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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Pauline Pope
Guest

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/

jo
Guest

Just sickening 🙁

Pauline Pope
Guest

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.

jo
Guest
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… Read more »
jo
Guest

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!

Pauline Pope
Guest
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… Read more »
M
Guest

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.

M
Guest

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.

vulgarwolf
Guest

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

Pauline Pope
Guest
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… Read more »
D.Right
Guest

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.

Sarah
Guest

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 !

vulgarwolf
Guest
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… Read more »
Wheelin
Guest
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… Read more »
Pugsley
Guest

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.

Shattered
Guest
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… Read more »
Pugsley
Guest
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… Read more »
Shattered
Guest

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.

 

 

Shattered
Guest

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?