As reported in today’s The Advertiser, WorkCover SA has bought in rapid-response teams and rigorous data analysis to identify fraud and problem areas as psychological claims for the effects “disrespectful behaviour” more than double in the last 12 months.
WorkCover SA has identified the growth in psychological claims, WorkCover’s most expensive category other than catastrophic physical injury. Workers compensation claims for mental stress grew by 68% since 2011.
About 50% of all psychological claims are rejected under the “reasonable management action” exclusion alone.
WorkCover SA tells “psychologically deranged” workers “they should just go and work for someone else”
Psychologically damaged workers left in limbo for months by WorkCover
The Advertiser January 04, 2014
Business Editor Christopher Russell
AN ALARMING increase in claims for psychological injury has hit the over-burdened WorkCover SA budget.
Claims for the effects of “disrespectful behaviour” have more than doubled, costing WorkCover millions of dollars. Claims for “work pressure” also have soared.
The poorly run system has resulted in workers sitting at home for up to four months waiting for their claims to be assessed, with no treatment or return-to-work plans.
A new management team has introduced measures to rein in costs and speed up processing of both psychological and physical injury claims.
However, chief executive Greg McCarthy admitted there was no hope of tackling the scheme’s political football – the $1.37 billion unfunded liability – without major reforms by government.
“At the end of the day, it is an insurance business and you need to run it as one,” he said.
“You could say that it’s been run as a welfare scheme – and that’s the problem.”
Mr McCarthy has brought in rapid-response teams and rigorous data analysis to identify fraud and problem areas.
But it will take up to five years to reach break-even let alone reduce the liability, he said in his first interview since taking charge a year ago.
Industrial Relations Minister John Rau, who says the scheme is “buggered”, has pledged to publish a reform plan within weeks.
Mr McCarthy’s team identified the growth in psychological claims, WorkCover’s most expensive category other than catastrophic physical injury.
“The data tells us there is clearly a problem here,” said general manager insurance Rob Cordiner.
Mental stress cases that entered the books in 2010-11 had cost $24.1 million by October this year, 49 per cent more than cases from the year before over an equivalent period. Payments grew another 7 per cent for 2011-12 cases and a further 12 per cent for 2012-13 cases.
Once a claim is lodged, WorkCover orders an independent medical assessment and takes statements from the employer, worker and co-workers – a four-month process.
“In that time, the worker’s being paid but nothing’s happening with the worker, the treatment or anything,” Mr Cordiner said. “It’s just an investigation as to whether they should be paid or not.”
WorkCover pays the substitute wage, which is not recoverable even if the claim is rejected. To streamline this, investigators now gather basic facts within five days and specialist medical practices report within 10 days.
About half of psychological claims are rejected because they are based on what reasonable action was taken by bosses.
Mr McCarthy said the aim was to support the injured worker and employer and let them get on with their lives.
“At the moment, by the time they’re three to four months down the track if they weren’t psychologically deranged before, they are now,” he said.
Getting workers off the compensation system also was problematic. After recovery, they often did not want to return to the same workplace.
“We end up with an insoluble problem that costs a lot of money,” Mr Cordiner said.
“It’s really an industrial issue, they should just go and work for someone else.”
Revised May 2014