QLD seriously injured worker who underwent total shoulder replacement entitled to nothing

nothing-workcover

We recently received an email from a QLD-based seriously injured worker, who after recently having undergone a total, dominant titanium shoulder replacement, after a work related accident had his/her workcover file closed, even though the workcover IMEs (and his/her own treating specialists) have deemed the injured worker’s injury not stable/stationary as yet, and as such the injured worker is not able to undergo a permanent impairment assessment as yet (which undoubtedly will score high enough to be deemed “seriously injured”). In Victoria, for example, we do know that a total shoulder replacement automatically scores 30% WPI (plus any % for residual incapacity such as loss of function, movement etc.)

What is perhaps more disturbing than having his/her file closed is that this seriously injured worker, who is for example not even capable of lifting a kettle, is being deemed “fit for work”, and -of course- workcover QLD forced this seriously injured worker to undertake various host employments (restricted duties). Now those various host “jobs” this seriously injured worker is subjected to, are quite humiliating in nature, as they involve for example answering phone calls all day… A far cry from what this worker was doing before his/her work accident. Add to that the fact that this poor sod has no access to any medical treatment, claim closed remember, so also no counselling should s/he need it… and one would guess that learning to rebuild a life after such a devastating injury would necessitate some professional help, huh? Let alone a vocational assessment and proper retraining…?!

The injured worker has the following question(s) and we would be grateful if any other injured Queenslander could possibly help point this seriously injured worker in the right direction, and offer some much needed guidance and support.

QLD seriously injured worker who underwent total shoulder replacement entitled to nothing

The seriously QLD injured worker’s story and plea for help/advice *

*This story has been slightly amended/censored as to ensure all identifying features are removed*

Good morning.  I need help or advice.  I was injured in a work-related accident in QLD (end last year).

I sustained an injury to my (dominant) shoulder which was so serious,  after several hospitals I was operated on and now have a prosthetic Titanium shoulder joint.  Workcover QLD accepted my claim, paid all the relevant medical costs and my wages (weekly pay) until (about mid 2013)  at which time they decided to close my claim.

Prior to this both my surgeon and the independent specialist Workcover QLD sent me to declared me NOT stable and stationary and would not be close to it before (at least) 12 mths post op.

I was made redundant/terminated from his position about mid 2013.  Workcover QLD arranged for me to attend (several) host employment stints (restricted duties) where I did very little except answer phones (I can’t even pick up a kettle yet).  I have been very compliant.

I will be left with a Permanent Impairment (PI) and will never return to a physical job ever again.  The reasons given by Workcover QLD to close my file are:

  • They deem me no longer incapacitated to work (note I am not stable nor stationary) and I will have a PI and will need to change my career
  • As I am not receiving treatment at the moment (Workcover’s own specialist supported this as no medical treatment will improve it at the moment, time is the essence) I am not entitled to anything

I have only received wages for about 9 months.

I have contacted Q Comp/workcover QLD for a review of their decision.  I’ve combed all the legislation and I cannot find grounds for them to stop payments.  In fact they told me to give them a call at the end of the year so they can then send me for another assessment.  I am due to be reviewed by my surgeon in about 2 months time which Workcover knows about.

Can you or any of your members direct me to any relevant legislation both supporting my premise and/or supporting Workcover’s decision.

Your help would be so very very valued right now.

Regards

B

At this stage, all we were able to come up with in our private reply to this seriously injured worker “B” is that basically we believe you are confused between the PI (permanent impairment) and work capacity. A permanent impairment assessment can indeed only be made once your injury or injuries have stabilised – in reality this means that your injury is not to get better or worse by 3% with or without treatment. Normally you can’t have an assessment until at least 12 months post-op. In your case, it may even take longer to get deemed stable, depending how well the surgery (prosthetic) went and if there are no complications (i.e loosening of components, infection etc).

Note: it is sometimes worth waiting or delaying your PI for serious injury

NEVER EVER RUSH INTO HAVING A PERMANENT IMPAIRMENT ASSESSMENT UNDERTAKEN – YOU ONLY GET 1 SHOT AT IT IF DEEMED STABLE AND CAN’T GO BACK FOR MORE. THE ASSESSORS DON’T ALWAYS GET IT RIGHT EITHER.

For example, in “workcovervictims” case who suffered a devastating shoulder injury (and many other injured workers) it took 8 years  and 5 attempts to pass her permanent impairment (PI or WPI) assessment. Workcovervictim eventually passed end of last year, with >40% WPI. All the previous attempts came back as injury not stable/stationary, as it was the opinion (in WCV’s case of the medical panel in Vic) that she would get much worse, and she did. Even after her last assessment, when they thought her injury was as stable as it possibly could ever be – she deteriorated unexpectedly within weeks and developed end stage avascular necrosis as well as other complications in that shoulder (in addition to all the rest) – for which she now needs a  total reverse shoulder  prosthesis (if still possible) in 1 or 2 stages.

Many seriously injured workers are forced to return to work (whether in “suitable” duties , or”unsuitable”, forced at gunpoint or appropriate etc) whilst awaiting their permanent impairments to progress their cases to the next level (i.e lumpsum, common law), and some still have a very limited work capacity even with certificates of serious injury (i.e.30% WPI or more in Vic).

So what we want to convey here is that the Permanent Impairment assessment has basically nothing to do with work or having a work capacity.

If the insurer for example sent you to a (biased) or ignorant IME who states you have a capacity for work, then the insurer will cut off your weekly pay on that basis. Worse, even, if your own surgeon (who may have a huge ego, or who may not realise what the insurer has up its sleeve with re to “suitable work”) stated in a report that you have a (very) limited work capacity after the total shoulder prosthesis, again the insurer will cut off your weekly pay, and force you to return to work, even in the most humiliating “restricted” job possible. We have heard about seriously injured workers having literally to lick stamps on envelopes as a “suitable” host employment, working in call centres (headset) and what not.

Some jurisdictions are allowed to cut off medical and like treatment when weekly pay ceases as well (see below for a quick comparison of all the legislation in all states)

What we perhaps forgot to add is that you are entitled to a vocational assessment and re-training:

While we all do want to return to work, the courts have also acknowledged that a job must be realistic for a seriously injured worker, and somewhat satisfying as well. So, this means that you have a full right to be retrained at the cost of workcover if you are no longer to ever return to your pre-injury work. This usually involves the workcover insurer starting off by referring you to a decent (and we mean decent) vocational assessor for an assessment, who should look at your CV, transferable skills, your interests etc and then formulate a plan for retraining, which could be just about anything, from a  computer course, to a university degree (depending on the level of earnings pre-injury).

 

Again, we do hope that our QLD injured workers are able to further guide this seriously injured worker.

 

[Posted by WCV3 on behalf of workcovervictim who remains very unwell]

 



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2 Responses to “QLD seriously injured worker who underwent total shoulder replacement entitled to nothing”

  1. Hi
    I’m from Qld, suffered a shoulder injury at work December 2011, and subsequent nerve damage. I am fortunate that I have had a decent run thus far through qld workcover. After treatment, including physio etc, for 6 months post injury, my case was closed, due to having to wait for injury to stabilize. Based on neurologists advice of some 12 months post injury to plateau and any rehabilitation that occurred by 18 months would be all I’m likely left with. It was only due to me being left with a permanent impairment ( currently rated 35% upper body, equating to approx 10% wpi, as per workcovers impairment assessment they ordered, that I decided down the road of common law. I suffer daily with pain that I manage with pain relief medication, along with trying to continue an as normal life post Injury as possible. Impossible i know, but gotta try right?! I was offered a lump sum by work cover,however this was purely based on the Injury and not pain and suffering , future impact etc, also have to mention a pittance of an offer. I am quietly confident that my employer can be proved negligent and that work cover will have to accept liability. I am extremely lucky to still be in my same position as pre Injury, however I struggle much much more with my role and am lucky that I can ‘hide’ if you like, on the inside panel position operating computer screens where the effect is not as bad as the outside role which is more physically demanding. I’m only 37 years old and I fear what lay ahead for me, as whilst I can stay in my current capacity, I still don’t know the long term effects my Injury will toll on me say 5-10 years from now. I know without doubt that consistent physical labour will be a thing of the past for me and I struggle with that aspect as like a lot of people, was physically able and fit to do anything before injury. All I can offer as advice, as being in qld, is once your case is closed and you dispute the reason for such action, Q Comp is your only avenue for recourse and a reversal of said action. Elsewise it would also be prudent to seek Independent legal advice of your Injury, case, and lawful avenues you can take, remembering the time constraints that apply for common law claims etc in qld. Hopefully I get a good result as in November this year I await their response on liability, and hopefully settle after that. Cannot come soon enough I must say. And hopefully you too can find some steps in the right direction.

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  2. I know just how you feel. I too have had shoulder surgery and still suffer daily pain in neck and r shoulder and arm.
    It sucks. Work thinks that shoulder op done….so all fixed. I wish 🙁

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