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 airIf 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.
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
- To learn more about how Medical Panels work, how they assess you etc, please refer to our article “Medical Panel or Judge?“
- More abut Conciliation: going to a conciliation conference for your work injury
Shortlink: http://aworkcovervictimsdiary.com/?p=9411
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 pay workcover. Then three months later, they cancelled it and am forcing me to go to conciliation This has caused a major setback to my recovery as I now have financial stress on top of my previous condition. It feels like ground hog day everyday as I can’t go out of the house except to the supermarket, my sons golf course and for a walk around the block without a member of my family.
I applied for concilation over six weeks ago and there is such a back log I still don’t have a date. The whole family is now under stress because we only have my husbands wage to cover all our bills. I went from 80K per year to nothing. All our credit cards are maxed and I feel bullied by the insurance company that said they don;t have to take all medical reports into consideration and they chose to go with their specialist and discount any of my doctors reports.
I can’t work as I struggle to concentrate, do day to day tasks like even shower and am fearful of walking out my front door.
Workcover has been taking my money my whole working life and when someone needs it and has a legitimate claim they force it to go to conciliation in the hope it all becomes too difficult. No wonder the system has a back log. Why do that to someone who is suffering from a stress related condition?
We are desperate and if something doesn’t happen soon who knows we might have to sell everything we own.
Tracy
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 injury – but of course referred to it as “adjustment disorder”, not PTSD like my treaters diagnosed. The IMEs they use are semi-retired and/or outdated as far as latest medical research. The IME said I was OK to go back to the bully employer – no mention of treatment or changes to workplace. Insurer knew employer was hostile and wouldn’t ever let me back after lodging claim, since he also had stated this in writing, so insurer got the dodgy IME to write another report to state it was ok for me to go back to “any” employer – again no treatment suggestions, nothing. Went to ACCS and then Medical Panel. ACCS do not have power to make decisions – especially when it is a “medical dispute”, which is most of the time, so after Medical Panels disagreed with the dodgy IME and of course that was 5 months later on no income and I was worse, the insurer had to back pay – but no interest to cover my maxed out cards etc. No interest because it was a “medical dispute”. So basically this is why the insurers do what they do – nothing to lose and in my case they kept my payments in their bank account for 5 months and earned interest on that amount while I was paying interest on my cards trying to survive. Oh, even though Medical Panels decision is binding, insurer waited the maximum time (2 weeks) to pay me before they would be penalised for delay, because in their words ” had to see if they were ok with the panels decision”. They really think they are a law unto themselves.
One thing I’ve learned is that it is not personal – insurers bully systematically and get away with it most of the time due to the weak/vague/unfair legislation in place. It is not about a safe sustainable return to work, for the insurer it is about getting injured workers off the payroll.
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.
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 though I am 47 I still try to see the good in people. At first with PTSD you loose touch with reality or a least I did and was at my doctors saying my husband abused me. I went totally loopy and it wasn’t till I had exhaused every avenue I could seeing three neurologists, going to three different hospitals, have MRI and CT scans, blood tests you name it, and then my boss coming to see me to tell me they were going to pay me, that I realised this was trauma, even though the doctors had said it was psychological from the first visit to hospital. I just didn’t want to admit I had broken as I was always someone who picked myself up and dusted myself off and got on with things. And then I went to see the insurance companies appointed independent psychiatrist who saw me for all of half an hour and didn’t wnat to know what had happened just the symptoms of what I had at the time. He then approved of it only to turn around and say because I was on steriods and had a arachnoid cyst (which by the way tested negative to have caused the condition) they were cancelling my claim.
Then the fun (sarcasm) started.
Tracy
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 it and plan for it. Keep going forward with your treatment too as leaving psych injuries to fester makes them much much worse. Ten years later, I’m unemployable, still suffering ptsd and Major Depression, homeless, and fighting with the Insurers for retraining to help me return to work.
@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.