WorkCover Vic Crackdown on injury claims

crackdown-on-injured-workers

A real shocker in today’s The Australian Financial Review! WorkSafe Victoria (WorkCover Vic) is now rejecting workers’ compensation claims at more than twice the rate of its counterpart in NSW ­WorkCover, amongst other things exposed in the article. God help the Victorian injured workers!

WorkCover Vic Crackdown on injury claims

Madame-Zena-authorBy co-author Madame Zena

A report obtained by The Australian Financial Review exposes that WorkSafe Victoria (WorkCover) is rejecting workers’ compensation claims at more than twice the rate of its counterpart in NSW WorkCover.

Further WorkCover’s agents have been branded as “out of control” and acting without “any real scrutiny” from WorkSafe.

As a result there are now calls for a Victorian parliamentary inquiry into the conduct of WorkCover agents and WorkSafe.

As revealed in today’s The Australian Financial Review, WorkSafe Victoria (WorkCover) is rejecting workers’ compensation claims at more than twice the rate of its counterpart in NSW WorkCover.

Even more startling, WorkSafe Victoria has cracked down on payments to injured workers, with staggering increases in the number of disputes over the last 12 months. A report leaked to the AFR exposes:

  • 43 per cent increase in the number of disputes arising from benefit terminations
  • 22 per cent increase long-term entitlement disputes
  • 20 per cent increase in disputes over the payment of medical and similar services
  • 15 per cent increase in general disputes
As rightly pointed out in the article, WorkSafe is without a doubt “inappropriately rejecting claims”, and the figures confirm that WorkCover’s agents (the insurance companies) have got out of control, rejecting and terminating workers’ entitlements without any real scrutiny from WorkSafe.
In addition, WorkSafe claims agents refusal to resolve disputes through the mandatory disputes process of the Accident Compensation Conciliation Service is leaving injured workers in Victoria  to fight through the courts for justice or walk away.

There are now calls for a parliamentary inquiry into the conduct of WorkCover agents and WorkSafe as a result of these alarming increases in claim declination and dispute rates exposed by the AFR.

It is worth noting that the timing of much of this crackdown on worker’s compensation benefits not surprisingly aligns with Ms Denise Cosgrove’s appointment and current tenure as CEO of WorkSafe Victoria.

Ms Denise Cosgrove, trans-Tasman pruner, said those on long-term benefits should be cut like “low-hanging fruit”. And that she has certainly done!

Compensation crackdown from WorkSafe Victoria

Financial Review – 

Victoria’s work protection body has cracked down on payments to injured workers, with a 43 per cent increase in the number of disputes arising from benefit terminations.

A recent report showed disputes with WorkSafe Victoria had increased by almost 15 per cent between the April 2011 to March 2012 period, and April 2012 to March 2013 period.

Even more startling was the 43 per cent increase in the number of disputes arising from the termination of WorkSafe payments.

The report also showed the number of long-term entitlement disputes had increased by 22 per cent. Disputes over the payment of medical and similar services had increased by 20 per cent during the same period.
Inappropriate rejections

WorkSafe is “inappropriately rejecting claims”, Victorian Community and Public Sector Union Work Cover services director, Geoff Lewin said.

“The figures confirm that WorkCover’s agents [the insurance industry] have got out of control, rejecting and terminating workers’ entitlements without any real scrutiny from WorkSafe,” Mr Lewin said.

“Agents are reversing the onus of proof, rejecting claims, and forcing workers to either walk away, or proceed to the court for justice.”

He called for a parliamentary inquiry into the conduct of agents and WorkSafe as a result of these figures.

“It is inappropriate for injured workers’ entitlements to be determined by the Victorian WorkCover Authority (WorkSafe) who is also the regulator,” Mr Lewin said.

“The dual position of the Authority is not acceptable, and an independent Regulator should be immediately set up to regulate the scheme without bias.

Agent representatives’ have made clear that they are bound by instruction from the Authority in rejecting claims, and not resolving them through the disputes processes of the Accident Compensation Conciliation Service.

The regulator can refuse to make payments beyond a conciliation conference, or only partially reimburse injured workers for medical bills relating to their workplace injury.

The union claims that WorkSafe had rejected claims at more than twice the rate of its counterpart in NSW ­Workcover.

The figures come after WorkSafe executive Denise Cosgrove said those on long-term benefits should be cut like “low-hanging fruit”.

Last year the Victorian government announced it would take $471.5 million in dividends out of the Victorian WorkCover Authority over the next four years in order to prop up the state’s budget, but claimed it would not affect services or jeopardise workplace safety.

A spokesman for WorkSafe said the authority and its agents were committed to providing “fair and high quality service” to injured workers and employers.

Cracking down

It rejected suggestions that it was ‘cracking down’ on the entitlements of injured workers.

It said that any change to an injured worker’s entitlements was done in full accordance with the Accident Compensation Act 1985 and the conciliation system was designed to ensure “that such sensitive decisions can be reviewed at any time by an independent umpire.”

WorkSafe reported in March that a surge in common law claims had dented the financial performance of the state’s workers compensation scheme.

A spike in already rising levels of common law claims added about $150 million to liabilities for the half year.

[Source: http://www.afr.com/p/national/work_space/compensation_crackdown_from_worksafe_E3bpLLhE9lKFdJKHfpssoJ]

 



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42 Responses to “WorkCover Vic Crackdown on injury claims”

  1. I wonder if there would be any kind of way to sue Worksafe for failing to ensure the safety of workers, failing to investigate and false advertising (eg The BS commercials about coming home safe) etc.
    Maybe even a class action?
    Are there any legal eagkes out there to answer these questions please?
    If not, is there anyone who deals with Worksafe complaints independantly?

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  2. There is the insurance ombudsman which I am looking into taking my claim to when I get my medical payments through. Insurance companies don’t like ombudsmen. Maybe we should all take a class action against worksafe and the insurance companies then maybe something might happen.

    There is also the fact of them failing to keep a worker safe after they become injured, they are failing in their duty of care!!!!!!! Isn’t Slater and Gordon going someone for failing in their duty of care. We could start a class action against Worksafe for that! They have a duty of care for the injured worker.

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    • Hi Pugsley,

      Just thought I would let you know you are correct, someone has had Slater & Gordon (Steven Lewis – Sydney) lodge a Fair Work Claim against their employer for failing to protect their safety from foreseeable psychological harm…that person is Mel Greig. Unfortunately it seems that even if you have a great case, no lawyer wants to take your case on without $1000 bucks upfront when you sign, and could cost as much as $15,000 with no guarantees of winning! And they want that money as they go…..none of this no win no pay, and even then they take 40% when you read between the lines! Let’s face it…the poor little worker gets crushed, and the rich can afford to litigate with abandon…it sucks 🙁 The rich get richer! Can’t even manage to get hold of Jobwatch (here in Vic) on the phone  (Free workers advice line), as the government has cut funding by 60%…yet the Criminals get Legal Advice and Legal Aid no worries…the system only punishes the honest, so it seems. Sure…you may get to go to court in 4 or so years time and win…..but how do you survive long enough to make it there?

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      • You’re right Shattered it takes forever to get to court and then  you have to pay legal fees. I was threatened by the other side that if I took my case to court and lost I would have to pay their fees as they had made me an offer and I didn’t negotiate a better deal with them. Actually it was my lawyers fault that a counter offer was not made in time. That’s why I was forced to settle. 18 months of no pay and then the threat of having to pay the other sides legal fees was just too much especially the mental state I was in. The legal profession also has a lot to answer for they all just want an easy time and force you to settle.

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        • Thanks Pugsley, I’m new here….but looks like I will be around for a long time yet! Sorry to hear about your railroading…I will make sure that we keep it in mind in regards to my husbands case.

           

           

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  3. Hi Everyone, I am looking at this pathetic crackdown by Worksafe Victoria in a different way. My claim was rejected even after the insurers IME doctor stated that my injury was work related. My ex employer and the insurer hoped that I would just go away. No money for 15 months, which was very hard with three school aged children. When my matter went to court the employer and insurer looked and sounded like idiots. All the medical evidence stated my injury was work related, but the insurer just did not want to pay. After them wasting two days of the courts time, the insurer and employer were left to pay a huge legal bill, wages, interest at 10.5% and so on, and they are still paying. What I am getting at is even though it is very very stressful and difficult to survive until your matter gets to court, the magistrates will soon get sick of these matters being listed for hearing in their courtroom when quite clearly the injured worker should have been paid from the day of their injury. Ms Cosgrove will soon learn that magistrates and judges have little patience for people who are wasting the courts time. This was made very clear to the insurer and their legal team when the magistrate handed down his judgement in my matter. Once you have that judgment you will also find that the insurer treads a much carefuller path in the future. If Ms Cosgrove continues with this path of rejecting claims that quite clearly should be paid, then it won’t be long before the courts are choked. I would like to hear other peoples views. To all, stay strong. Its a struggle but it is one that we all must win, because people such Ms Cosgrove are playing with our lives.

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  4. Great to hear wheelin, and that’s another precedent in the record books for other people to lean on.  that’s why insurers try to drag things out and starve people, then offer pittance.  On my last visit to court the offer they made would have been less than 1k in my pocket after all other expenses…my solicitor looked at me and asked what I wanted to do.  For the sake of under 1k, lets run it through trial I said, I will have my day in court and tell exactly how it is.  There was an opening that day for a trial to start, but the defendant adjourned paying my legal fee’s for the day, and it will continue later in the year.

    for the risk of a tiny amount I would prefer to get up on the stand and have my say, and get my piece across…in the grand scheme of things where does 1k go these days, satisfaction can feel so much better

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  5. The ACCS (Conciliation) is pointless.  You take a grievance about your insurer (usually not paying, rejecting your claim etc) to Conciliation and the insurer just attends because they have to and the Conciliator has no power to enforce anything.  So the insurance companies just continue to refuse to pay your entitlements and basically say “go to court”.  What is the point of the ACCS? Its a toothless tiger.

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    • Conciliation is an absolute waste of time and money. In my case after waiting 4 months for my day , they , the insurance company,phoned and stated they wouldn’t be coming !,,,,, I wasn’t aware it was optional. Anyway let the bastards answer to a magistrate in court. Hopefully it will be bye bye blackbird !

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  6. Conciliation does seem to be a real time waster, especially when the Insurance Agents are allowed to get away with constant breaches to the Case Management Guidelines. I’ve already had two Conciliations this year in relation to my desire to be retrained so that I can find work that accommodates my impairments and in relation to meeting my FOI requests from September 2012. Both conciliations were attended by “newbies” to represent the Insurer. They knew nothing of my matters and apart from squeezing another five documents out of them on my FOI claim, there was no real movement forward. In between Conciliations the Insurers have continued to block my requests, and deny them using quasi legal arguments that have no basis in the law. The first Conciliation was 8 months ago!  That’s 8 months of income earning potential I’ll never get back.

    If there is a direct path to the Courts, and enough real injuredworker advocates in the legal system I’d recommend taking the legal route. Unfortunately the Worker’s Compensation arena seems to be heavily infested with parasites posing as advocates. Their financial interests and the cosy, predictable working lives that the current Workover provides for them, means that they line up with the system that is abusing injured workers.  Injured workers remain trapped on our lower branches, just waiting to be plucked and juiced by any Agent of the Workover, while the parasites enjoy incomes that even as unimpaired workers we could not aspire to without being labelled “greedy workers”.

    Whilst workers are being denied legal representation in Conciliation, the Insurance Agents are sneaking them in to represent them in Conciliation. I started my requests with my Case Manager a couple of CM’s ago. Since them I’ve had another Case Manager and the Senior Legal Manager obstructing and humiliating me on my requests; a very young Case Manager stand-in who was helpful in some ways but obviously charged with getting some irrelevant personal information out of me; and two different reps fronting up to Conciliations. How can any matters be settled when there is no one in the Claims management system charged with seeing a single matter through?

    I wish ACCS would take some more public stands against the manipulative and bullying behaviours of the Insurers. Claims Management is succeeding in trivializing and mocking the whole Conciliation process.

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    • @Pauline: in relation to your issues obtaining FOI documents – the (updated) online claims manual states:

      Dealing with information disputes

      Both the ACA and FOI Act include dispute and review provisions for resolution of particular disputes.

      Documents do not exist or cannot be found

      If the decision is that documents do not exist or cannot, after extensive search, be located, the notice of decision should advise the worker to seek review of the decision by utilising the agent’s and WorkSafe internal complaint resolution procedures.

      In addition, the decision notice must inform the worker of the right to complain to the Victorian Ombudsman (and provide the contact details for the Ombudsman – Level 9, 459 Collins Street, Melbourne Vic 3000 or at http://www.ombudsman.vic.gov.au) for ATI requests or to the FOI Commissioner for FOI requests.

      Commissioner’s contact details are:

      FOI Commissioner
      P O Box 24274
      MELBOURNE VIC 3001

      Tel: 1300 842 364

      Email: enquiries@foicommissioner.vic.gov.au

      Web: http://www.foicommissioner.vic.gov.au

      See: Missing or non existent documents

      The original decision is taking too long

      If an agent/WorkSafe does not provide a written notice of its decision to a worker within the statutory timeframe a worker may:

      contact the agent to confirm the status of the request
      complain to the agent and/or WorkSafe exercising their complaint resolution processes
      complain to the FOI Commissioner for FOI requests or to Ombudsman Victoria, an independent impartial and free service, for ATI requests.

      Access to information request

      The worker can apply to the ACCS for conciliation.

      FOI request

      The worker can apply to VCAT for a review of the request on the assumption that the agent has refused access to the documents. This is called a ‘deemed refusal’.

      Worker not satisfied with the original decision

      Access to information request

      A worker should be given the opportunity to request a review of the original decision by an internal Senior Officer within 28 days of the date the worker received the decision.

      This is in addition to a workers right to apply for Conciliation directly to the ACCS within 60 days from of receiving the decision.

      The review is to be carried out by a Senior Officer and a response provided within 14 days form the date of receipt of the application. The Senior Officer must be independent of the original decision and will make a fresh decision.

      FOI request

      A worker has the right to seek a review by contacting the FOI Commissioner within 28 days of the date the worker received notice of the decision.

      The FOI Commissioner’s review is taking too long

      The FOI Commissioner is required to respond to a worker within 30 days of receiving a request for a review. If the Commissioner does not respond within this timeframe and the time period has not been suspended by the Commissioner, then the worker may seek a review of the decision by VCAT.

      Worker not satisfied with internal review decision

      Access to information requests

      Conciliation

      If a worker is not satisfied with the agent’s internal review decision, they can apply for conciliation to the ACCS within 60 days from the date of the original decision.

      FOI requests

      Victorian Civil and Administrative Tribunal

      If a worker or WorkSafe/agent is not satisfied with the FOI Commissioners decision, either party can apply for a review by VCAT within 60 days of receiving notice of the Commissioner’s review decision.

      Conciliation unable to resolve a dispute

      If the ACCS is unable to resolve a dispute and:

      the Conciliation Officer indicates that a direction might be issued for documents to be provided and the relevant documents contain personal information about third persons, the disclosure of which may be ‘unreasonable’, agents should consult their Senior Legal Manager
      a genuine dispute notice is issued, the worker may choose to apply to the Magistrates Court. The Magistrates Court has jurisdiction to inquire into, hear and determine any question or matter relating to a decision, recommendation or direction in respect of a request made.

      AC Act: S43 Jurisdiction of Magistrates’ Court

      AC Act: S107A General right of access to information under this Act

      [posted by T on behalf of WCV]

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      • Thanks Poo, you’ve given me plenty of “right channels” to go up. Wonder how far the Claims Management will take it? I am going to get my documents, no matter what. They’re part of my history and the explanation of how I got from who I was as a worker to who I am now. Aah I love a good paper chase, it leads to such interesting revelations about my employers and the operators of the Workover.

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  7. The ACCS does actually have power, but its not as enforceable as a judge.  when I had conciliation the conciliator told me “I can award in your favour, the insurer will wait the maximum 28 days to lodge a dispute and then it has to be taken to court anyway, so if I give you a notice of genuine dispute you can start court proceedings sooner”

    the frustrating thing about courts is that if you challenge a speeding fine…its anywhere from 1-3 months and case is heard….workcover its anywhere between 6-10 months

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  8. In my case the agent DID NOT DISPUTE the direction notice. The directions notice order the claim to be accepted.

    What the agent did was wait till the expiry of the period of the directions notice (16 weeks?) and then simply claimed that I no longer had an entitlement to “ONGOING” payments. IE they accepted my claim but then stated that I was no longer suffering from a compensable injury.

    I wish the conciliator had issued a GD for me – would have been so much less painful.

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  9. Also in my case, it probably didn’t help that the manager of the local agents office was so openly corrupt that upon making the blatantly wrong decision to terminate my claim immediately took up a highly paid job with my employer where he then blocked my return to work.

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  10. M, the Agents are so shifty and the system turns a blind eye to their machinations that all involve burning out the injured worker’s energy to resist their bullying and injustice. They can drag things out forever, when we need action now.

    The Workover is pretty crazy making, but this site offers support and somewhere to vent while you’re going through it and excellent information to help you put up the best fight you can. And somewhere to post your wins when you get em!

    Mind you, I’m reduced to counting it as a win for me if I can get the Agents to use more than 10 workers to successfully curtail my current requests for retraining and FOI. I have to get my joy off the idea that I’m making them work hard even if it’s not to my benefit. So far, I seem to have exhausted three Case Managers, one Senior Legal Manager, one Agent ACCS Rep. People keep leaving their jobs. We may be miserable, but it seems, so are they.

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  11. Maybe its time to organise some protests outside Worksafe / Pollys offices and the insurer offices? I think Unions should be involved in this also as its in their interest too!

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  12. So right Jo. There is a blog just started on site for anyone who’s interested in campaigning against the Workover. It’s called IW Action4Justice. Check it out.

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    • Thanks Pauline,   I will read it now. I believe something is very very wrong and corrupt with the Worksafe/Insurer/ACCS system, Worksafe and the ACCS seem to be almost powerless against these insurers which need to be held accountable for their actions.

      The last time I applied for Concilliation, the evidence I had collected was overwhelming in showing the wrong doing of the insurer and they were directed to continue payments even without a concilliation conference. But still I was criticised by the concilliator for not having a Phone contact number!

      The people working for and with these insurers must be bordering on criminal, I’ve had their surveillance people Trespass on my property peaking into House windows (by their own admission) and videoing me from behind a bush on my property!  I’ve read some of the surveillance logs where they haven’t seen me so have suggested to the insurer they need a way of drawing me out to film me WHAT THE HELL!

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  13. It just doesn’t make sense does it? And it feels unbearably cruel. The whole notion of worker’s compensation has been totally corrupted. I wrote a rather long article on the blog about that if you’re interested, here’s the link:

    http://workcovervictimsdiary.com/2013/04/welcome-to-the-workover/

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