Your workcover insurance case manager will not take care of you

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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.

 



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21 Responses to “Your workcover insurance case manager will not take care of you”

  1. What I find is the trend to replace Case Managers. I’ve had 3 in the 12 months I’ve been on Workcover. This latest new one (as he said is for “serious injuries” – I seem to have acquired this status after the Medical Panel result in my favour) asked me (seemingly placatingly & helpfully – but I don’t believe it for a minute), “Is there anything we can do for you?” My terse answer was; “Well for a start, you could pay for my backyard to be cleaned up as the Council has been on to me as it’s a fire hazard and I haven’t been able to afford it on Centrelink benefits”. (And yes I do know that now they owe me 6 months back-pay in weekly entitlements – but that will also take them at least until end of January to organize – I hope they enjoy THEIR Christmas breaks!) My backyard hasn’t been mowed etc. in 12 months (I can’t even start, let alone use my mower due to my injury – I managed to scrape together enough money to have the front lawn mowed once for $60, but was quoted a minimum of $200 for the back -so it hasn’t been done) and someone’s complained about it to Council. Council’s given me a 2 week time limit for it to be done before I’m fined. Anyone want to lay odds that the insurer will delay authorization, so I can’t meet the time limit? …. No? …..I thought not! My Thursday Diamond Day feeling (when received news of my Medical Panel win) is rapidly diminishing distant memory!

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    • @Sarah Jane
      Hi And great news re the medical panel Stick it up them.
      Now in regards to your back payments from your insurer Tell your new C/M if your in Vic That they have to back pay you within ten business days.
      Less what you have been paid by social security.
      take your medical panel letter to social security and they will inform the insurer how much they have paid you and that will deducted from your w/c payments.
      I have just been though all this shit and can give you a couple of phone numbers to help you out.
      Just email me.
      with regards to your mowing you need to have your re hab provider come out and write a report on why you can not mow your lawn tell the pricks you live on your own and have no family to help you ( Most Important)
      With regards to C/M I`m on number 54 after nearly 3 years so don`t Stress.

      Kind regards Captain Harry.

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    • Sarah it has taken EML South Australia 3 .5 years to supply me with a domestic cleaner after I notified them that I was facing eviction from the landlord.

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    • @Sarah Jane, most councils will assist if they know your position… They may be able to put you in touch with a charity or volunteer group for the short term… Or give an extension..
      I have teen boys, they have to help me as my cm says I cannot get assistance because I have them both living at home.. this is a sore point for me as they were both in senior years (VCE) at school. If they were working its a different story, but they are unable to get work as they don’t have transport nor the money to buy clothes for work as I no longer receive pay from employment, nor payments from workcover. I was paid upto end of January 2013 and totally reliant on Centrelink sickness benefits from March this year. I had to cease work because there was a delay in providing treatment to my accepted injury and I couldn’t physically nor mentally do my job. I now have another new cm. Young, and not much life experience.
      Over it too…

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      • Thanks Grand Poo for your lovely comments.
        You know that I’m always available to help poor injured sods though this shit system.
        Hopefully the advice I’ve given to Sarah Jane helps her navigate the system a bit better and she stops getting screwed by the insurer’s continuing Bullshit and denials.
        Will buzz you a bit later on Poo for a chat and an update.
        Love you Darling take care.

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  2. The least qualified person in the room (the case manager) can under the new O’Farrell Workcover system pretty much rule over your treating doctors and specialists. If a person were considering terminating themselves (as I have) rest assured I will not go alone.

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  3. “or tell you they will attend a ‘compulsory’ conference with your treating doctor”

    Are conferences really compulsory? I thought only IME compulsory.

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  4. I HATE THEM ALL .THEY ARE A PACK OF PRICKS AS CAPTAIN HARRY SAYS . WHEN I HAD SURGERY EVEN THE STAFF TREATED ME LIKE I WAS GETING IT EASY WITH ALL THE MONEY ???????? WHAT MONEY!!!!!. A NURSE SAID TO ME , I SHOULD GET HURT AT WORK AND GET ALL THE GOODIES .THIS WAS SAID TO ME !! THEY KNEW I WAS GOING TO KILL MY SELF OVER WORKCOVER, I WAS SO UPSET CRYING WANTING TO GET HOME ,MY HUBBY SAID I HAD OVER REACTED. THE NEXT DAY HE WENT TO ASK ABOUT SOMETHING AT THE HOSPITAL MAIN DESK ONLY TO HAVE THE GIRL YELL OUT TO HIM ,OH!!! THE ONE ON WORKCOVER !!!!!! HE CAME TO MY ROOM AND SAID YOU ARE RIGHT THEY ALL KNOW YOU ARE ON WORK COVER ,I ASKED WHY???HE TOLD ME HE NEVER GAVE HER MY NAME OR ROOM NUMBER. THE THING IS WE MUST HAVE A RED FLAG ON OUR HEADS I WAS TREATED VERY POORLY IN THIS HOSPITAL NEVER AGAIN WILL I GO BACK . WE ARE HERE AND WE WILL FIGHT BACK AND WE WILL BE COUNTED. START STANDING UP TO THESE BASTARDS !!!!!!!!

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    • Dear Suzanne,im so so sorry this was done to you,what a pack of pricks don’t worry people in hospitals get hurt too.Im a firm believer in KARMA and when she bites shes a bitch.I think I would have put in a complaint if only to make myself feel better.

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      • Thanks Tony ,I should have but I was in to much pain .

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        • Dear Suzanne,i can understand that,there just all arse holes.People are so misinformed about workcover,until they are in the system then wow are they shocked,sometimes it does some people the world of good.

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  5. Can anyone make a suggestion as to how to get the insurer to communicate and to pay up. It has now been 2 weeks since the Medical Panel result in my favour. I heard once by telephone from my new CM (the 4th when I counted up) who told me that my referral for treatment by the specialist would be processed quickly & easily. Yet still I am waiting. The deadline for carrying out the (local) Council notification to clean up my yard has of course passed (and I’ve tried to get an extension). Yet I am still waiting for authorization from the insurer for the work to be done, despite sending the request from my GP as the CM had requested (the insurer claims that they rang my specialist -thinking he was my GP perhaps [????? I have asked the CM’s manager repeatedly do they not have a centralized file on me either in hard copy of electronic form] The specialist obviously would not give them such authorization. Why would he, as we have not discussed that? I have had to pay for every minute I have seen him thus far, WTF would I waste money talking about that with him???) I’d already emailed them with the GPs letter plus the Council letter and a READ RECEIPT to ensure as far as possible that they received the information. I am supposed to be paid 6 months of weekly entitlements that the insurer cancelled due to their toady IME. Centrelink has now cancelled my entitlement to Newstart. So the insurer now has me in a place of great vulnerability. Now we are floating on to Christmas when my employer closes down for 6 weeks, so it’s unlikely I will receive this entitlement until late January or February next year. My doctor tells me that he has not been authorized to give me a Certificate of Capacity beyond 28 days, which means I am not likely to be receive any income when the employer closes down so the paymaster and the Workcover administrator (who processes my Certificates of Capacity) will be on annual leave. I’ve asked the insurer for authorization for the doctor to extend the Certificate of Capacity to allow him to write one that extends beyond 28 days. I supposedly received a new Case Manager 2 weeks ago. I have emailed him 3 times re. these issues, with none of my request for Read Receipts acknowledged. Then I received an email from his superior that referred to some of the issues I had raised in my emails (so I KNOW they had received them and they were not returned as not sendable from my server) asking for a Certificate of Capacity asap – so I emailed it to this person straight after seeing my GP. Received an automated reply to communicate with yet another person in the insurance co. which I did. Then received an email from this person late this afternoon telling me to communicate directly with yet another person which I have now done. Am I being given a deliberate run-around, or is this insurer just hopelessly disorganized? It seems that their delegation of tasks has turned “delays due to processing” into a paper shuffling and file transferring art form. But do you know, for the first time this morning after sending about 6-7 emails about these issues, I have received my first read receipt? I had enclosed an introductory sentence to the effect that I had requested a read receipt and therefore hoped that my request would be respected! And wonder of wonders, it was!

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  6. Sarah Jane please email me
    harryrort@gmail.com
    And I should be able to help you out and give you some phone numbers.
    Regards Harry

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    • @Harryrort – THANK YOU *Captain* so much for helping out with answering questions and offering support.
      For those who didn’t know, Harryrort is part of aworkcovervictimsdiary as stated on our team members area: “Harryrort is Diary of a Workcover Victim’s Captain – with 6 medals and 8 stars he reigns over all things social, including the (now past) forum(s).“. The nicest bloke you can imagine 🙂

      I’m still having a very difficult time, with ongoing infection complications (with my prosthetic), lots of hospital appointments, still heaps of pain, and let’s not even mention the psych/emotional impact this all has on me.
      Typing remains problematic, and is particularly very painful (and using the touch pen left handed on the pad does my head in!).
      So, all help and support from anyone is greatly appreciated.

      Grand Poo X

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    • HI Harry I did a big post today I am pretty hopeless at just about everything, but re reading over this site today I felt like just maybe I could send a letter to the PRIME MINISTER, yes work cover is a STATE BY STATE but I think it has become a FEDERAL MATTER so many injured workers have been pushed over to Centre Link and Medicare these are not STATE run so not only are the injured works getting in the guts so are they .I am looking at putting what I have written its not much but with IME’s ripping the system off ,the poor guy who set him self on fire and the tragic suicide of ASHLEY BRYANT ,maybe its time I stood up for myself the only way I can do this is to send a letter just maybe he does not know ,what do you think Harry

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      • @Suxanne,
        Our PM is just as bad… see my other post in reply to yours…
        He is again hurting those that can least afford it. I have been pushed to Centrelink for benefits and he has just slashed $40+ a fortnight of what I receive because I get Income Protection, and its not much either, doesn’t cover my mortgage. Now I have $90pw to spread between bills, food and medical, because most of my medical has been discontinued by CGU…
        I guess luckily my 2 youngest are on youth allowance so we have a bit extra, but they are in higher education so still have books and amenities fees to pay. Effectively now they are in part supporting their Mum… on a measly $285 per fortnight that they receive.
        ALL politicians need to receive an email/letter and then maybe, just maybe we might gain something.

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  7. Hi all, I tried harryrort and workcovervictim3s’ suggestions. I rang a contact in Workcover Assist who made an excellent suggestion as to how I approach the insurer and also made a complaint to the insurer’s complaints’ department and quickly, within less than a day, all the ducks came out to sit in a row. I now have almost all the authorizations I sought – save one for which they lost the documentation. ALSO FYI: If your employer’s company is closing over Christmas New Year and your doctor is only authorized (as is usual) to give you a Certificate of Capacity to a maximum of 28 days, did you all know that according to the VWA website, you can request the insurer to authorize an extension on the 28 days to cover such exigencies, which I successfully requested for the period when the employer’s business is closed? I found this and repeatedly made the request, which was finally recommended for authorization by the insurer’s Complaints Dept. person. My GP did not know this and was pleasantly surprised, although he does insist I make monitoring visits in the interim (which is in the interests of us both if this ever ends up in court). Just thought some of you may be facing something similar over the Christmas/New Year period and would like the heads-up. I have been bounced around between various people in the claims dept. of the insurer for over a week now, but as soon as I put haryrort’s and workcovervictim3’s suggestions into effect, plus my own little research gem seeking authority to extend the coverage of the Certificate of Capacity beyond 28 days, everything is finally OK. Also, I have now officially been given my 5th Case Manager (who I have had previously), plus the other 5 insurer personnel I have been delegated to communicate with over the last week; some of whom have been “absent today”, “out of the office”, “not at their desk right now”, or “unavailable for phone call” when I tried to phone. When I emailed, all but one would acknowledge my Read Receipt request. However, the insurer’s Complaints Person was able to cut through this expeditiously, exponentially and most effectively!.

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    • @Sarah Jane
      I’m So happy for you mate that it has been finally been sorted and amazingly they can cut through all the bullshit as soon as the case complaints Manager becomes involved and wipes the Smug smiles off the know it all shiny arse Case malingerers.
      And i’m glad some divine intervention from JC put the wheels in motion for you.
      As i told you the CCM can be your only friend at the insurers and keep them on side for any future issues you may encounter.
      And bugger the negative naysayers on this site who just want to Poo Poo your ideas This is why the site is here to help navigate through the bullshit and lies and SSS Tactics that all the insurers try.
      Knowledge is power United We Stand Divided We Fall.
      Glad i was able to help in a small way and now you can have some peace of mind over the Christmas Break and not have to worry so much.
      Number 5 Case manager Remind them everytime they try to give you the handball treatment Put me through to the CCM they hate it because it affects there bonus as i told one the way your going you will be down at the salvos looking for a handout this Christmas the way you’re going.
      All the best with everything and you know how to find me if you need a hand again Sarah Jane Happy to help.
      Warm regards Captain Harry.

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  8. Thanks for your advice, help and support Harry ! Believe me it is most appreciated! Looking forward to a Merry Christmas and a Happy New Year when it seems I might have enough money and a clean house and yard to welcome in the New Year! I wish all of you to be blessed with the same! I feel blessed to have accessed this site. Love and best wishes to you all at AWVD for the Festive Season and 2015 which is hopefully a much better year for all of you and yours!

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