Workcover insurers withhold, tamper with and falsify medical evidence

hiding-evidence2

We’ve heard it over and over again from countless injured workers: workcover insurance companies are dishonest in the name of profit, period. One such a tactic is to withhold video evidence of an injured worker – because it supports the level of impairment reported!

Workcover insurers withhold, tamper with and even falsify medical evidence

hiding-evidence2

Since aworkcovervictimsdiary’s existence, we have had thousands of injured workers complain about the unethical practices of their workcover insurer. In particular, several extremely disturbing issues have been reported over and over again, by injured workers of ALL states. These notably include:

  • the workcover insurer (and/or case manager) ‘losing’ files which contain crucial medical evidence about the injured worker
  • Very selectively ignoring medical evidence from top medical specialists which would enhance and certainly advance  the injured worker’s claim
  • Workcover insurers (and/or case managers) failing to disclose vital medical reports to for example Independent Medical Examinations (IMEs); Dispute Resolution bodies such as Conciliation, Arbitration etc.
  • Top medical specialists’ reports being overrruled by workcoover insurer’s doctors (aka so called Medical Advisors – we like to call them failed doctors, for who on earth would want to do such a “job”), nurses (aka nurse advisors, again, nothing more than failed nurses, unemployable in a medical setting!) and even non-medical staff, such as the wannabe-God case managers
  • Medical assessments being made on injured workers by workcover insurer’s-paid doctors without even seeing the injured worker or consulting with the injured worker’s treating doctor and/or specialists… I who have never seen you, never examined you, not at all experienced in the field of your injury, or worse, medically untrained (even unregistered or >80 years old) decide how badly injured you are (not) and what’s best for you (not)!
  • Doctors who have lost their medical licenses due to disciplinary reasons (oh yes!) doing medical “investigations” and “assessments” of injured workers (both physical and psychiatric examinations)
  • Physical and/or mental harm/hurt caused by workcover insurer’s medical examinations – happens more often than you think!
  • The workcover insurer (and/or case manager) withholding video evidence of an injured worker (because it supports the level of impairment reported!) and engaging in totally inappropriate video surveillance of injured workers

Routinely withholding surveillance video evidence from injured workers

We have heard from several injured workers that their workcover insurer has (apparently routinely) withheld video evidence from these injured workers, despite the FOI legislation requiring full disclosure, when asked!

This revelation came after several injured workers discovered – via FIO or their lawyers- that  rather large sums were paid to private investigators for surveillance of them – although no surveillance results were in their files!

We would like some ANSWERS

Recently a severely injured worker shared the following:

“They [case manager/insurer] just refused to put that investigative information on my file when I identified it”. “You couldn’t do this in a criminal court. If you withheld that kind of information during discovery, you’d be in big trouble.”

This injured worker said he was told by the [workcover insurer] “that the investigations (surveillance conducted on him) proved irrelevant to his case. ” (WTF!)

If someone secretly surveils an injured worker for, let’s say, a month and they can’t find any indication that s/he is faking or exaggerating her/his injury, does it not stand to reason that might in fact support his/her claim?

Like so many of us, this injured worker believes “that there is a culture of denying claims within the (workcover system/insurer) and it will go to lengths to actually speed up  that process“.

A former workcover case manager shared the following with us:

“They have a system of incentives where they pay people [i.e. case managers] more based on their performance, and one of the many criteria is cost. How do you control costs? I can speak as a former case manager that there were  performance indicators, but when they reviewed performance, they always came back to cost of the file and getting rid of it.”

Another severely injured worker shared the following:

“I complained a video tape used in my case appeared to have been edited, with quite large time sequences removed. At one point, the investigators also appeared to video tape the wrong man.”

He was told by the insurer that it is against its policies for video tape to be edited. “We contract with professional investigation companies whose techniques … are driven by the rules of our own standard of investigative ethics.”  “The [insurer] investigation unit does not allow editing to be done by our service providers.”

At the time of the surveillance, this injured worker also had no clue what was going on.
“My neighbours saw these people over there and someone went over there and they said they were plain-clothes police officers watching a drug dealer” …. “And this came back to me. And so here I didn’t realize, the person they’re watching was me!”

Private investigators go to great lengths to misconstrue an injured worker’s condition

The former workcover case manager states that private investigators routinely go to great lengths to misconstrue a injured worker’s medical condition, and did manage to “catch many behaving more energetically than expected”.
One such a case stands out:

“The problem is, that injured worker was on huge doses of Oxycontin and Endone (paid by the insurer), and he was at his mother’s funeral. He had advised (the insurer case manager) in advance that he was going to go to his mother’s funeral, and that he was going to try to be a pallbearer because this was the last time he was going to be able to do anything for his mother.

You can guess it… they took the opportunity to video surveil him, and the surveillance video showed that he could lift weight as in helping carrying his mother’s casket. The video tape also showed he could sit for 25 minutes instead of the 10 minutes or so he had claimed was also shot at the funeral, in the church.”

“This poor injured worker said to me, ‘I know I did that stuff. And for 2 weeks afterwards I could barely move,  crying in bed, the pain so bad, . But damn it, I was going to my mother’s funeral’ “.

“Thankfully he took this matter to court and  won his case.”



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