for each claim they finilise, so there is no incentive for them to follow the legislation unless they are made to.

annie
Guest
hope you guys can give me a bit of advice. ive been on workcover for 12 months as i have ptsd from being bullied by my asshole boss. 3 weeks ago i was sent to ime for updated assessment cause i think allianz want to cut my weekly payments off. then this week my claims manager tells me they want to send me to another ime for a ‘supplementary report’. has anyone had this happened to them? I dont get why im being sent back for another ime assessment only 3 weeks apart & why i would be sent to… Read more »
Don't give up!
Guest
Annie, hang in there girl!  You most probably got bullied because you are a superstar and your boss was threatened by you – doesn’t make much sense I know but that’s because most bully bosses are psychopaths with major psychiatric disorders!   As far as your PTSD –  since most IME’s out there go by outdated DSMV guidelines that don’t even mention workplace bullying, you’ll 99.9% of the time be diagnosed with “adjustment disorder”. I worked for a psychopath boss too and and have the same condition, so know what you are going through – although didn’t know about this… Read more »
About Money NOT People
Guest
About Money NOT People
So here’s my story.  I’ve gone past the 2nd entitlement period and was approved some 5 years ago by the Medical Panel for S.93CD payments.  This means I have partially gone back to work but WorkCover is to make up the difference between my current part-time income and my old full-time income.  Once a year the insurer sends me to one of their “doctors for hire” aka IME’s and each year they say no change in my ability to work.  Then earlier this year I see what amounts to the 5th IME since the Medical Panel decision and he says… Read more »
workcovervictim
Guest

@Tracy – so so sorry you too are experiencing the workcover system as it truly is. Many of us, physically injured workers are made mentally ill by the way we are routinely being treated by the insurer – their modus operandi being known as SSS or Stall, Starve, then “Settle”. I can only begin to imagine what it must be like when you suffer from a primary psychological injury.

You may want to consider joining our private Forum, where you can seek more advice and support at this most difficult time.

Pugsley
Guest

Sorry for what you are going through Tracy, I too have been on this merry go round and after 16 months I am still trying to get payments. The lies and deceipt that employers, insurance companies etc, pull to get out of paying you is rediculous. And as for going to their IME dont get me started on the rubbish that happens there. Good luck.

Tracy
Guest
I just want to curl up in a ball and sleep for the rest of my life or better still die and put everyone out of their misery.  I wouldn’t be able to sleep for the rest of my life anyway as I only get four hours sleep of a night time due to the PTSD.  Seven months of sleep deprivation can’t help with my recovery. I thought that because I was honest and sought to see if there was a physical reason for my condition first, I would’t have any trouble.  What a naive little girl I am even… Read more »
Pauline Pope
Guest
I feel for you Tracy, the Workover is really hard on psychiatric injuries, they know how vulnerable injured workers are and they take every opportunity to bully us and give us financial stress. I was left without income and psychiatric treatment for ten months before my claim was forced into acceptance by Medical Panel decision. Still had to wait another month or two after that to get any money. The Claims Manager ordered an IME assessment and surveillance on me before she bothered to back pay me. Try not to get too shocked by the meanness of this system. Expect… Read more »
xchanging also
Guest
hi there, reading your blog I was thinking – this is me!!.  I am on workcover for bullying and harassment, resulting in  major depression, panic disorder, agrophobia and some PTSD symptoms .  Xchanging decided to send me to a IME, after 12 months.  the IME report wasn’t to bad, stating my injury was from work place bullying and would require further phyciatric care for the rest of the year, and that I was unfit for any duties, so then they asked for a supplementary report, the report one month on states that I can return to work within one month on his… Read more »
xchanging also
Guest

also still waiting for conciliation after 8 weeks and hearing nothing, no date, no money, no life!

Pam
Guest
I have been and still go there sometimes….that awful feeling of not wanting to be here anymore and just tired of all the bullshit….I also understand that feeling that they want you to be dead so they dont have to pay you…I too attempted suicide after a Medical Assessment Tribunal decision that found I had a zero impairment…but by the grace of something I dont understand…I am still here…those bastards have taken everything from me…but the one thing I will never ever let them take is my birthday….stay strong….I just went through another disappointment in my case but this site… Read more »
Tracy
Guest
I am currently off work and have been since August 6th 1012.  I suffered a severe nervous breakdown at work.  Initially we sort medical advice and had all the tests done to rule out any physical condition.  all tests proved negative.  It was then I realised with the help of neurologist that this was a nervous breakdown and it then started to make sense.  I have been seeing a psychologist and psychiatrist and am on two type of high dose medication.  Both concur it is a workplace PTSD.  I saw a psychiatrist for the insurance company and they agreed to… Read more »
Corrupt System reigns
Guest
Corrupt System reigns
Hi Tracy Hang in there.  Ring the manager at ACCS to get your date set.  There is a back log because of the way insurers abuse the scheme. I worked for a firm, where I (and many before me) were bullied out of their jobs by one of the partners – a complete psychopath.  My experience is similar to yours in that it was accepted after an 6 week investigation, only to be terminated on a dodgy IME report 3 months later – see a pattern?  Wonder if it is the same insurer/same IME.  This clown said I had the… Read more »