Most common mistakes injured workers make

injured-workers-mistakes-oops

In this post, we highlight the top five common mistakes injured workers make during the life of their workcover claim.

Most common mistakes injured workers make

1. Injured workers often talk too much

mistakes-injured-worker-smallAnswer all questions asked truthfully, but do not volunteer additional information about your life. Do not write extensive letters (or emails), or any letters to a workcover insurer/case manager more than a few sentences. Defer all questions about restrictions and limitations to your treating doctor(s) and all questions about your occupation/job to your employer. Answer all questions asked truthfully, then be quiet. We highly recommend you only communicate in writing. A workcover insurer can’t hold against you what YOU DO NOT SAY.

2. Failure to read the workcover law (in your state) and gain knowledge about your entitlements and rights.

mistakes-injured-worker-smallObtain a copy of your workcover law(s) as son as possible and know what you are entitled to long before sh*t hits the fan. By being able to quote sections from the relevant Act, you will be see a “different” approach by your case manager. S/he will go quiet, even apologise (sometimes) and even go as far as delay or cancel yet another IME. Learn as much as possible about the workcover legislation in your state—we’re here to help you!

3. Failure to discuss your workcover claim frankly and openly with your treating doctor(s).

mistakes-injured-worker-smallA workcover claim should always be discussed with all your treating doctors, or at least with your GP. You and your doctor should decide how to handle frequent and repeated requests for, for example, information, IME’s and even surveillance.
Doctors are not always willing to support injured workers when faced with vexatious requests from an insurance company. Talk about it in advance, make sure your doctor is well aware of your claim. Ask your doctor(s) to notify you of all requests they receive from the workcover insurer.

4. Failure to stay in control of your workcover claim

mistakes-injured-worker-smallMaintain a diary of everyone you speak to including names, dates and topic. Obtain a copy of all medical information yourself and submit to the workcover  insurer with  confirmation of receipt. Never fax without a printed confirmation of fax receipt. Ask questions, take names. Find out who is really making the claims decisions, get supervisor names, and/or ask to speak to supervisors (aka Team Leaders). Be polite, but stay in control of the claim. Enforce deadlines.

5. Failure to realise the workcover insurer is not ever acting in your best interests

mistakes-injured-worker-smallWorkcover insurance companies make money by NOT paying claims (i.e. benefits, medical treatment, weekly pay, home help, physio, counseling etc). This is the entire concept behind workers comp insurance “risk”. Never believe a workcover insurer is acting your best interests. Understand the intent and motivation of any workcover insurer (and case manager) and act accordingly.

 

 

[Dictated by Workcovervitim and manually transcribed on her behalf]

 



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3 Responses to “Most common mistakes injured workers make”

  1. They are great tips, particularly keep a diary/transcript of ALL phone calls, emails & any correspondence/meetings, where you went, who you spoke with, what was said & what was the outcome.

    Re the short emails with your caseworker/insurer. I think this would have to depend on individual cases. In psychological injury it could work against you. If you are that composed & that rational to be able to maintain control of your emotions then that could also be used against you.

    Doctors & specialist also see a lot of claims/cases as well & they are not going to be your best advocate, YOU ARE. They do not know you as well as you do & the tip about being honest with your GP is essential & your psych if you are also seeing one as well.

    Make sure you agree with any recommendations they make & if you don’t, then put it in writing & make it clear this is not your opinion.

    I was denied treatment as it was complimentary therapies/alternate which my doctor recommended & we fought 4 mths to get approval & then 12 mths to hang on to. Despite improvement & despite no evidence at all to remove its approval, a new caseworker just axed it all, including medications. My doctor does not have the time, plus he then died a few months after suddenly & I had no one to advocate in the form that was needed. With assistance we researched & put together a response & I addressed fairly every single one of their claims with scientific & medical evidence & wrote to a few people who specialise in trauma & treatment.

    Whilst I did not have all the treatment plan reinstated, some was & it wouldn’t have happened from writing a few lines.

    These companies primary role is to DISEMPOWER you, to make you feel like you have no control & when it is particularly a psych injury & let’s be honest even if you have a physical injury you will have experienced trauma from the injury occurring as well; you are at a vulnerable time, you are vulnerable & they are well & truly aware of that.

    I had an IME write a report which supported the removal of all the treatment. The report described me as a “blonde woman” I am dark/nearly black in hair colour! There were many errors in his report, including the wrong work place. Yet the part they used was denying recommendations by my GP to continue with treatment.

    So I wrote to the IME personally. I addressed each of his errors & I addressed him professionally as someone with a moral conscience. I thought it might not work, yet I was going to have my say & I wasn’t going to let this report go unchallenged with all its errors (as it is not the GP or the Psychs role to do that either).

    6 mths later the IME was asked to write another report & I went to see him again. I was already assessed as having 18% permanent impairment (psych) by my own IME & yet this IME, having already written a damning report earlier, then concluded permanent impairment at 29%.

    I think it depends on your level of experience & capacity to engage with professionals & having spent a great deal of my working life preparing for court/writing court reports engaging with medical & legal professionals, I wasn’t going to write a 2 line short response when these people were undermining my well being & not only devastating my life, also my children’s.

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  2. As a severely psychologically injured worker I have found second time around the use of my husband as my agent with the insurer stymies them a bit. A lot of workers comp depends on the belief of a reasonable person and the balance of probabilities. Stick a reasonable person in as your agent and it removes some of the games they play knowing you are psychologically injured.

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  3. Keep the common mistakes and tips coming! We’ll eventually compile a long list with all injured workers’ experiences and own ‘tips’.
    With re to keeping short correspondence with your case manager, of course it depends on your particular situation, but generally speaking the less you say the better as your case manager can and will hold certain things you write against you. An example was an injured worker who was prescribed imaging (also nuclear imaging) to a likely infected shoulder (site of injury). Because the injured worker had also developed (and mentioned) a red,swollen finger joint on the same arm, which was thought to be due to spreading of shoulder infection to finger (osteomyelitis/bone infection), the pathetic CM denied the shoulder imaging even though they were urgent and prescribed by a surgeon (no approval needed). The injured worker had to appeal the matter and it took months to obtain an approval letter for the radiology place to undertake the tests. This CM used the ‘red, swollen finger’ to deny the shoulder infection tests (!), stating it had nothing to so with the work injury and twisting it the other way around as it were. So, less is more.
    Don’t go on about your symptoms, defer them to your medical treater(s) and simply write a short email stating something along the lines of “my surgeon has requested I undergo imaging to x, please provide me with a pre-approval letter for the hospital/radiology facility… Copy of the request attached. Should you have further questions please contact surgeon..”.
    The same applies for anything medical, for example do not ever write about your physical restrictions etc, as they may and will use it against you if they undertake surveillance and you happen to ‘do an activity’ which you said was restricted or something along those lines.
    Another way of dealing with the game playing is by requesting your CM requests IME appointments, informs you of cutting off benefits (i.e. physio, counselling etc) through your treating GP. All correspondence is to go to your GP (or other treater like a psychiatrist, psychologist) who will then inform you, the injured worker. A lot less games are played that way.
    You can also cc your lawyer (or medical treater) in all your email correspondence – CMs hate it as it opens their ‘transparency’ and manner in which they address your queries/requests etc.

    Anyway, keep the tips coming!

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    Workcovervictim3 June 23, 2014 at 7:23 pm