Workcover case managers: the good, the bad and the ugly

GOOD-BAD-UGLY-workcover-case-manager

Workcover case managers come in many different shapes, sizes and – especially- characters. They can be young and extremely inexperienced, lacking communication and basic people skills; ,  many are in their forties, divorced and utterly miserable sourpusses, some are male, most are female, some have years of experience and have undoubtedly gone through a “work hardening programme”,  some are fresh off the street and so inexperienced and non-educated in the law and in medical terminology it’s frightening, many are, yes, lazy and incompetent,  a  very few are decent. The most important difference in those different “types” of workcover case managers, however, is perhaps that there are – broadly speaking-  two basic types: the pro-active and the re-active case managers.

Workcover case managers: the good, the bad and the ugly

worst-workcover-case-managerCase in point: every injured worker who is experiencing outrageous issues with their workcover claim, is better off getting a pro-active workcover case manager allocated, rather than be stuck with a nightmarish re-active one.

Same applies for employers. However this is easier said that done. Many employers, companies etc are in fact allocated/assigned a case manager or a team of case managers (depending on the size of the company). If the employer/company doesn’t complain, or is not really involved with the workcover claims running, then they get whomever is allocated/assigned to handle the claims and “look after” the company – be it a good, a bad, an ugly, a pro-active or a re-active case manager.

Did you know?

There is no rule anywhere that states that an employer/company has to accept whoever gets allocated or is assigned to handle their files.

There is also no rule that states that the case manager cannot tell the treating doctor that the injured worker’s claim is denied because of an IME. There is no rule stating that just because a claim is denied that the case manager can’t take 2 minutes explain to the injured worker what options they have for appeal, or how they can mediate the process if they want to fight the denial. There is no reason why an email cant be addressed within a short time frame if the case manager is in the office, no matter how busy the s/he is or how many claims s/he’s handling.

Same applies for individual injured workers – there is no rule anywhere that states that you have to accept the case manager who’s allocated to your “file” or “claim”; and if you happen to have an evil case manager, it is your right to:

  1. Put in place a restraining order  (intervention order) against that case manager (i.e. no telephone calls, all correspondence to be send in writing via post to yourself, your advocate or even your doctor!).

    Here is an example of such a (real) letter:Dear Madam:I write to you in relation to your recent conversation with my wife over the last couple of days but most particularly today’s date at approximately 2.10pm.You may or may not be aware of my wife’s medical condition and prior direction to the former Insurers GIO.  Therefore, I will stipulate and remind you of those at this time yet again.  My wife suffers from a serious psychological injury; your continual communications with her only aggravate the situation.GIO was and now we remind and direct GALLAGHER BASSETT that ALL communications are to go through my wife’s Legal Representatives.(Legal Reps details)From this date forth, my wife directs Gallagher Bassett not to communicate with her directly in any way shape or form, no telephone calls, no letters, no emails, not even messenger pigeons NONE WHATSOEVER.You have been put on notice and failing which my wife will have no other alternative but to apply for an Intervention Order against any personnel from Gallagher Bassett that tries to contact her.  She is NOT WELL.Signed

    (See sample letters)

  2. Request another more human case manager: Here is an example of such a (real) letter:

    We refer to the above matter.We have received a copy of the exchanges between our client and [case manager name] at your office dated [insert date](copy enclosed for your ease of reference). We were disappointed to note the content of  Xchanging’s response to our client ’s request for payment of overdue expenses including the following: “we don’t  want  to feed her behaviour  again”,  “once again she is becoming demanding with her emails and I w ill not be responding ”.We understand that on the foot of previous problems, there was an arrangement made that all communication be made via the treating practitioner. Our client instructs us that this agreement was contravened, as a result of which she lodged a complaint with Xchanging expressing her desire that a new Case Manager be appointed.  We do not believe her complaint has yet been acknowledged.It would seem that there is now an administrative block on [ case manager name] receiving emails directly from our client.  Consequently our client has been sending her correspondence to [name]who is the RTW at the [workplace].    Against this backdrop, with respect, we consider the relationship between our client and [case manager] has broken down and this is affecting our client in a very negative way.We consider that the best course of action in this situation would be for the file to be re-allocated to a new Case Manager.Yours Faithfully,Signed

    (See sample letters)

What is the difference between a pro-active and a re-active workcover case manager?

A pro-active case manager will respond to your email(s) within a few hours, a day or two at most

 Case managers spend most of their day at their desk, handling their files. Some files/claims are more important than others, but a pro-active adjuster can differentiate between what needs to be handled now, and what can wait. Part of the case manager’s job is to  promptly response to any communication they receive from an employer, who is their client; and from injured workers.  Even if the case manager doesn’t have the answer to the question right away, a response needs to be sent back to the employer or injured worker ASAP that at least acknowledges receipt of the email and that the case manager will get back to them as soon as possible.

On the other hand, re-active case managers will not put the employer first, let alone the injured worker(s). Why, because they lack humanity (!) and believe that a 5 second email to an injured worker or employer is not important. They will eventually respond to you only when you start to get angry, that’s why they are re-active.

If you notice your case manager not responding to your questions within whatever time-frame you deem acceptable, then you need to raise the issue (= complain) to the case manager’s boss – the Team Leader in the first instance.

A pro-active case manager will return your phone call

Sane as for emails or letters, if someone  (injured worker or even the employer who is the client) is calling about their claim, or about a medical issue, the case manager has to return the call as to keep the claim moving forward. Again, an case manager spends most of their day at their desk, and they do have a phone and while we do understand that they can get very busy they still need to return our phone call(s).

Many case managers simply ignore our injured phone calls, calls which are very important and often stressful to us and can range from weekly payment issues to request for surgery approval. If your case manager does not return your phone call(s) within a time-frame that is acceptable to you (i.e. 2 days max) then we do wonder if that case manager has an issue with telephoning, maybe they need to find a new type of work! Again complain with the case manager’s supervisor in the first instance. Injured workers that call their case manager 3-4 times with the same question, waiting for a never-returned response is unacceptable. Basically re-active case managers will only return calls that they deem “important” on the day, that is, if they return them at all. After all, they are ‘above’ everyone else it seems and have their eyeballs rolled up so far they are no longer un-rollable. Again, we wonder whether these types of case managers would not be better in another line of work altogether.

Workcover case managers seem to repeatedly forget that injured workers have no (or not much) idea what is going on. They do not know much about “claims” (hey, we only lodge 1 usually),  they don’t know much about the legal process, it’s not that the case manager is volunteering any of that information, hey.

It is not fair to us, injured workers that our questions are not addressed and explained.

Perhaps case managers ought to imagine if “the claimant” was their sister, husband, or mother, or-worse- themselves!How would you like it if that is the way they are being treated?You have sent emails and left voice messages with no response, that behaviour can simply not be tolerated, period. Rright!

Proactive case managers will handle the medical needs of the injured worker promptly

Approvals have to be given for surgery, diagnostic testing, physio, medications, home help etc. This means a phone call (or a fax/letter) has to be made from the doctor or the provider to the case manager. Now, a good, human pro-active case manager knows that the sooner they get that approval to the doctor/provider, the sooner the injured worker can move forward with getting the treatment they so much need and the sooner they can get back to work. By giving prompt approval the injured worker gets better and the claim also moves “forward”.

Reactive, often inhuman case managers fail to give prompt approval for no reason other than that they obviously feel a sense of “power”, or perhaps sarcastic enjoyment that the injured workers (aka malingers/fakers) are suffering because of the case manager’s “power”.

Doctors, surgeons, physio and other service providers will end up making multiple calls for approval for medical treatment or medical services or  for billing information, with no response. …Then when the suffering injured worker calls to schedule their next appointment, they find out that the doctor is still trying to get a hold of the case manager and that the surgery (whatever) had to be cancelled/postponed again. This will then prompt the injured worker, no “fed up” to call the case manager, to find out what the [f*cking] problem or delay is. The bewildered injured worker will then most often also contact their employer (if they are still on RTW) and complain about the fact they can not get the treatment (i.e. surgery, medication, physio etc) they need so they can get better and get back to work.

So by now the re-active case manager has 3 separate parties (injured worker, doctor, employer) making numerous calls and emails to them on the exact same issue. This is just improper behaviour. Had the  pathetic case manager returned that 1 phone call to the doctor back in the beginning, the rest of the issues and numerous voicemails, calls, perhaps faxes and letters of complaints would have been avoided. So we ask, what the f* is their problem? Why do these “case managers” not go work elsewhere if they can’t be bothered?

Pro-active case managers take the time to explain what the issues are

Case managers often forget that not everyone knows what they are talking about.  People, such as injured workers, treating doctors etc do not have claims-training and have no idea what is going on with a claim or how a claim process works (i.e. approval for surgery).

A pro-active, human case manager will actually take the time  to explain the issue to whoever is calling, emailing,etc whether it is the injured worker, the doctor, or the employer. For example, if a treating surgeon is calling to approve a surgery for his injured worker patient, and this surgery is not approved for whatever sinister reason, unless the case manager tells the surgeon that the procedure is not approved and why, then the surgeon will keep on calling. A good, human and pro-active case manager case manager will take the 2 minutes it takes to tell the surgeon that the surgery is not approved under workcover, for example because of a [dodgy-sorry!] IME, or because the surgery is deemed not work-injury related, or for other “legal issues”/whatever the case may be. Then at least the surgeon knows, and can note their files as well so they do not keep calling the case manager, and can explain things to the injured worker as well.

Reactive and pathetic case managers, on the other hand, will usually fail to respond to the call at all, which starts the circle of phone calls/emails etc again. The surgeon calls looking for approval for surgery and gets no response. The injured worker calls the surgeon to find out when their surgery is, and the surgeon tells them that they cannot reach their case manager. The injured worker then calls the case manager, and gets nowhere. So they again go to their employer, who then has to place a call to the case manager to find out what is going on… and so on and so on.

If a workcover insurer wants to be in the business/provision of health care to injured workers, then surely a more CARING attitude needs to be adopted, by their representing case managers, rather than the present adversarial policy!

[Post dictated by workcovervictim and manually inserted on behalf of workcovervictim]

 



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One Response to “Workcover case managers: the good, the bad and the ugly”

  1. Hey ALLIANZ you’ve given me 7 bad fuckers  7 ugly ones have you got any good ones

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