The war between the injured worker & the workcover insurance company

workcover-insurance

You may not realise it, but at the time of your workplace accident(or illness) you actually enter a war zone. And that war is between you and the workcover insurance company.

Workcover insurance companies exist to make money

Workcover insurance companies solely exist to make their money by not paying workcover claims-or by paying as little as possible. Did you know that for every day the workcover insurance company doesn’t pay on your workcover claim, it can invest that money and earn interest for its own profit. Every dollar the workcover insurance company doesn’t pay in claims increases its bottom line profit at the end of the (financial) year.

The war between the injured worker & the workcover insurance company

Every workplace injury (or illness) case turns into a series of battles with the workcover insurance company. Your lawyer’s job is to win the war and to secure your rightful benefits as well as the best possible settlement.

Conversely, the workcover insurance company and its own  defense lawyers have two specific goals:

  1. delay the settlement and/or
  2. make the settlement as small as possible

(By settlement we also mean any other benefit, such as payment for medical and like treatment/services; weekly payments etc.)

Workcover insurance company tactics

Whilst we have posted many articles about the workcover (and its defense lawyers) “dirty” tactics (which we have come to name SSSStall – Starve/gaslight – then Settle); listed below are commonly used workcover insurance tactics used in the work injury war zone.

  • (Pretending to) Be Nice

Workcover insurance representatives (often called case managers) are trained to be nice to workplace injury victims especially those who don’t have a lawyer!

Did you know that workers compensation insurance company studies have shown that injured/ill workers treated in a friendly way are more likely not to hire lawyers. Studies also show that workcover victims without lawyers settle their claims for much smaller amounts. So if you don’t have a decent lawyer, don’t be surprised that your workcover insurance case manager calls frequently to ask about your medical treatment. Don’t be surprised if they seem kind and ‘deeply’ concerned about your welfare, particularly at the beginning of your claim. But, please, never ever believe they have your best interests at heart. And also remember, during every conversation your case manager will be (generally recording the conversation),  taking notes, and what you say may even be used against you later. Case managers are not your friends, period.

  • Requesting Unnecessary Information

Workcover insurance companies have many excuses not to pay for a CT, surgery, physio, counseling, and not to settle deserving cases. One of their favourite excuse is that their file isn’t “complete.” In other words, they want every record, every bill, every piece of paper concerning your case before they will evaluate it for a requested benefit or a settlement. Very often they want documents having nothing to do with your injury, including old medical records from long ago. They are looking for information to deny your claim or benefit or to reduce the amount of the settlement you may be entitled to.

  • Deliberate Delaying (or stalling) the claim

By holding onto your settlement money, or money that is to be paid for a surgery, physio, counseling, home help, whatever; the workcover insurance company earns interest on that money. So delay is to the workcover insurance’s advantage. Early in a case, the workcover insurance company may claim it doesn’t have all the medical records ‘needed’, or needs “further information”. In the middle of the case, the workcover insurance company will insist that you be evaluated by a doctor they choose— an “independent” medical examination. At the end of the case, if it goes to court, the workcover insurance company will refuse to settle until the case is scheduled for trial; many settle on the court steps! Delay is in their interests, because they earn interest on any money they don’t pay.

Did you know about the following quite remarkable statistic, which is widely quoted in the Accident Compensation jurisdiction in Victoria?:

  • 90% of serious injury cases are rejected by the VWA; and
  • 80% of serious injury cases which proceed to court are successful!

It is indeed very clear from this statistic that something is very wrong with the workcover system!.

  • Disputing Medical Treatment

A favourite tactic.The workcover insurance company will contest the amount of treatment you had. Sometimes they will claim you received “too much” treatment for your injuries, or that the treatment was “unnecessary”, or “unreasonable”. Many workcover insurance companies use computer programs to “prove” that you over-treated or that you should have recovered more completely than you have! ( see Are you allowed sufficient time to recover from your work injury?) But, on the other hand, if you— the injured worker— don’t pursue regular treatment, the workcover insurance company will argue that “this pattern” proves you weren’t seriously injured in the first place. See what we mean?!

  • False Defenses

Because they make money from delay, workcover insurance companies will use any excuse to postpone a fair settlement. Sometimes the insurer will, for example, claim that the “accident” report was wrong and that you caused your own injury. In such cases, even where the insurance version is contradicted by eye-witnesses, the insurance company will refuse to settle because they have a defense, even though it is an extremely questionable one!

  • Holiday Settlement Offers

Workcover insurance companies love to take advantage of the misfortunes of injured people. They know that money is extremely tight when you’re out of work and injured. If you look closely at the “statistics”, you will notice that every year, starting in (mid-late) November, injured workers as well as their legal representatives will receive calls or letters from insurance case managers, offering you a low-ball settlement offer. The workcover insurance companies know injured workers need money for bills and for Christmas. They offer money at times when the injured worker is most pressured to take it.

  • Invading Your Privacy

As you well know by now, workcover insurance companies routinely hire private investigators to follow and photograph workcover victims. No law prohibits an investigator from talking to your neighbours about your activity level, or conducting video surveillance without your knowledge. And,the insurance company may not have to disclose their surveillance information until the case is almost ready for trial!

  • Uncovering Your Injury History

It is well known that insurance companies all contribute to a computerised data bank which keeps track of all claims filed in Australia. Within minutes of receiving notice of your workcover claim, the insurance company can run a search listing all prior accidents and injuries. So by withholding information about prior injuries from your doctor or lawyer, you won’t prevent the workcover insurance companies from uncovering your previous claims. In fact, they will know when and where you were injured, the type of injury, and even the settlement you received (if any). The companies wait for workcover victims to lie under oath about prior injuries, and then confront them with the truth – portraying you as a liar and discrediting you. Such a lie is far more damaging to your case than admitting the prior injuries honestly and up-front.



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16 Responses to “The war between the injured worker & the workcover insurance company”

  1. I would be very interested to know where this database of prior claims is held. Any contribution to this database, especially by a scheme agent, would have to be a breach of privacy (or at the very least and arguable breach).

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    • I’m even more interested in getting access to whatever records are maintained (at least for any related to me or people I’m assisting) in this database. Does anyone know how I would go about doing that? Would it be covered under Freedom of Information?

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      • Here’s a paper “Inquiry into aspects of workers compensation” which talks about the database.

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        Workcovervictim3 July 16, 2014 at 5:47 pm
        • Thanks … This is news even to me

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          • As for FOI which we are all entitled to. I have asked CGU for reports that they have but did not present in court (I wonder why) and even requested my lawyer to obtain them and they even give him the run around. so even though we are supposedly able to access information about our own claims I am yet to achieve that after 5 years.
            If you read your Medical certificate that you sign you automatically authorise any agency under workcover including all WC Insurers to share your information so there are no privacy laws breached.

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            • I was having a discussion with my lawyer and GP re insurance co’s and them accessing your info…once they have stopped paying you and your medical etc you can write and inform them that their access to your private records and contacting Dr’s and specialists, or other health providers that you pay for out of your own pocket is revoked…and therefore any info they obtain about you after this is a breach of privacy etc ..You may need to send individual letters to hospitals etc stating they the insurance Co has no legal obligation to you and that access to your records is denied….hope this helps

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  2. I found a letter from my Doctor in amongst an information request I sent to my insurer, the letter was a reply from my Doctor to the insurer that asked if the Car accident I had at xxxxxx date contributed to my injury!
    Thinking back (10 years) there was an accident where a Car damaged the plastic rear Bumper on my Car requiring a replacement Bumper even though it was just a bump.
    At the time my partner had been driving Home from the Supermarket alone when the accident happened but as the Car was registered and insured in my name I must have popped up on a shared insurer database (RACV Car insurance)

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  3. There is absolutely NO such thing as a national database of all insurance claims. It made for a good story thats all.

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  4. Could someone answer as to whether they believe insurance companies send injured workers to the same independent occupational physicians because they know that they will get the same result every time, beneficial for the insurance company.

    CGU have the worst case managers

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    • Let’s just say that CGU have referred someone I know to a number of IMEs over the past year and they have all without exception appeared on this site (Karma Bus). Strangely enough, my own FOI request to WCV got me a list of three IME accredited psychiatrists in Melbourne of which none appear online with any negative feedback (here, or ratemds for example).

      I’d say there’s a pretty clear case that certain “Independent” examiners are perhaps “preferred” by the likes of CGU when it comes to assessing injured workers. Wouldn’t it be interesting to get a look at referral statistics for IMEs at the bequest of insurers and see if there is any pattern to referrals and quality of service.

      I’d bet that information would have to be prised from their cold dead hands though!

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      • @Silver I know for a fact that CGU have a favourite IME they send their worksafe clients too. My GP who is the worksafe GP here in the NT gets annoyed when he sees this medical whores name and states quite vocally that CGU use him all the time as he writes garbled bs that CGU love… even tho at the end of the day it costs CGU more in the long run with their protracted lengthy delays and dishonest ways in removing clients from their books.. I have recorded proof where my casemanager discusses my case with a mediator stating how she initiated physio and transport for me and I never attended once..Hello 1. I did not know about this arrangement and 2. isnt the treating DR or surgeon suppossed to request these things? CGU are as dodgy as hell!

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  5. Where do I find on this site a list of IME’s that are perceived to be….what I would call pretty quick to get the examination over and done with

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  6. after all the doctors and court case.s i finally got my work cover and was paid back pay to day of injury i just put in tax return for 12/13 tax yr same yr i got payout and got a $25.404.89 tax bill that i got no way in paying how the hell do i end up having to pay tax and not them. The moneys that went into my back was what i understand to be after tax another words $108.000 $48,000 which of that went to center link $60.000 to me they pay $4000 on all that i get $25,000 bill But if i had be able to put a tax return in for each of those yrs i would have got a return NOW HOW THE HELL IS THIS FAIR Remember this is workcover weekly payments they had denied me

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    • It is possible that the income has been incorrectly stated… there should be amendments to the returns where you were in receipt of centrelink benefits and there is a rebate allowable for lump sum payments. Also if you had put the funds into an income stream you wouldn’t have had to pay tax to the full extent.
      I can’t advise anymore as I have just resigned my agents registration, but would suggest writing to the ATO giving them all the information on your payout and repayments of income, send copies of your payout statement/letter and overpayment advices from centrelink. OR go to one of the bigger accountants in your area. H&R Block have experienced people at their head offices, you can give your info to a consultant/office manager and they will either know how to do the return/amendments or send it to head office…

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      • This link may help

        http://archive.treasury.gov.au/documents/1355/HTML/docshell.asp?URL=Division_54_Review_Final_Report_Exemption.htm

        In Part:
        General taxation of compensation payments

        Lump sums
        In many cases compensation paid to injured people consists of an undifferentiated lump sum for loss of earnings, loss of earning capacity, pain and suffering and reimbursement for medical costs. Such lump sums are generally not subject to income tax because they are not income in nature.19 Nor are they subject to capital gains tax because of a specific exemption for certain compensation or damages receipts.20
        However, a lump sum will be taxable if the payment is compensation for loss of income only. A lump sum will also be taxable to the extent that a portion of the lump sum is identifiable and quantifiable as being compensation for loss of income.21 This is possible, for example, where the parties agree that a certain portion of the payment relates to a loss of an income nature.

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  7. Hi everyone, just a heads up that our beloved leader Workcovervictim is out of action for a while due to a severe infection & is in the hospital maybe for some time yet. Some patience would be greatly appreciated as replies to emails & blog updates will delayed. Sending her our warmest wishes & support to heal & feel better really soon.

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