When injured on the job, many workers may be surprised to learn that workcover insurance companies routinely stop payments or deny many workers comp benefits.Whilst we have previously written about common tactics used by insurance companies to minimise workers compensation payouts, this article focuses on manipulation of information, power, or a communication process to deny a benefit, in this case household help.
Ahh Allianz – how can I arrgh-gravate you?
Injured workers just want to have their wages and medical bills paid while off from work. Unfortunately, workers compensation lawyers exist because many workcover insurance companies cut off an injured worker’s benefits without reason!
Below is one such common strategy these insurance companies (in this case Allianz) use to either avoid or minimise their payouts for workers compensation claims. Whilst one may believe that injured workers simply suffer the consequences of the “bureaucratization” of workers’ compensation, rest assured that it is a deliberate stalling or denying tactic!
Allianz suspends or ceases the payment of household help for NO reason
In this most frustrating case, a seriously injured worker had had to fight long and hard —and all the way to the Medical Panel (Vic)— to obtain basic household help. The seriously injured worker was eventually successful at obtaining “ongoing 2 hours per fortnight of household help” by means of a legally binding Medical Panel certificate, in 2012.
Medical Panel certificate (2012)
The injured worker received his (meager) household help uninterrupted for about 2 years, until recently, when a senior case manager from Allianz decided— off the cuff— to cease the injured worker’s household help, and without even the basic courtesy of informing the injured worker.
Injured worker is notified by the home-help company 1day before his cleaner is due that Allianz has ceased household help
First email from the seriously injured worker to the “senior case manager” (right click to enlarge picture(s)
Note that the injured worker attached a copy of his Medical Panel certificate.
It has come to my attention 1 hr ago that you have taken the liberty to cut off my home help funding. Not only is this illegal given I hold a legally binding Medical Opinion Certificate allowing me ONGOING 2 hrs per fortnight of home help (since 2012); but you also did not even have the courtesy, let alone the humanity to inform me of this cut off. My regular cleaner is scheduled to come tomorrow and I am informed by (the service provider) that she will not attend unless you sort out this “mess” today.
Secondly, I am still awaiting a booking for my taxi to attend my surgeon tomorrow as requested on (date). Please do not blame me for your absence in office and simply comply with the legitimate request , as per ACCS certificate. You would be the first person to have “special” policies in place to book a taxi at 5-6 days notice. Your colleagues can do it at 2 hrs notice, so can (xx)
I am becoming very distressed by the way you are handling my “case”. Failing to rectify the above will be followed by a formal complaint to the VWA, (incl. ACC, Medical Panel), xx (employer) and my legal team as well as with Allianz Management.
I look forward to your response.
Attached is a copy of my Medical Panel Opinion re home help
Response from the “senior case manager”
He “cannot” locate a referral for the injured worker’s home help…!!? (But he was sent a copy of the legally binding Medical Panel certificate).
Second email from the seriously injured worker to the “senior case manager”
It has now been 1 month since you cut off my home help, without notice and without any valid reason, and breaching a legally binding medical panel certificate stating the need for ongoing home help 2 hrs/fortnight (since 2012) – I have re-attached the Medical Panel certificate FYI.
I have not received any home help assistance since (xx) of this year – and as such have missed out on (xx) hrs of much needed assistance so far, which I expect to receive retrospectively.
You state that you ‘do not have a referral on file’ – could you please explain what this means. I have received home help uninterrupted since the medical panel’s opinion (and even received appropriate increases to 2 hrs/ week) by xx, without the ‘need for whatever referral’ you now seem to ‘need’.
If you are referring to my medical certificates of incapacity, these are sent to my employer – (xx). The last certificate was sent to (xx) on (date) via email (with confirmation of receipt). The latest certificate was issued by my treating GP on (date) and covers from (date) 2014 me until (date) 2014 (3 months). Again, the certificate specifically states the need for home help (xx) due to (xx)
It is your responsibility, as my case manager (and a “senior one” as well) to ensure you liaise with your client, (employer) for matters such as the certificate of capacity (and vice verse). Unless you specifically ask me to send you a copy of my certificates, which I am happy to do.
You simply have no right to cut off my (or any other seriously injured worker’s) home help, for no other reason than ‘ not having some whatever document on ‘your’ file’.
You have caused me great inconvenience, distress, pain and possible injury for trying my hardest to clean up a little here by taking away this meager yet vital home help, and I urge you to immediately reinstate it and add 2 x 2 hours retrospectively to make up for lost ‘cleaning’ (home help).
No response from the “senior case manager” followed.
A week or two later, the injured worker is advised by letter that he has been allocated (yet another) new case manager.
(third) email from the seriously injured worker to the new “case manager”(+ cc’d to old senior case manager, employer, and injured worker’s LAWYERS)
Unfortunately, to this day, I have not received any information about the obscure reason(s) why my home help has been discontinued (effective xx) without any formal or informal notice, nor has my home help been reinstated as per my last (numerous) emails, and a legally binding medical panel opinion entitling me to ‘ongoing 2 hrs/fortnight’ of home help.
I request you immediately reinstate my home help as a matter of urgency. If you refuse to do so, please ensure you write me a letter denying the funding of my home help (and the reason(s) why), so that the matter can be brought back to the ACCS, with the full intention to seek and commence legal proceedings for breaching the legally medical panel’s opinion.
You have been put on notice and failing to reinstate my home help, or provide me with a written , explanatory denial letter will lead to the commencement of legal proceedings against Allianz.
Note: As has always been the case, but again, from this date forth, I direct you (and Allianz) not to communicate with me directly via telephone. I request all communication be done in writing, email is fine.
Response from the “new case manager”
I’m glad you have received my letter.
I’m unsure why services would be discontinued. I have contacted the home help provider and have given them approval for services/catch up hours for the periods that have been missed.
If you have any other issues that you have outstanding, i would be happy to help clear them up for you, feel free to contact me.
Have a great day.
What can we learn from this case?
Many injured workers may be surprised to learn that workcover insurance companies routinely and impromptu stop payments for medical and like services, such as household help, for NO reason whatsoever, adding a great amount of frustration, bewilderment, anxiety and anger and potential injury/aggravation on the part of the injured worker. Unfortunately, the sad reality is that workers comp lawyers exist because these insurance companies cut off an injured worker’s benefits without reason!
It is only after the injured worker consulted his lawyer and discussed the strategy that would be implemented (that is commencing legal proceedings!), and copied the lawyer’s team on his email(s) to the case manager(s), that suddenly, the injured worker’s household help benefits were promptly reinstated and admission was made that [the case manager] is “unsure why [household help] services would be discontinued”! Needless to say that no apology was ever made, and that it took the injured worker an additional 2 weeks to actually re-obtain the service (allegedly due to ‘miscommunication’ with the service provider).
So, in order to avoid (more) unpleasant consequences of workers’ compensation, in this case the arrgh from Allianz, please be stern and harsh in your letter(s) or email(s) to your case manager(s) and always cc your legal team. It (a real threat to commence legal proceedings) may just well prompt them to ‘do the right thing’.
[Article dictated by Workcovervictim and transcribed on her behalf]
This post has been seen 1681 times.