Top 5 workcover misconceptions

workcover-mythbusted

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.

The idea that someone stays home and avoids work when they are able to actually work is not the norm.

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.

 

tipYou 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]

 



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8 Responses to “Top 5 workcover misconceptions”

  1. Has any of you been contacted yet by the insurance companies wanting to do a work capacity assessment on you? They may say your payment shave gone up but they will not stay that way after Dec 2013. Workcover is telling the insurance companies to offer you a little bit of money and then suddenly your payments will stop. This is a real issue, but how many of you know this? About time Workcover came clean. What a disgusting legislation and what a disgusting state Government

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    • Hi Carol, my insurer advised me in early January that I would have a work capacity conducted, still waiting for it. I feel they are waiting for my work hours to increase before they come up with their miscalculated work capacity assessment, thereby justifying cutting me off, by being able to provide an example of actual earnings should I challenge through WIRO. They will then most likely terminate my employment and say you have the capacity to earn X amount of dollars per week, we don’t need to provide you with any income or support, “Good Luck Finding a Job”  ! the state government is a sham only looking after big business not the Voters. Be also warned Federally Tony Abbott has agreed with O’Farrell cuts to workers comp. My advice don’t vote Liberal State or Federal and convince as many people as you can.

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    • Hi Carol,  I was informed of this also & I’m just as frustrated with my legal rep who I feel has had just as much taken away over these changes as the Workers.  Now we have to apply for legal aid to be able to fight these matters out? & to get a IME done? to dispute the crap one which is paid to be written against us???
      In January I was cut back in income & then told I had to go to another vocational assessment, the case worker said it was for a work capacity assessment. I requested someone who specialised in psychological disorders given the last IME I had wrote “I have seen this blonde woman of …..today” & I have near jet black hair!!! Yet they still accepted his report.
      So I had someone who seemed to get the whole issue & was very positive, even ready to give a copy of the report & then everything went sour.
      The report never came to me & I was told that the insurer owns it, which is true, yet why then was it a secret?
      The work capacity assessment has still not been completed.I am still on the reduced amount.  They have been doing rehab which involves University study.  So they have me no notice and cancelled all my treatment on the same day I got the notice (denial of partial liability), they also then cut my rate, all in the middle of exams.  I believe it is a calculated attempt to de rail the treatment & rehab process (which is costing them) & they’ve done their sums & think it would be easier to write me off completely & then pay the damages down the track rather than both as my injury is permanent & they know how this will go, considering my employer was negligent.
      I couldn’t cry for a long time & today I have just cried & it won’t stop; I’ve thrown things, I have always been an advocate for people who are unfairly treated, I’ve never experienced the psychological torture & abuse that goes on within this system in any other Goverment organisation (despite their failings as well).
      I have a psychological disorder, with anxiety & depression.  The insurer has been warned in report after report after report that they are escalating the symptoms and contributing to the downward spiral of th treatment, particularly after they ceased approval for all the treatment.  I tried the appeal & yet we all know where that goes!
      So now I’ve tried WIRO – the review office, yet basicallyy they have as little power as CAS, which also was frustrated.
      I was thinking that I have some spare shit on my garden from horses down the road that maybe I could send some in a nice box to my QBE caseworker who obviously is a bit low on shit at present since they keep giving it to me? What do you think

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      • Hello,

        Always demand copies of your paper work. Write everyday.  Copy in a manager, then copy in QCOMP then start copying in the Ombudsman.  Keep your emails short and succinct and re-iterate that they have failed in their duty to supply you with a copy of information and this is a breach of the act and right of justice.  Read the legislation and learn it off by heart.  Just as workcover seek to get you on some small technicality, you may do exaclty the same by understanding what a professional response is and what they are legally bound by.  if the report says a blonde woman, then  that is simply not you, it cant be and the report needs to be recitifed or a statuary declaration provided that satisfies proof.  Just as workcover wont accept ‘perception’ or a statement without any evidence, so too are they bound by the same rules of truth and these need to be pointed out and shouted to every authority they are answerable to.  I undertsand how hopeless the path forward may appear, it takes a long time before a minister for example is heald accountable for receiving many complaints and not acting-however, start the paper trail and get good at it.  Summon your will and focus on where and how they are failing you and point it out.  Then make sure to take time out, to breathe to watch the birds and hear children play for those moments can never be taken away from you.

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  2. How good would it be that the so called good reporters who consistently seize and mislead the public with their warped versions of workers comp stories suddenly found themselves injured?

    I bet when the shoe is on the other foot they will cry out as loud as they possibly can about the injustices injured face!

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    • Those uneducated psychopath reporters are slaves and beggars and they are ready to say anything in order to keep their employment alive, I beat they will ever be bullied or harassed at work place though they spend most of their time outdoor working alone and wandering around as paparazzi.

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      Xchangingvictim April 9, 2013 at 5:51 pm
  3. a clever and funny thing to do is in the search bar of your facebook page type in workcover and then narrow search down to public posts you will be very surprised at how many people are suffering also I have come across people that have started working as case managers some have looked very young and inexperienced so there must be demand in case managers

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    • Hi Katey,

      There is a demand for case managers, for one purpose only. They have been recruiting since the O’Farrell workers comp changes took effect, there purpose is to get through as many old cases as possible in order to cut benefits and medicals off. It will be short term employment for case workers not just the newbies. Once they get through all the older claims they will have their employment terminated as they will be deemed excess staff un totally un-needed.

      As for facebook be careful investigators will be searching for anything, photo’s, comments, etc..

       

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