A complaint has been lodged with WorkCover NSW about the behaviour and actions of a Claims Manager

workcover-complaints

Last night we received an interesting “story” (via our share your story page) from “WeNeedEthicalandFairWCSystem” titled “NSW TMF Claims Managers”

A complaint has been lodged with WorkCover NSW about the behaviour and actions of a Claims Manager

NSW TMF Claims Managers

By “WeNeedEthicalandFairWCSystem”

A complaint has been lodged with WorkCover NSW about the behaviour and actions of a Claims Manager of the Workers Compensation Division of the NSW Treasury Managed Fund. This fund provides almost all NSW public Servants with Workers Compensation coverage.

The processing of public servants’ claims has been contracted out to a number of well known private sector Insurers to perform the statutory functions of the NSW Self Insurance Corporation.

The complaint lodged with WorkCover, and unanswered by the senior staff of WorkCover, includes a litany of alleged deceit, provision of false material to Medical Examiners, breach of Workers Compensation legislative obligations and WorkCover Guidelines.

All par for the course so far in terms of complaints and inaction by senior WorkCover staff re a complaint.
However, this complaint contains a potential very serious sting in the tail for both the Claims Manager and also WorkCover.

It appears that the NSW Government, in its rush to contract out a statutory function, did not properly research possible implications for private sector organisations that perform statutory functions.

Initial advice indicates that the NSW Independent Commission Against Corruption Act 1988 defines such organisations as public authorities and any staff dealing with functions such as Workers Compensation Case Managers, Medical Examiners, Rehab Coordinators etc as public officials.

The probable public authority public official status seems further substantiated by the Public Finance and Audit Act 1983.

So what does this potentially mean for Claims Managers and WorkCover.

Claims Managers who perhaps believe they can perform aggresive behaviour to private sector workers compensation claimants cannot perform such behaviour to public servants.

TMF Claims Managers must ensure that their practices and procedures and attitudes meet the standards required in the ICAC Act 1988. Behaviour that meets the definition of Corrupt Conduct under sections 7-9 of the Act will constitute corrupt conduct. Therefore if Claims Managers endorse this behaviour because they receive financial incentives to reduce or deny claims they too are liable to being accountable under the ICAC Act.

Claims Managers are remunerated a contract fee from the public purse for performing a statutory function – many 100s of millions of NSW public monies dollars. These contracts include financial incentives using public monies!

For WorkCover, the primary monitoring body, to be informed of potential corrupt conduct and not acting in any manner even if only to receive legal opinion, may also be corrupt conduct. This occurs even if the potential for corrupt conduct is not realised. There is certainly no impediment to WorkCover separately investigating breaches of Sections 3 and 119 WIM&WC Act 1998 and offences under section 283 of the 1998 Act as is their statutory role.

In short WorkCover or rather the senior managers who have decided not to do anything can be investigated by ICAC and may be found to have engaged in Corrupt Conduct.

This occurred in another NSW Public Authority that failed to investigate reported potential corruption that eventually was found by ICAC not to be corrupt conduct. However the senior managers who failed to act upon the complaint were found to have met the definition of corrupt conduct and were later dismissed from their employment positions.

The behaviour of WorkCover is compounded if it has not sought advice from NSW Treasury seeking their advice on Claims Managers contracted critical service standards and service level agreements with Claims Managers.

Watch this space because the recent Workers Compensation amendments may appear to some Claims Managers, unaware of public authority constraints, to be a green light to process claims even more rigorously.

 

2 Responses to “A complaint has been lodged with WorkCover NSW about the behaviour and actions of a Claims Manager”

  1. Can this be retrospective? I know a few GIO Case Managers who would definitely would be in breach of the ICAC.

  2. Something must be actioned Australia wide concerning the actions of the case managers.
    It’s corruption! Not only corruption but they draw the trusting managers into their scams. Who are left holding the consequences. Giving thought to what could occur to managers if they hold professional status. Eg nurses, Drs, Heath workers, teachers etc; to be lured into breaching the ethics and standards of a profession against a colleague. Is serious. In many codes of ethics and standards, to refuse appropriate care treatment or respect to colleagues is seen as a breach of professional standards. If serious enough one could loose their registration. Now if the case manager is advising the professional into corrupted practices. Who may wear the consequences? Is not just the injured worker who is placed in a adverse position.