One of the IWSN’s main contributors and veteran of a fixed assessment process, Gail, has some sound advice for all injured workers in NSW, and elsewhere. We know that insurers routinely doctor shop until they get the answers that best suit their own purposes and not those of the injured worker. This advice is especially important given that insurers will soon start the process of exposing injured workers to assessments in order to deny or reduce cost liabilities.
Protect yourself from insurance company medical assessors
What ever the injuries, if you are not improving, then it is essential to get a referral to a treating medical specialist to properly assess your injuries. They can order the MRIs and other tests and once you are properly diagnosed with regard to what your injuries are and you have treatment needed worked out it is much harder for any insurance assessor to overlook this evidence.
Your nominated treating doctor usually knows a good specialist to refer you to and if they write the referral and send it to both the specialist and the insurer the specialist will usually get permission for you from the insurer. If the insurer refuses, then go anyway and use Medicare. Medicare will get their costs back later if you get a lump sum and then you claim it back from the insurer.
It is best if you ring your case manager to get permission for any treatment and keep them fully informed so when the request from the treating doctor comes in they will know.
Make sure you get your specialist to explain exactly what your injuries are and how they will affect you. We used to have a list to read from. Dates of injury, treatment, imaging studies etc.
There are certain things the assessor must ask and do so the more you know the better off you are.
The new assessor information states the assessor must have qualifications in the area of your injury so if you are sent to a colorectal surgeon for a shoulder injury ask to be sent to someone qualified and ring claims assistance if the insurer refuses.
When you see a specialist for treatment they have to write a report to your nominated treating doctor and to the insurer so ask them to put the recommended treatment in the report and ask them to send you a copy of the report.
You can also get second opinions and use medicare if you need to. The more accurate your reports from your specialists the better your evidence is.
You will then have proper medical evidence if you are sent for a work capacity assessment. I f you are sent to a work capacity assessor they can say you are able to do some work you would not be able to do in your area so be really clear about whether or not you think you are ready to return to work and if you be very clear about what you might be able to do. When filling out any forms they give you don’t put down you are interested in something you know will not be possible for you to do.
I know a young woman who put down she liked children and liked people and they said she could become a teacher or a psychologist, completely overlooking the fact that she was in constant pain and could not use a computer due to having one arm she couldn’t use. They also overlooked the four or more years at Uni when she didn’t have any school levels to actually get into the courses. The also overlooked the two small daughters and husband that ran out when things got tough. She also had domestic assistance so how unreal was the suggestion she go off to uni to become a psychologist or teacher when she can’t even put out washing or clean without help?.
The new laws don’t care that there are no jobs they suggest available where you live so be aware of that.
Ask the assessor to discuss what might happen if there is a great possibility of deterioration from a return to work. If your surgeon says you will deteriorate or aggravate your injury with certain types of work tell you must tell the work capacity assessor.
You can now be made fit for work that could never be available in your area and after a certain time without work you lose weekly payments and have to go on Centre-link. You have no legal support for this but good medical reports stating your exact restrictions and injuries can be used to send to the insurer to ask for a review.
We are all on shaky ground. My insurer is at least waiting till I have all my medical assessments from my treating spinal surgeon to decide if I need another medical assessment for percentage of injury before sending me for the work capacity testing.
Good luck, we will all need it to deal with all the extra assessments and God help us all if we all get told we can get a job dusting for an hour a day like my husband was told. He was a mechanic !!
There will be a lot to learn so maybe a booklet could be written to help people once more is known. Lots of people who have had assessments would be able to help with support and advice.
[Workcover victim: whilst virtually all of this extremely useful information applies to all states, it is worth reminding all injured sods that the workers comp legislation varies from state to state. Given that we are staring to cover the whole of Australia, I believe it is important we make reference to the state where the relevant legislation applies, as not to confuse people too much]