Another day, another workcover claim denied

workcover-claim-denied

Almost on a daily basis we receive emails from genuinely injured workers who have had their legitimate claims DENIED by their workcover insurers,without much explanation other that “we don’t believe you did it at work”.

We can’t help but notice that the frequency of such denials appears to have increased over the past few months. Ironically it coincides with media articles alleging that for example WorkSafe Victoria (WorkCover Vic) is now rejecting workers’ compensation claims at more than twice the rate of its counterpart in NSW ­WorkCover; and other various “crackdowns on injured workers” and “workcover shake ups” in various states.

Take the case of injured worker “T”…

Another day, another workcover claim denied

The injured worker’s Story

I injured my back at work which resulted in an acute bulging disc. At first Allianz approved the compo on restricted terms. The disc eventually got that bad that my neurologist admitted me to hospital for emergency surgery. Allianz refused to pay for the surgery so it was done on the public system.

Since then Allianz has cancelled my claim stating I didn’t injure my back at work.

I have a solicitor and Ive been informed by several doctors that I have no capacity to work.

The figures discuss IF I WON my case is around $20,000 …

…it seems unfair because I genuinely did injure my back at work.

How TERRIBLE is this guys? Now, whilst we don’t know the full circumstances around the injury and how it occurred, what we do know is that when people don’t report their injuries IMMEDIATELY (as it happens), most (dirty, greedy) workcover insurance companies (and many employers) will take advantage of the situation and lie through their teeth, make up all sorts of stories that “it did not happen at work”.

Tip: Report any work injury when or as it happens

We’ve said it before and we’ll say it again: if you are hurt at work, report it and report it immediately!

One of the biggest mistakes you can make if hurt at work is to try to ‘shake it off’. If you do not report an injury at the time it occurs, the chances are very good that your employer, or its insurance company, will deny that the injury happened at work.

This is especially true if for example you happen to injure yourself on a Friday, but decided to “shake it off”, wait and see, only to get much worse over the weekend and report it on Monday – rrright – you see from here that they will accuse you of having injured yourself over the weekend and not at work!

One of the most common reasons that an employer (and the workcover insurer) denies an injury is work related is failing to report it on time, which is IMMEDIATELY, on the same day at the very least.  If you injure your back lifting on a Friday and decide to see how it feels over the weekend before saying anything, it will cause huge problems.  Even if your employer believes you, the workcover insurer can and often will still deny the claim under the presumption you must have injured yourself at home (or sport/activity) over the weekend.  This so so common!

In Vic you technically have 30 days to report an injury, in other states longer, in others less,  but even waiting 24 hours can be too long.   The best thing you can do is report the injury IMMEDIATELY, and if it truly turns out to be nothing you will look like you worked through it and didn’t complain. Nothing lost.If you don’t report an injury, you’re the only one who knows you’re hurting.  Sometimes all it takes is some lighter duty work for a few days and you’ll be better.

It is also extremely important that you go and see a doctor on the same day that you injured yourself -be it a GP, an emergency clinic, hospital – so that it is DOCUMENTED. Even if it’s only a “sprain” which could later turn out to be much worse.

Reporting accidents can affect your employer’s workcover premiums (and risk rating). For example, “the new NSW scheme has particular premium ” incentives”  for small businesses that prioritise claims management and return-to-work performance”, it even includes things like “small employers that return an injured worker to some form of work within 13 weeks of the injury can be eligible for a 10 per cent discount on their premium”…. etc. Read between the lines here!

However, you need to protect yourself, because when it comes down to it, you are oftentimes expendable – especially if you can’t perform your job any longer due to an injury that you cannot obtain treatment for.

Most issues regarding accident reports can be remedied over time, but t is better to know your rights now than to learn about them when it’s too late.

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Hopefully, in injured worker’s “T”‘s case, her/his lawyer(s) are working very hard to get liability for his/her legitimate workcover claim accepted. Many are successful, but it takes time and a lot of stress and frustration, and your case may need to go all the way to Court.

[Post dictated by WCV and manually transcribed on behalf of workcovervictim]

 



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4 Responses to “Another day, another workcover claim denied”

  1. if this is the case maybe someone needs to start a mexican wave of boycotting the workforce until they fix this workcover system up! At the end of the day what is the point of working if you have no rights, which means an employer can now push a worker that hard they break and then dump them. WTF has happened to Australian workplaces.

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    .................. September 25, 2013 at 3:45 pm
  2. We received the following comment via email from injured worker “G”:
    Your article on claims being denied is spot on . I attended another IME for insurer Allianz with psychiatrist Dr L (in July this year).
    As a result of this I contacted Allianz to find out the finding of the examination.
    At first they said they had not received it but when I contacted them a second time they told me that they would send it to my solicitor.
    I got a copy of it and it stated that my claim was now declined and that they would not be paying Weekly benefits and medical expenses as from (around October)

    After originally accepting the claim [8 years ago !!!!] they have now declined it as according to them not work related.

    ——

    How on earth is this possible after 8 years guys? Surely this is criminal on the part of the insurer, who is using 1 (most likely highly biased or corrupt) IME report out of dozens or hundreds (after 8 years) to illegally terminate a claim!
    And they’re wondering why our workcover schemes are in deficit?Hell! It”s called DISPUTATION costs, for surely injured worker “G” and his/her lawyer will fight back and appeal this utter nonsense.

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  3. And another one denied.!!

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