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:
- delay the settlement and/or
- 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 SSS – Stall – 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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