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?
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) 😉
….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).
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”.
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]