According to tabloids, government, workcover and their agents it is “not rare” to learn that an injured worker who is unable to work, is actually “gainfully employed” while claiming workers compensation and that malingering and corruption is a “significant concern”.
Why on earth would injured workers commit deceit, fraud or malinger?
With 8 years of being trapped in the workers compensation system, I conclude that the system is in fact rorted by insurance companies; doctors and some lawyers! Fact is workcover leeching off the system costs taxpayers far more than injured workers.
Some would have us believe that injured workers are “rorting” the system, and yeah, perhaps less than 1% of injured workers try to do so, but I bet you know how hard it is – virtually impossible to do so!
Take for example the all to common occurring:
- workcover insurance companies shaft injured workers with “their interpretation” of the compensation Act – for example, how many times have you [the injured worker] been sent for an “assessment” with a so called independent medical doctor on the false pretexts that “your own doctor has not provided the information”? Or take for example those injured workers who were assessed has having permanent injuries and have been compensated with a [tiny] lump sum, for those permanent injuries – now why do insurance companies still send you to independent assessments given that you have already received a lump sum for the proven permanent injuries you are suffering? They’re permanent, duh!
- How about case managers and insurance doctors downgrading your permanent injuries? How does that work?
- How about so called independent doctors (IMEs) giving false ans misleading levels of impairment?
- Let’s say you have a back injury – you will be assessed whether there is any loss of use and or permanent impairment of your back. Depending how bad your back injury is you may get 5 or 10%. Most likely insurers and IMEs will go to great lengths to prove that you back injury was in fact “pre-existing” [fact is all people when they get older have some sort of “degeneration” of their spine! That’s just part of getting older.]. You really can’t “fake” it because x-rays, scans, MRIs will PROVE it. So this means that you can’t expect to have a “bruised back” [or leg or arm,…] and expect to be on workcover long term or get a “large” payout, simply not possible.
- Fact is if the insurer pays for an “assessment” or a “report”, then chances are that doctor, rehab provider, etc. is biased. You do not cut off the hand that feeds you. I am pretty confident that all (99%) doctors have either been paid or been told by the government not to give legit (high) levels of impairment
- Medical certificates: how is it that when you are severely injured and end up on workcover long term with PERMANENT injuries, then you still have to supply medical certificates of incapacity every 28 days? Given that the workcover insurer knows very well that you suffer permanent injuries [some injured workers may already have received a lump sum for those permanent injuries] so why is it that further medical certificates are required? Permanent injuries don’t go away, hellooo! So why on earth the need for ongoing medical certificates and ongoing independent medical examinations? Why? Simple, this is a well know tactic used by workcover simply to give you the “sh*ts” in a desperate attempt to return you to work, at all cost.
- Why do case managers organise “conferences” with your treating doctor, even though you have been PROVEN to have been permanently injured? Simply in an attempt to have your certificate of capacity amended folks. Insurance companies don’t care if you are really unfit or unable to work and really don’t give a toss if you were to return to work (under duress) and re-injure yourself. They will blame you for “agreeing to RTW”!
- Did you know that case managers, who for example attend a conference with you and your doctor do so in order to make a case. Check out this very real story: a worker who suffered a bad back injury (and was assessed as 35% total body impairment) attended the required “conference” with his case manager and treating doctor. He was feeling very stressed that he had to attend. He could not obntain taxi travel from the insurer and is simply unable to cope with public transport. So he did the impossible and drove himself (20 minute trip). He took more pain medication so he could drag himself to the “meeting”. In agony he sat in the waiting room for more than 30 minutes. Guess what, the case manager stated to the doctor that “hey, given that the injured worker drove here (20 min driving) and was “able” to sit in the waiting room for 30 minutes straight, he is clearly fit for some work, would you not agree?”. Bang! What are you supposed to do? Lie on the floor? YES! If your pain is so severe that you have trouble sitting in a chair in a waiting room (be it your own treater, and IME or a “conference”) by all means, go and lie on the floor!
- We know of cases where a case manager has made a point that because an injured worker is capable of attending the doctor every month for a medical certificate, they can work! If you happen to drive your car to an appointment, they’ll say you are “fit to work as a courier”!
- And what about “rehab”? Attending rehab service providers and vocational assessments. On most occasions the rehabber will tell you that in order “to participate” you would need to have your medical certificate changed. Then you beg your doctor do this, and start looking for suitable work, which gets repeatedly knocked off because it is “outside your restrictions” or prospective employers do not want to take the risk hiring you. Rehabbers will drag your “rehab” out so they too can make a good buck from workcover. And then, suddenly the insurance stops “rehab” and “vocational guidance” – WTF? Here you are trying to return to work but, sorry mate, see you later, your certificate was changed to “fit for some work” under FALSE pretenses- and you are cut off workcover – helloooo! How many times were you refused retraining? A TAFE course? Then they write to you “because there is no foreseeable return to work for you, we are not prepared to fund this course”. Do they really want injured workers to return to work? But they keep sending you to IMEs to “see if you are fit for work”? Especially when you have proven permanent injuries… duh?
- Provide a home address and chances are someone from the insurance will be videoing you. Have nothing to hide, sure! Walk to the post box and try to bend over to pick up the newspaper and you’re gone! Walk to the corner shop and carry a bag home and you’re gone! They are utter vultures trying to “catch you out” in an ognoing attempt to get you off their ($$$) books!
- Injured workers “rorting” the system? Think again! You may be able to “rort” the system for a week or two, but then if X-rays, scans, MRIs can’t PROVE that you have [semi]permanent injuries a massive “red flag” will be waving at you! And then you would still need to fool the insurer’s doctor and the insurer – and whilst they VIDEO you!
- As you can see it is virtually impossible to “rort” the system as an “injured worker” – and why on earth would you want to “rort” the system? Money-wise its definitely not worth it. Sitting at home and watching a terrible midday movie again? It’s not living! Your bills and mortgage don’t stop, rent, rego is not free so why would you want to love a pauper’s life along with having to deal with a horrible insurance company? Lump sum payment? Forget it, first of all you will be assessed by biased insurance doctors and have your “injury” downgraded if not entirely dismissed should you not have X-ray, scan, MRI PROOF. Furthermore a lump sum is a very small amount of money, the amount set in a table. For a certain % impairment you get a certain amount of money. Even if you were a total write-off you could expect just about $50,000. Most injured workers don’t even qualify for a pathetic lump sum (i.e. no lumpsum if you are less than 10% impaired). Many seriously injured workers get ZERO permanent impairment, because pain does not rate!
- The workcover system has been designed, solely, to force injured workers (regardless of their status/condition) back to work and at any cost. Fact is there are NO provisions under the workcover Act for injured workers who simply cannot return to work because of the severity of their permanent injuries. This is where case managers have been brainwashed and made to believe that, yeah, even totally paralysed people in wheelchairs can “work”, for example they can have a saxophone glued to their mouth and sit at train stations and wait for handouts; or quadriplegics “licking envelopes” to say they are “gainfully employed”. This brainwashing technique simply says that there is no such a thing as a “totally disabled” person.
A little more about the so called injured workers’ fraud
Fraud implies intent: intent to defraud, intent to misconstrue facts and to hide it from somebody to get something. There are quite a few legit injured workers who have been accused of fraud but who just may have made legitimate mistakes. Take for example, a severely injured worker who is asked by his treating psychologist/psychiatrist to reconnect with the world (socialise). The injured worker happens to be religious and decided that volunteering for church on Sunday morning (i.e. helping collect money, light candles, make coffee or sit at a “stall for the poor selling $1 made home scarfs”). Now this injured worker is accused for fraud – how is this person to realise that unpaid volunteering at the church would be “considered work”?
The most pathetic of accused “fraudsters” is perhaps the fact that they may have made a few hundred dollars here and there, and for that they may have been arrested, lost all their benefits and pay back fines! Most “fraudsters” have legitimate claims!
Now what about people who were working and had a little side business selling some goods on eBay after hours? When they are injured the law says insurers can not consider the money they made from eBay sales while they were working to determine the injured worker’s overall wages (PIAWE). Yet if they are still doing that after they are injured, the court, judges, insurers, case managers etc will consider those to be wages (income) and it become a FRAUD problem! Now how does that work?
I still remember the following article appearing in a NSW news paper in March 2012:
A WORKER who claimed tinnitus because of excess use of her Blackberry phone has received $1.2 million in workers compensation over five years under what the government calls antiquated WorkCover laws.
The woman received her settlement and ongoing payments because of psychological workplace stress after the incident.
Another man sustained injury to his finger on his non-dominant hand five years ago, reported the incident months later, and has since received workers compensation, physiotherapy, hydrotherapy, pilates, psychological and psychiatric treatment, holistic treatment and a gym program – valued at $400,000.
A bar attendant who intervened in a fight outside his workplace between two men who were not patrons, suffered minor bruising and has since received almost $300,000 for psychological and physiological trauma.
Finance Minister Greg Pearce’s office rolled out the examples in a bid to show why the workers compensation scheme needs reform.
Mr Pearce said, under the scheme, last year more than $100,000 was spent on remedial massage and $1.3 million on physiotherapy for people injured more than three years ago who are deemed fit to work. More than $440 million had been spent on medical services for people injured more than three years ago who are deemed fit to work.
These cases were exposed by the Finance Minister (Pierce) of NSW….
Now, now, now, first of all I believe these claims are totally false or at the very least grossly exaggerated of misleading. They are possibly completely fabricated in the attempt to change the workers compensation NSW Act.
For this to be true, the injured workers would have to fool their own doctors, but they would also need to fool the insurance doctor, the insurer, medico-legals and then also convince a lawyer that they have a legitimate case, then go to court, sue for negligence and win. I don’t think so…
But, in the remote chance that these claims are true, then all I could conclude is that hundreds of thousands injured workers have missed out on compensation they should have clearly been entitled to! The insurance agents and the government would be BROKE!
These extreme cases above would have to have gone under the Common Law Damages Claim… and yet how come the MAJORITY of seriously injured workers are NOT entitled to a common law claim, but are forced to stay in the workers comp system, with a tiny weekly pay and some medical treatments paid for? So the majority of seriously injured workers are clearly being ripped off, right?
Under Common Law you would sue your employer for negligence (their fault for your injury). You would need to prove that your employer was either negligent or at fault. If successful (rare cases) then you may get let’s say $500,000 in compensation. But for the majority of the seriously injured workers this same injury may only get you $50,000 (lump sum), weekly pay of less than half your salary and then “the pension”. Great isn’t it? Who is being rorted here? Yep, the injured worker over and over again!
It certainly appears that the Act exists solely to protect insurance companies and employers! For example, did you know that you can only proceed with a common law damages claim in NSW before 3 years (from the date of your injury) has lapsed? So, how come? Those of us who are seriously and PERMANENTLY injured – injured for LIFE – can only start common law within 3 years – does this mean employers and insurance companies live in utter fear that one day we may serve them with a common law notice? Is that why the 3 years are in place? I wonder – think about it.
There are other extremely important areas that you need to seriously consider:
If video surveillance demonstrates that the injured worker is working beyond the limits set forth by the authorised /treating physician, why is the injured workers doing this?
- Is the injured worker forcing himself to work beyond physical limits to keep from being bored, spiralling downwards into an even more serious depression, or trying to be somewhat productive in his/her debilitated life? Is the injured worker extending him/herself as an attempt to participate in his/her own work-strengthening? Has the injured worker been encouraged to attempt some productivity every day, despite severe pain (i.e by their treating psychologist/psychiatrist)?
- Or, as case managers appear to suspect, is the injured worker clearly demonstrating a functional capacity far beyond what his physician believes it to be? Think again about the example of the severely injured worker with a back injury, FORCED to attend and sit in a waiting room for 30 minutes.
- Is someone recommending to the injured worker that he/she remains in his residence, not venture out, and be on guard for investigators documenting his every behavior? Would YOU be surprised to know that many injured workers are not only severely depressed, that they have lost their social circle and are socially isolated and that, yes, many have become totally paranoid, constantly looking over their shoulders, because of the sheer fear that they will be spied upon 24/7 and that “by doing someting/anything” the insurer will state they are not as “bad as they portray to be”, they are accused of malingering because they happen to smile at their kid’s birthday party; or worse, that insurers will believe “it’s all in their head”. But, on the other hand, if you do not leave the house, “they” will go to great lengths to state “you are never at home – so you must be working a second job somewhere illegally”…
- Is someone advising the patient to appear as though his limitations are more severe than they truly are? Is it a surprise that, when you are accused over and over again of being a fraudster, milker, malingerer, whatever, and that you are constantly being spied upon, that you may portray your limitations more clearly?
Fact is many injured workers receive a large amount of misinformation and disinformation that results in their making poor decisions.
Such advice most often comes from within and outside the family from those who are truly ill-informed as to what a person needs in life, and beyond finances. This advice comes from the seriously naive position that all of life’s ills are resolved financially and that the patient’s self-image and self-worth have a monetary rather than emotional value.
Those ill-informed, naive people have NO clue, they do not know what they are talking about – for there is no money, or at least, only very little (a lumpsum barely covers your accrued debts, you loss of wages etc) and in order to obtain “that lump sum” they forget to tell you that you will be dragged to hell.
What an injured worker needs to know is that “you may have permanent limitations and chronic pain despite any care that is provided.
Any little money you may receive will eventually be depleted, and you will continue in your life with your pain, disability and symptoms.
[Post pre-dictated and entered on behalf of WCV]