Do you really think that your workcover insurance company is a humane and considerate entity that aims to pay claims promptly and fairly? Think again. Your workcover insurer’s main purpose is not to protect yo, nor care for you; in fact, insurers often try to avoid paying legitimate claims. The name of the game is delay, deny, defend or, as we came to abbreviate it as “SSS” – Stall, Starve, Settle. Insurance companies will delay payments, deny legitimate payments alltogether and defend their actions by forcing injured workers to litigate. Why? To maximise their profits!
Your workcover insurance case manager will not take care of you
“My workcover insurance case manager will take care of me in my workcover case” —we’ve heard it many times before, especially from newly injured workers.
Do you really think your workcover case manager will take (good) care of you? Think again. They are not a good neighbour, they’re not your friend and you are certainly not in good hands.
You are actually at war and at a pretty sophisticated one. The workcover case manager’s job is to save the workcover insurance company money, period.
Many case managers get bonuses and ‘special’ recognition for saving their workcover insurance company money. And, you guessed it, the only way to save money is by denying claims and by paying the least amount possible.
That’s one of the reasons why your case manager will, for example, get a nurse case manager or tell you they will attend a ‘compulsory’ conference with your treating doctor, in order to try to persuade your doctor to get you to return to work. That is also why they hire private investigators to try to find any ‘evidence’ that you may not be following your doctor’s orders.
In our injured opinion, the worst thing case managers do, is deliberate delay your claim – any part of your claim. They like to delay, delay, deny, delay, delay, deny and delay and deny some more. This is their normal routine or modus operandi. They will delay making payments, they will delay medical treatment, they will deny that you’re allowed to have an MRI or some other prescribed test, and then they will dispute that test and then they will delay setting up another IME appointments, and then they will deny medical treatment by setting up a second IME opinion.
Ever thought about it? If all workcover insurance case managers do this systematically with every claim, they literally save billions of dollars for their insurance company!
If all case managers, for example, delay paying out $500,000 dollars for 30 days across the board with all the injured workers that they have/manage, they save $25,000 for just one (1) month of delays and denials in interest alone.
One of the more sickening types of delay is frivolously denying workcover claims while knowing that an injured worker is under (severe) financial pressure, in order to try to get the injured worker to settle a claim, or a part thereof for pennies on the dollar.
This ‘SSS’ practice also forces many injured workers to choose between whether they should wait for approval to get their medical treatment or to settle their claim in order just not to lose their house.
Always remember that if there is any ‘grey’ area in a workcover case or claim, the workcover insurance company will deny your claim. That’s why it’s so important to be very familiar with the workcover law(s) in your state and to learn as much as you can about the workcover insurers’ dirty tactics.