Everyone has opinions on what workcover is. Some are correct, but most are in fact misconceptions, most often sensationalised by our biased media. Everyone may have heard of someone that tried to get away with milking the workcover system. Most of these (few) people are caught through routine investigation, and their cases get resolved. The stereotype of injured workers being fraudulent malingerers is false, as for the most part (95-99% of cases), workcover claims are totally legitimate, and, most importantly the injured worker returns back to work, or at least, wants to return to work.
aworkcovervictimsdiary is getting sick of hearing and reading oversensationalised workcover misconceptions, and in fact, receives many distressing emails from injured workers each time the media “stings” again, as was the case with Comcare over the Easter holiday.
For example, the grossly misleading recent press releases suggesting that the “average” injured worker is provided with hundreds of thousands of dollars in (unwarranted) “massage therapy”, or is paid a “meditation retreat” is simply not true, just look at the “press-release” or media blurb and you will soon see that there is no evidence whatsoever of the utter BS written. Funny how such a grossly exaggerated “press releases” usually coincident with upcoming elections, huh?!
Another example are the commercials seen on TV about injured workers collecting hundreds of thousands of dollars. Again these are really not true for the average claim. When looking at the bottom of the screen it will tell that the people on the commercial are actors, not even the real claimants/injured workers. Most of the marketing material surrounds car and liability accidents, where pain and suffering is translated into a certain dollar amount. This is not exactly true in workcover. There is no pain and suffering payment. And only a few states allow the option of a common law damages claim, and then only if you are very seriously injured and are able to prove negligence on the part of the employer – not exactly an option to most seriously injured sods! Workcover insurance companies are there to provide reasonable and necessary medical treatment, and wage loss. Some states allow a permanent disability payment, or impairment rating, on top of wage loss (aka Lumpsum), but that is it. And, needless to say that the average injured worker will have to fight very very hard to obtain his/her legitimate basic entitlements, such as weekly payments, home help, even surgery.
And, to prevent anyone throwing up again, let’s not even mention those over-sensasionalised cases of workcover “fraud” we see on 60 Minutes and like minded channels…. Arrrghhh!
Top 5 workcover misconceptions
Let’s just get the facts straight and go through the most common 5 workcover misconceptions surrounding the mystery world of workers compensation.
Misconception #1: Workcover is not Welfare
Compensation or workcover is not a free payment an injured worker is entitled to! Oh no. Just because you are injured at work, it does not mean a guaranteed payment or coverage for basic medical/weekly pay benefits.
There are a lot of very strict, and not too ethical (!) criteria to be met in order for a claim to have you work injury classified or accepted as “compensable”by the greedy workcover insurance Even if your claim is “compensable”, it also does not mean anything can be or will done!
Injured workers, even the most seriously injureds have to “play by the rules”, and do as they are told by the Almighty, medically untrained, bonus-greedy workcover case manager.
In the majority of moderate to serious injury cases, injured workers have to fight for every medication, x-ray, MRI, CT, physiotherapy session, counseling, medical treatment (including surgery), and any other benefit (i.e. home help, taxi transport, hydrotherapy etc.) that the law says the injured worker is entitled to!
The workcover insurance does what injured workers call deny and delay, gaslighting, or starving you out (aka “SSS” Slow the process, Starve you, then “Settle”). The workcover insurance literally tries to break you emotionally, physically, and financially during this time to get you to settle out your medical and indemnity benefits for the lowest possible amount. During this process the injured worker often loses everything they own.
It is a widely known practice that they will push you to the limit, their main objective is a) that you GIVE UP (and no longer pursue that particular benefit you’re entitled to -hey: every little bit counts for them!) or b) that you are so sick and tired and frustrated that you go off workcover and get decent treatment under your normal Medicare or private health fund.
Many genuinely injured workers have no option but then to seek financial assistance from Centrelink, while the workcover insurance continues to find ways to deny liability for legitimate claims!
Misconception #2: Nobody gets rich from workcover
Depending on the state they live in, injured workers basically give up the right to sue in civil court in exchange for what are essentially no-fault workcover benefits. The workcover insurer
pays is supposed to pay lost wages, medical care, and (vocational) rehabilitation. Pain and suffering as an additional payment is not available or applicable to a workcover claim. The amount of money an injured worker receives is a percentage of average gross pay…. and is very little, i.e. 70 to 80% of what they were earning gross before they got hurt. There are typically no increases for inflation (unless you count 1%), and each state has a maximum limit that a person can get per week as workcover payments, which is barely enough to survive (weekly payments can also be terminated even if you can’t return to work!).
And, even if a claim is settled for a certain amount of dollars, it is typically not a retirement jackpot… Lay people forget that for example a ‘compensation” awarded of let’s say K300 means $30,000 for 10 years, or $15,000 for 20 years! Can you live of $30,000 per year in Sydney? In Melbourne… Ahh,…!
Misconception #3:Workers compensation benefits will be stopped if the injured worker declines reasonable employment.
If the employer offers a light / suitable duty job, within the injured worker’s medical restrictions, the injured worker cannot refuse it and still get paid weekly pay benefits. Whether this light duty job is something an injured worker is trained to do, is actually safe to do, or is an insult to their professional skills, etc. is irrelevant to the insurer (and many employers), adding insult to injury.
If there is a welder sitting in a chair staring at a clock for a job, then that’s it for the poor welder. If there is an injured nurse with broken shoulders put into a “suitable” job where she is made to spent all day doing ECGs (extremely repetitive work on the shoulders) and exacerbates her shoulder injuries, well tough! If a seriously injured worker with a mangled arm is repeatedly refused medically requested/prescribed ergonomic aides in the workplace, and even has a certificate stating he is not allowed to continue work unless these aides are implemented, and tears his freshly operated mangled arm to pieced over and over again, who gives a sh*t? The injured workers are “back at work”, their claims are ” suspended” basically and the case manager (and the employer) get a big fat $$$bonus for returning these people to work at gun point. … But, the media (incl, workcover authorities and insurers) dare to portray injured workers as “lazy” malingerers who don’t want to return to work (fast enough)… and, hold on, who because they don’t return to work fast enough, develop psychiatric conditions. Hmmm. Think again!
For light duty/suitable jobs, they have to be deemed something that the employer gets a “gain” from performing, and almost all jobs within an employment facility can fall within these parameters. So, yes, many injured folk are provided with degrading jobs, just to stop a case/claim to be “compensable”.
Many injured workers are also routinely sacked by their employers because they got injured, and where does that leave them? They are unemployable, or at least it is very difficult to find a new job when you are seriously injured…and at the same time the workcover insurance company, through the use of their medical whores, deems you not totally unfit for the forseeable future and yep, your weekly payments are stopped and you are thrown on the scrapheap.
Misconception #4:Workcover fraud is extremely low
We would venture to say that actual workers comp fraud is less then 5% of all claims. And that number may even be way too high; many studies suggest fraud is as low as 1% or less.
For a case to be deemed as fraudulent, it must meet a certain criteria, which are hard to meet, and most cases will not even come close to being worth the pursuit of fraud in a legal court case. How many times have you read/heard that an injured worker got jailed, or fined in a Court of law? Once a year? How many claims are there in Australia per year? THINK AGAIN!
Also, if a certain injured worker is claiming to be unable to work, and the workcover insurer – as they routinely do- get surveillance of them outside doing some gardening around their house, this may not make the case actual “fraud,” as it falls more within the injured worker not following their medical restrictions and going outside of their treatment plan as deemed appropriate by their treating doctor. This MAY provide the case manager with the ammunition to dispute ongoing benefits, but not exactly to pursue the case as overall fraud. Big difference.
Workcover fraud, as a whole, is not a major problem within the workcover system!!!! Sure there are a few injured workers who don’t follow their medical restrictions, miss another “indpendent” doctor appointment, or ignore the dodgy pitbul-style “rehabber’s” demands, but this provides only a dispute for ongoing medical benefits, not fraud. There is a HUGE difference between the two.
Misconception #5:The vast majority of workers comp claims are paid, and don’t go to court
Generally, most simple, straight forward workcover cases are accepted (i.e. fractured leg, laceration etc) and the injured worker gets treatment, and goes back to work.
Sure, there are those odd few out there who try to do what they can to avoid going back to work, but after an IME is performed, or after some surveillance discovers them being active out and about, they are really, very quickly flushed out and denied ongoing benefits. I mean the workcover insurer opandus modi is to treat all injured workers as GUILTY (of fraud/malingering/whatever) until proven innocent, so to commit “fraud” would be really really hard and, who in their right mind who want to stay on such a sickening, adversarial system a second longer than needed!??? There is NO money to be gained, only harassment, abuse, deteriorating health, psychological injury.
Usually after a denial, and weekly payments stop, genuinely injured workers “get on the wagon” and get their treatment, so they can return to work and have their workcover cases end. Some will go to lawyers and try to get what they feel they are entitled to, and they will file for mediations and hearings, but the litigation usually is settled before a case is tried in front of a judge.
The stereotype of injured workers being fraudulent malingerers is false, as for the most part (95-99% of cases), workcover claims are totally legitimate and the worker returns back to work, or at least wants to return to work.
You may also want to read or re-read the most common workcover myths>>
[post dictated by workcovervictim and manually inserted on behalf of non-malingering WCV]