Injured workers encounter unreasonable delays in obtaining medical treatment

medical-care-delay-injured-workers

Fact: many injured workers encounter unreasonable delays in obtaining diagnostic and medical treatment. The workcover system continues to delay access to medical care for workers who are injured or who become ill on the job, due to delays caused by all too frequent cumbersome IME processes and often frivolous challenges and appeals by workcover insurers, which have also resulted in a backlog to dispute or appeal hearing schedules.

In addition the pre-approval (i.e. for surgery) requirement enables insurers to undermine medical recommendations and common sense as they can delay approval and therefore compensation for treatments just about indefinitely.

Injured workers encounter unreasonable delays in obtaining medical treatment

delay-medical-treatmentThe delays in approving medical diagnostic and treatment procedures frequently increase costs when there is a deterioration of the affected injured worker’s health or medical complications. Long delays in treatment often result in the injury lasting longer and getting more severe.

Another result of these delays is the psychological stress it puts on the injured worker… to always be considered a fraud or an exaggerator until proven otherwise.

These obscene delays are also causing (good) medical providers to leave the system, due to lengthy periods of non-payment for services rendered, and frustration with refusal to approve accepted diagnostic and treatment procedures.

In today’s climate we find workcover insurance companies imposing hard nose tactics during the claims handling process. This ideology of deny, delay, defend is for the sole purpose of swelling the ever growing profit margins of the insurance industry. One such tactic is -of course- the “Independent Medical Examination (IME).

Workcover Authorities ought to collect and share data, supervise the content and rigour of IME reports/assessments, and better regulate IMEs

Countless injured workers are misled to believe that IME’s are independent and/or impartial. Designating a doctor hired by the workcover insurer (or authority) as an “Independent” medical examiner should be prohibited, period. Instead, such doctors should be clearly identified as “insurance” medical examiners.

Workcover insurers schedule IMEs (after IMEs, after IIMEs) to allegedly review whether the injury or illness is  really related to work, the degree of temporary or permanent impairment, and the appropriateness of medical diagnostic and treatment procedures. The IME does not engage in any treatment, but typically does a rather cursory examination, documentary review and ‘interview’ of the injured worker. Unfortunately, many of these IME findings often lead to a significant cut in benefits, be it weekly payments or medical and like benefits.

In addition, by (over) using IMEs, there is a need for the injured/ill worker to continuously prove the severity of their injury. Many such IME doctors will view injured workers injuries as non-serious, or – commonly- as ”inconsistent” with the injury. The practical result of this is under-treatment and a failure to meet the injured worker’s medical needs. Another result is obviously the enormous psychological stress it puts on the injured worker to always be considered a fraud or an exaggerator until proven otherwise.

What’s worse, these independent medical examinations can (and often do) also lead to major delays in obtaining approvals for diagnostic or medical treatment procedures. And these delays can cause medical complications which ultimately cost more than the original treatment itself!

We believe the current system of IMEs often interrupts the timely provision of medical care and weekly payments benefits to injured workers.

As far as we know, no jurisdiction reviewed the quality of medical information, so in other words there is NO quality assurance! There is no systematic review of these IME reports and no feedback to these ‘assessors’. Those IME’s who send problematic reports (even those with errors and missing information) are not targeted nor reviewed.

In the absence of a fully independent regulatory overseeing body, who should be assuring quality, supervising, reviewing and scrutinising the content and evidence-based “rigour” of IME assessments and reports,…

…We believe that our workcover authorities should collect (and publicly share) data that identifies the IME  and the workcover insurance carrier who regularly provide opinions solely for the purpose of denying the injured worker benefits and generating litigation. This, in our opinion, would provide a basis to remove from the system those highly biased IMEs.

We cannot understand why lists of IMEs are not made public… but can only guess…

Currently, there are no real requirements for insurers to have an evidential basis for ordering an IME. They will often not even bother to contact injured workers’ own treating doctors and specialists, and even if they do they will inevitably question the opinion and recommendations of even the best practitioners in the field.

This has led to the routine use of IMEs. The current rules basically allow workcover insurers to cut benefits including medical treatment unilaterally, based on the findings of one IME, until there is a dispute hearing (Conciliation, Medical Panel, Arbitration, Court etc).
We strongly believe the cost of -yes-frivolous IMEs is a significant financial waste in the system.

The fact that insurers use them routinely to try to reduce benefits and medical care begs for a regulatory solution!

Furthermore when a more serious injury occurs, it is also common that a number of medical specialists may be involved, such as experts in orthopedic care, pain management, and psychology. However, it is common that workcover insurers will deny treatment and reduce or cease weekly wage benefits based on opinions from IMEs who do not even  have accreditation in relevant areas of specialty!

 

[Article dictated by WorkcoverVictim and manually transcribed on her behalf]

 



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4 Responses to “Injured workers encounter unreasonable delays in obtaining medical treatment”

  1. I am to go before a medical panel in Vic., my medical expenses etc. have been terminated for over a month now and I mjust wait quite a while for the Medical Panel (because of the backlog). However, although my injury is physical I shall also be asked questions re. my mental health as well; is this normal?

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    • @Sarah Jane, They generally ask questions to see how your coping but my Medical Panel didn’t specifically ask directly, I have been on antidepressants for pain though… My solicitor advises to not “whinge” about stuff, but to be to the point. I guess some can’t help but “whinge”, as it affects their day to day living… You need to go prepared for any question, you can say you don’t recall if thats the case as our memories can be affected by being in pain all the time. Now I have my Medical Panel ruling I am supposed to be able to continue having medical covered for that body part… but the cm still likes too try it on and refuse necessary treatment.
      Some Dr’s are of the opinion that depression causes pain, those Dr’s that treat chronic pain are trying to have Chronic Pain classified as its own “disease/condition”. It is generally accepted that the body heals over a period of time and if your pain doesn’t stop then your nerves are misfiring…
      This is not always true as pinched nerves, compressed discs, and facet joints can all be a long term cause of pain. Although I have read that even disc pain stops after a while.
      Surgeons don’t understand what they cannot see, if pain continues they feel its in your head…
      All in all, there is a vicious cycle of pain causing depression and depression worsening your perception of pain… I think a lack of sleep fits in there too. Those of us with chronic pain just wish it would go away and give us our lives back.
      I found this website helpful in understanding much about back and neck pain:
      http://www.cleaverspine.com/ I don’t know the Dr so am not recommending him, just the information his site has. another is: http://www.metropainclinic.com.au/

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      • @Sarah Jane – may not be applicable to you, depending whether you’re going to the VIC Medical Panel for permanent impairment assessment in the context of for example a serious injury certificate or common law damages – but since a legal case in Sept 3013, Medical Panels will now (only) convene Medical Panels to assess only a physical impairment when a Certificate is served in respect of physical impairment and to assess only psychiatric impairment when a Certificate is served in respect of psychiatric impairment.This decision is important for respondents and their insurers because it means that the Medical Panel is no longer compelled to consider both physical and psychiatric injury in circumstances where psychiatric injury is pleaded in a claim for damages, but no psychiatric injury certificate has been served. This should significantly reduce the costs associated with referring claimants to the Medical Panel and the delays associated with the parties determining whether both physical and psychiatric impairments should be assessed….
        See our article: http://aworkcovervictimsdiary.com/2014/01/medical-panel-assess-injuries-subject-certificate-assessment-degree-impairment/

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        Workcovervictim3 September 9, 2014 at 4:25 pm
      • @Woowoo

        All in all, there is a vicious cycle of pain causing depression and depression worsening your perception of pain…

        I think you are spot on, it took me a while to “get” it, but it is so true.
        I also firmly believe that mental health has everything to do with whether or not someone can successfully deal with trauma – any kind of trauma: physical or mental.
        Furthermore I believe that our current workcover system(s) has problems/or does not like to ‘deal’ with injured workers’ mental health. Basically, an injured body part is still (mainly if not only) treated with no concern nor any understanding of the psychological, mental and/or emotional impact of the injury. And, quite often, not addressing / treating the psych impact of a trauma (i.e. serious or traumatic workplace injury) simply adds that insult to injury, causing many of us to become ‘lost’ (depressed etc), delaying our recovery and, ultimately, our return to work….

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