Compensation bombshell: Maladministration and psuedo-scientific measures add insult to injury: Professor


Gordon Davies, Clinical Associate Professor at the University of Wollongong raised some  extremely important points which were either overlooked or blatantly ignored at the NSW Workers Compensation Inquiry in June this year.

Professor Davies highlighted the adverse outcomes experienced by injured workers as a result of insurance company maladministration and questions the reliability and validity of ‘Permanent Impairment Assessments’.

It is important to note, that despite his referral to psychiatric based assessments, the Professor also alludes to the fact that all AMA impairment assessments in general are questionable and subject to wide variations based on the biases of those assessing – as is often the case when insurers send injured workers to their preferred assessors (otherwise known as doctor shopping).

If taken seriously both of these issues would bring into doubt the whole premise of the recommendations that were eventually passed as well as highlight the fact that the system was already causing significant distress to injured workers and will increase significantly with the passing of new laws.

For example, we know that the central measure used for limiting and denying claims are based on Permanent Impairment Assessments, and as Professor Davies points out ‘ these measures are more an art than hard science and are neither reliable of valid.  So the whole premise being used to manage and compensate workplace injuries are based largely on a lie?  It seems so!

However we now know that insurance companies are free to become increasingly hostile whilst injured workers and their families will experience further hardships that can only lead to negative outcomes for injured workers and their families..

Summary of Professor Davies’ Submission

First that insurers  be required  be required to meet higher standards of administration in regard to timely payments and approval of medical treatment.

Second that the assessment of permanent impairment is not evidence based and has questionable reliability and validity.

Click here read A Prof G R W Davies’ Submission

5 Responses to “Compensation bombshell: Maladministration and psuedo-scientific measures add insult to injury: Professor”

  1. Oh and lets not forget that insurance case managers take it up them -uneducated selves to DOWNGRADE impairment ratings and even court awarded serious injury certificates!

    So even the most seriously injured workers who “qualify” for “serious injury” are still harassed, bullied, lied to and schemed out from being fairly compensated. It seems to me that insurers and their unethical bribed “raters” are more powerful than even our own court system!

    We do know of several catastrophically injured workers who had their “benefits” terminated under the label “malingering” even though a COURT of LAW awarded them a serious injury certificate. In VIC you need a whopping 30% WPI to qualify for “serious injury” and that % is based on the very misleading, non-scientific AMA guides for permanent impairment.

    Is it a wonder that so many seriously injured workers do NOT see a way out of the “system” and suffer massive secondary psychological injuries due to the sheer mismanagement of it all. And, of, course, conveniently “secondary psych injuries” are not compensable, huh.


  2. Thank you John for sharing this important submission.

    As I/ we have blogged ad nauseum, Under the WorkCover legislation physical injuries must be assessed in accordance with the fourth edition (VIC – some states use the 5th edition) of The American Medical Association Guides For The Evaluation Of Permanent Impairment. And that, folks, is the real sh*tty problem!

    Although these Guides are now in their sixth edition, the WorkCover legislation requires the fourth edition to be used. They are just about 20 years old and they are banned in civilised countries such as Canada and the USA.
    The Guides have also been modified by the legislation which basically removes the pain chapter – how SICK! Pain is NOT ratable!

    The Guides have therefore been the subject of significant criticism because they also provide relatively worthless impairment assessments for musculoskeletal injuries particularly spinal injuries.

    The use of the AMA guide (4th Edition) is based on pseudo science and designed to do only one thing: to stop people — especially the most vulnerable — from being fairly compensated.

    Did you know that the AMA Guides state up front that:

    They do not — NOT — purport to be “scientifically valid and reliable”
    Impairment ratings in the guides are “merely ‘estimates’ of impairment” based on “consensus” not “scientific evidence”
    Do not apply to “every type of impairment”
    That “certain conditions (such as psychiatric reaction to pain) are not explicitly ratable under the Guides”
    Should “not be used for direct financial awards nor as the sole measure of disability; and
    Are based “not on science but on ‘legal fiction’, ‘consensus,’ and other unsupported assertions”

    Yet, the VIC Government uses these American Guides, what US Courts have determined as, “arbitrary” percentages to a victim’s injuries

    I happen to be in the possession of the AMA guide book 5th ed (and 4th amendments)(hard copy). I will publish some more hard FACTS about the use of this “guide” over the next few days.

  3. It’s good to see this challenge to the Medical assessments in the Workover. It’s just like a lottery really. If your luck is in and you strike a human being with real integrity and knowledge of their profession, you will get one kind of diagnosis. If you are dead unlucky, you will get one of the Workover’s hired guns who will toss all sorts of unsubstantianted accusations and diagnoses into your report. Really bad ones will abuse you during the process of information extraction for the report, and leave you in a greatly exacerbated condition. Nothing rational about this system. 40 minutes they get to extract information to compose their shonky diagnoses.
    Before I submitted my claim, I began to see a Psychiatrist in the belief that she would diagnose and treat my condition. I saw her 5 or six times over a period of months. Whenever I attended an appointment, I cried all the way home, walking down the street, and sitting on the train. Sometimes I dissociated and found myself in a pokie den hours later. I couldn’t think straight at all when I left her room. I couldn’t understand when I was going to start getting better. I talked constantly about what had happened at work, but felt worse and worse as the appointments proceeded. Finally I asked about when treatment would begin, and she told me: “I don’t do treatment, I do medico-legal assessment.” She advised me to find a psychologist, which I couldn’t afford at that point, and to submit a Workcover claim. I still don’t understand her role in my case, except to make me realise that I was going to be sick for a long time. What I do understand, is that it took at least five sessions for her to feel that she had sufficiently understood all the details of my bullying experience and the level of damage it had caused in me. 40 minutes with an ill-informed (thanks to insurer maladministration) IME who is a total stranger to me just doesn’t cut it.
    Constant maladministration on the part of my case manager, CGU, really impacted on the severity of my workplace injury and has had the consequence for me that at 61 I am struggling with mental illness, unemployable due to the injury and CGU’s failure to retrain me for work that accomodates the disabilities in me caused by the workplace injury, and now, finally, homeless as well. CGU was shown to be engaging in “maladministration” and indeed criminal behaviour when it ripped off millions from the Workover trough in Victoria. Yet, CGU remains a “case manager” in other state Workover systems. When will they have to account for their massive failures to their duty of care for me and every other injured worker who fell into their clutches?
    Having now had the misfortune of being transferred to Xchanging, I think I can safely say CGU are not the only company that is blind to any notion of duty of care to injured workers.

    • Pauline, they are all the same – they are insurance companies and they are only interested in denying claims to increase profits, however in this case they are dealing with injured and vulnerable people and as a direct result of their mismanagement, further injury is caused. A precedent has been set in court (refer Cadbury Shweppes vs Davies).

      All in bed with each other – my hubbies reference to WorkCover’s support of their agents. The Ombudsman’s May 2011 exposure of agent mismanagement, privacy breaches etc also resulted in nothing except fines to the agents, such as in CGU’s case. But these agents pay so much back to WorkCover, that WorkCover keeps them on, doing their dirty work for them. That is why the system is corrupt. A complete conflict of interest. Lets hope the parliamentary inquiry into Work Place bullying is not another complete waste of time.

      I am sorry to hear about your bad experience with the unethical psychiatrist. We go to doctors in the good faith of receiving remedy, not further injury! No doctor, especially a psychiatrist, should cause your tears. I was practically forced after an IME Report to start seeing a psychiatrist, and I read and found one with no negative reviews. I was lucky. I have added my review on him on the website. He knows that WorkCover makes his patients worse. It is really important that you rate the psychiatrist you saw so that others can avoid her. Review the doctors listed and make sure they are not known insurer bitches before you see another one. Sorry I have trouble referring to them as “guns” as this has positive connotations for me, and there is nothing positive about them!

      All in bed with each other! September 25, 2012 at 8:12 pm
  4. Am I surprised? No, it is further evidence the NSW government is getting kickbacks from the insurance companies.