The role of the all-mighty, non-medically trained workcover case manager


We all know by now that Workcover case managers come in many different shapes, sizes and – especially- characters. They can be young and extremely inexperienced, lacking communication and basic people skills; ,  many are in their forties, divorced and utterly miserable sourpusses, some are male, most are female, some have years of experience and have undoubtedly gone through a “work hardening programme”,  some are fresh off the street and so inexperienced and non-educated in the law and in medical terminology it’s frightening, many are, yes, lazy and incompetent,  a  very few are decent. They are  pro-active and  re-active case managers. Most don’t give a hoot about the plight of the injured workers, and -perhaps most importantly -and the most frightening part, as most of you know, is that it is our medically untrained, totally uneducated workcover Case Managers clerks are allowed to make that life or death decision for us, by over-ruling. How cool is that! They actually get to play God!

“…Advice from the most senior Medical Staff in the country can be overruled by Case Managers, and often Orthopaedic or Neurosurgery is delayed or never done on the whim of a Case Manager “who decides that it is not necessary.”The Case Managers, employed by the Insurer, and the Return to Work  Coordinators have the right to withhold treatment recommended by specialists, or to over-rule evidence based treatment based on thorough medical knowledge…”

[Professional Health Partners P/L stated in their submission re the NSW workcover overhaul the classic statement of facts]

The role of the all-mighty, non-medically trained workcover case manager


You don’t believe us? Well check out the statement made on workcover SA’s website for example entitled:

Case Managers

The case manager is responsible for deciding if the claim can be accepted for compensation under the legislation. The case manager will work with the injured worker (since when?), employer, health provider(s) and rehabilitation provider to coordinate the return to work process.

Their role includes – and please read and re-read between the lines for it is all there:

  • case managing the claim from an administrative, cost and legislative perspective
  • developing and approving programs and plans in consultation with all parties
  • ensuring information provided to injured workers about their rights and responsibilities is made available in a language or format suitable for the worker
  • assessing the requirement for workplace rehabilitation intervention through consultation with the worker, employer and treating doctor
  • determining the rehabilitation and return to work objective and goal(s) for the worker if required
  • selecting a rehabilitation service provider to provide user services
  • assessing the requirement for medical expert and other support services in consultation with the workplace rehabilitation consultant and treating medical practitioner
  • reviewing programs and/or plans to ensure they are progressing towards the identified objective and goal.

What does this say to you? Yep: the workcover case manager has TOTAL control over you, the injured worker – even though s/he  has never ever seen you, has no medical or allied health knowledge, is not a doctor, not a “rehabber”, and is just a “clerk” really! How bloody frightening is this?

Add to that the fact that all insurers we know of usually have an incentive or bonus program (for case managers) tied to the reducing the number of workcover claims or reducing the benefits paid to legitimate injured workers, even the most seriously injureds amongst us… and yes, it is a recipe for disaster. And so it is that many case managers primary goal is to focus solely on finding an excuse or basis for denial or delay of legit benefits to the injured worker (i.e. surgery, weekly pay, home help, physio, hydro, pain management, counseling etc etc).


You can read heaps more about those bizarre but powerful creatures here :all articles related to case managers


[Original Source kindly shared by co-author Trinny:]

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


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4 Responses to “The role of the all-mighty, non-medically trained workcover case manager”

  1. A properly trained case manager would have a Diploma in Community Services (Case Management) and would actually have ethics. They are actually taught that in the diploma!
    They are bound to doing the right thing and if they cant they are to remove themselves from the case.

    These so called case mangers are clerks that have been bullied into submission by the insurance companies and it is a disgrace. They need to be held accountable for what they are doing and hopefully one day they will.

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  2. If they had to have a Diploma in Community Services we would have two Case Managers per Insurer not the Dozens of Clerks that are turned over frequently; I have no idea what sort of training they get now? maybe just a short Course in how the Insurer operates and definitely NO ethics!

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  3. Just because they have a Diploma in anything does not give them skill! I have several qualifications & post graduate, it comes down to the individual & training. No course can adequately train any person for the individual case management requirements of each industry. Having worked as a case manager for some years I was appalled by the treatment I received under Workcover.
    My caseworker who threatened me if I wasn’t nice to her that she had the power to cease all my treatment & with an assessor (hired gun) she did just that – despite upgrade in status, retraining & a return to work plan! It totally undermined the very goals the insurer had.
    After stating this she then told me I had no understanding of her role as (despite several months into my case) she had “NOT HAD TIME TO READ THE FILE”.
    So here she was making judgements, assessments, questioning the medical treatment, changing the case plan, disrupting the progress & had absolutely no knowledge of the incident, the ongoing threats or the treatment plan.
    There is a John Grisham movie/book about this very approach. These are NOT qualified CASE WORKERS – they are administratively trained & are called case workers/managers, they have no medical training or training/skill other than administrative.
    An actual case worker engages with their clients/cases face to face – this is avoided by the insurer – this is purely an administrative role.
    They are paid to avoid litigation & reduce costs at all COST! including the harm to the injured worker. They just deny, don’t pay, reduce & avoid & you have to be tough enough & strong enough to hold on for your life & fight back.
    Try claiming your superannuation – it is a very different type of case management/work role. I’ve had two totally different experiences. My super insurer/underwriter has been efficient, sympathetic, courteous, quick to respond & follow up.
    This is NOT about case management – this is about the company policy & procedures which are in the job description of those who case manage for the claims insurers.

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  4. So true Jane that is exactly what they are like. My case manager for my income protection is an absolute gentleman and treats me with respect and believes that I was bullied by my employer as they proved it to him by not returning my income protection forms to him for over seven months. Then when they asked for more information the employer to this day still has not responded. My income protection people decided to pay me anyway as they could see the way the employer was treating me.
    Work cover case managers are not properly trained and should not be called a case manager. If they cant even read your file and then they are making decisions that affect your life it is disgusting and they should not be allowed to get away with it. If every person on work cover took their complaint to the insurance ombudsman instead of their solicitor I wonder what would happen? They don’t like ombudsmen being called.

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