What would a workcover case manager change?

dude-wtf

A few days ago I received an interesting email from my “informant”, a former workcover case manager who worked for some years with Allianz and still remains in touch with some of her case manager colleagues. The former case manager had a coffee-discussion with a bunch of ahhlianz case managers and the topic that came up was “If you had access to a magic Genie who could grant you one wish in regards to making a change in the way workcover claims are handled, be it legal medical, benefits, etc. etc. What would you change?

What would a workcover case manager change?

“If it was me”, replied a “senior” case manager, “I would change the way doctors get paid, maybe have a flat rate schedule for injuries or something like that where the doctors would have some skin in the game, Right now, we seem to incentivise doctors to not make injured workers better – the longer treatment goes on, the more money the providers make” [WTF!]

As I discussed the “topic” with my “informant” we came to the conclusion that

With regards to the response of the “senior workcover case manager”, we don’t quite know or understand what her ‘stake’ is in the workcover system (or in Allianz) 😉

However, as an injured worker,  I can say that doctors (and specialists etc) are not prolonging treatment under the workcover system, …

….and certainly not under the “new” system which is geared to cut of medical and like treatment after 2.5 years (i.e Vic and NSW)

With the endless workcover “administration”, demand for triplicate “additional information”, and workcover agent “treatment guides”, “utilisation reviews” and what-not, our  medical treatment is controlled somewhat effectively, by uneducated, non-medically trained case managers who seem to be above, not only, all super medical specialists, but also above the law.

Let’s not for a second forget that “starve ’em out” is the tactic or modus operandi used by all insurance agents (aka SSS – Stall, Starve, Settle).

The delays result from the medical/legal process and delays in getting Conciliation, Arbitration, Medical Panel or even Court hearings where necessary to resolve disputed medical issues.

And then there are other major issues such as “independent medical examinations” that take an inordinate length of time, further delaying injured workers’ recommended and needed medical treatments. Case managers will happily fork out thousands of dollars for “IME” after “IME” (aka “doctor shopping) in the hope of hopes to obtain a report in their “favour” so they can ultimately try to deny a completely legit and appropriate medical treatment, recommended by specialists in the field.

Then, of course and as is the case more often than not, when the case manager, the “insurance doctor”, the IME(s), the injured worker and his/her medical specialists and the injured workers legal advisors/representatives cannot come to an “agreement” regarding medical treatment, access to the medical treatment for the injured worker is again removed until the injured worker has gone through some more “administration” and a full dispute procedure, which usually involves a referral to a costly (flat fee of $5000) Medical Panel, and which takes months and months!
So the injured worker’s access to resolve a disputed issue…timely as may be the case if the parties could agree in the first place is no longer an option either!

As for change…  my wish would be to get the changes necessary to bring the pendulum back toward the center of things! More equitable to the injured workers.  Get the system fully expedited, the “approval for medical treatment” process, schedule IMEs timely, allow for fast dispute resolutions and, oh, please just don’t go into a full dispute (conciliation, Medical Panel, Court) when you actually fully well know that the injured worker will anyway be awarded his/her medical treatment, etc.

I don’t see any incentive to delay an injured worker’s progress where an office call is paid at about $0….(?) Hardly worth the doctors or the secretary’s time. [Doctors  receive no reimbursement for any time spent talking to employers, insurers or rehabilitation providers!!!]

Keep in mind, whether it’s Industrial/Occupational medicine, or general practice/specialty, medical care in this country is a fee for service system.  Also, as I mentioned above, triplicate (or more) and excessive diagnostics aren’t necessary as the injured workers medical records are readily available in the system. Injured workers doctors and specialists SHOULD be trusted with the presumption of correctness in a treatment plan.

This discussion could go on and on… but that’s my take, as a seriously injured worker on “your request for change”.

Expedite and apply the statutes  as intended. Without manipulation by the parties.

You would be surprised how much money you, case managers, would save your companies and how much faster injured workers would recover and return to work!

Anyways, if you could change something about WC what would you change?

 

[post dictated and entered/transcribed on my behalf]

 

5 Responses to “What would a workcover case manager change?”

  1. Ditto Pauline

    I agree totally – it is a conflict of interest.  The same insurer should not be handling both employee and employer, however, there is also the conflict of interest between WorkSafe and their agents.  Don’t they pay their agents but also get a rebate from them?  It is like they use the agents to do their dirty work.  One face to the public and their propaganda adverts, but really they want to deny as many claims as possible and save $$$$$.  They whole system is a conflict of interest.

    With respect to reference on this website to “case managers”, and the article in this post, I agree but would like to clarify, that from my own experience, it is the other members of the case team, the “Technical (LOL) Manager” and the “Team Manager”, who have been working there for enough time to have forsaken their humanity, who cause the problems, who harass and bully in order to achieve their bonus etc, often behind the scenes making the decisions, while the Case Managers are the frontline scapegoats who deliver the message.    The Case Managers are often young, untrained and bullied into the sick team dynamic and I believe that is the reason they often change.  Many must realise what unethical places they work in and get out.  I’ve had one only case manager who was the direct culprit. The only apologies I’ve ever received was from case managers powerless to stop the orders coming from above them, from those who do think they are above the law, know more than the doctors, and that threat all claims as suspect, and all doctors with disdain, because financially it suits them to do so, especially since money & ego has replaced their souls.

    • Right on Disgusted. As I see more and more of its ugly bones, I think Workover is riddled with conflicts of interest, some built into the law, others residing in policy, and all of them disadvantage and harm the injured worker.

      Here’s a vomitous quote I just had to copy from the Victorian Worksafe annual report. this year:

      “The number of common law lodgements and associated legal costs increased more rapidly than forecast. Plaintiff legal costs in particular have been a high growth area in the past and we introduced a Fixed Cost Model this year to address this area of our liabilities. The Fixed Cost Model enables us to provide plaintiff lawyers with predictable and fair remuneration for a successful or well-managed application. We will keep working with our legal and other stakeholders to ensure common law benefits remain sustainable. “

      Now I no longer have to wonder why it so often seemed to me that my lawyer wasn’t working in my best interests – he didn’t have to, since the Workover would pay him “fair remuneration  for a successful or well-managed application. I guess the Workover would consider my claim “well managed”, neither of us could call it “successful”. I was well-managed into accepting less than 10% of my actual claim!

      How’s that for a conflict of interest!

    • I’d really like to think they could change the behaviour described in the quote below which I copied from the Victorian Ombudsman report of his investigations into insurer’s record keeping practices in the Workover. He was moved to make his investigation because of a rising tide of complaints from workover victims and their treating practitioners.

      “In a non-paperless office you only have to destroy the incoming accounts. So if it [the measure] is based on timeliness of payment from receipt of account, and let’s say you get to the end of the month and you have got a wad of accounts you haven’t paid and they are past the due by date, you turf them. (Manager from QBE). “

      Seeing this explains to me how they could spend over two years resisting repaying me a medical re-imbursement of over $500! At CGU they had a locked cupboard in which they dumped all the refund applications and other correspondence from injured workers that they didn’t want to deal with! Think I’m gonna write on my enveloped when I write to my new case managers “Consign this correspondence to the locked cupboard at your peril”!

  2. Good post aworkcovervictim. As far as I can see, doctors actually hate having their patients on workcover. In fact many now routinely refuse to deal with workcover claims because of the abuse and bullying from the insurers, and because they feel bad when they see what happens to their patients under the Workover regime.

    I feel quite strongly that I would have recovered from the post workplace bullying breakdown within less than a year, given access to treatment. Yet, my claim was denied and it took ten months to negotiate the system to have it accepted. During that period I was lucky enough to be picked up by a psychologist who worked without payment from me to prevent me from carrying out my suicidal ideation and urges. Once I was in the system, i found that my condition was continuously exacerbated by the insurers and my condition became chronic. I am even worse now, in times of exacerbation of the Post Traumatic Stress and the Major Depression, than I was when I entered the system. It is so confusing and harmful for the insurers to treat injured workers as adversaries. Maybe we need to push for our own “independent” case managers, after all, in an adversarial system, it is a conflict of interest for the same case manager to be managing the affairs of both the employer and the injured worker.

    Actually, I think we should push the system over and start again. There is already a move to create a national system, we should make sure it doesn’t end up looking like the State based Workovers from injured workers’ point of view.

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  1. WorkcoverVictim (@WCVictimsdiary) - October 13, 2012

    What would a workcover case manager change? http://t.co/C5ywltaw