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 stalling and denying claims and by paying the least amount possible. In this article we’ll give you some tips on how to deal with a non-responsive case manager.
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 all-together and defend their actions by forcing injured workers to litigate. Why? To maximise their profits!
Workcover case manager does not respond – what to do?
First of all rest assured that many workcover case managers deliberately do not respond (or if they do, they respond very late) to injured workers’ calls, emails and letters. It is not just happening to you, but to countless injured workers and it simply part of ‘the game’.
What you can do when your workcover case manager does not respond to you
- Start by writing a formal, registered letter to your Case Manager, his/her Manager (e.g Team Leader)
- Write a complaint letter to the WorkCover Authority, as well as to the (managing) Director of the workcover insurance company if you / your letter has been ignored by your workcover claims department. State your position very clearly: namely that you have been/are being ignored!
- In your letter(s) attach a list of all the dates when you phoned your workcover case manager without a response and send all copies of correspondence (such as emails, letters and faxes) which clearly requested a response.
- Make sure you (kindly/respectfully) request for assistance and cooperation from your case manager/claims department and always state a time limit for a response (be reasonable with your time limit; i.e. 3 to 5 business days)
- Letters sent to the workcover Authority and the (managing) Director of the insurer should always be via registered post
- From experience we do know that a well-documented letter is generally answered pretty quickly (3-5 days).
Sample Letter to the WorkCover Authority and/or Director of the insurance company
Note: this is a general and broad letter, take out what you need and adapt it to the person(s) you’re sending it to.
(By Registered post)
[Your name, Claim Number, Address, email address and telephone number]
Date of Accident: March 1, 20__
Dear Mr. Difficult:
Your insurance company (or your Agent’s [name]) claims representative (or case manager etc.), Mr. Cannot Help, (Phone # (03) 123 456) has made numerous promises to pay for my [medical & Like / weekly pay/ whatever] expenses, but has not honoured his word, nor your Agent’s (insurance company’s) word, to date.
I have sent numerous sent letters (and/or emails etc) to your [Agent claims representative / case manager] on Jan. 1, 20__; Feb. 2, 20__, Feb. 27, 20__ and Mar.1, 5 __ All of these letters have unfortunately gone unanswered. Attached are copies of all my letters /emails/faxes to your [Agent’s] representative / case manager.
Additionally, I have left phone messages with Mr. Cannot Help’s secretary/Team Leader/ whomever, Ms Brickwall, on Jan. 12, 20__, Feb. 1, 20__ and Feb. 20, 22, 26, 20__. All of my phone messages have gone unanswered.
If your insurance Agent [insurance co.], such as your car insurer, ignored 8 letters, 11 emails, 6 faxes and five messages regarding [whatever due], would you cancel your insurance policy? Unfortunately, I, the injured worker (or Agent’s claimant), cannot cancel [my workcover insurance company.]
As you can see from my attached copies of my letters/correspondence (etc), I am about to lose my job, and I am unable to obtain badly needed medical attention because of your Agent’s reckless/uncaring/ignoring/whatever behavior.
Your current advertising spots on TV, billboards, radio, internet etc. promise that you (name of insurance company) treat injured workers well and that those who are unfortunate to have suffered a work injury are in your good hands. Your (or Case Manager/ Agent’s Director…) conduct (or lack thereof) is certainly not good evidence of being well-handled or friendly.
I, the injured worker (claimant) just want my injury treated (e.g. surgery), some temporary transportation/home help (whatever), and my legitimately weekly payments so I can pay my rent/mortgage and eat. All of these expenses have, to date, been promised by your [Agent’s representative, Mr.Cannot Help]. Additionally, Mr. Cannot Help has promised approval of [surgery/whatever] so I can seek medical help so I can get well/better. I have no money. Your company/Agent has strung me out to my last cent.
But for your [Agent] carelessness , and more importantly, your company representative’s/case manager / whoever breached promises, I would not be losing the enjoyment of life that I enjoyed before my workplace accident.
Please call your [case manager / whoever], Mr. Cannot Help, and ask him to issue the [whatever] he has promised for the past three months.
How would you feel if you had no money for rent, no job, no medical treatment and no transport? Place yourself in my shoes for a few minutes.
One way or the other, please take care of these injustices today. A simple phone call to Mr. Cannot Help should certainly solve this frustrating problem.
Very truly yours,
Mrs. Dollar Focussed
Mr. Cannot Help
Notes: “Agent”: means the workcover insurance companies under the WorkCover Authority in your state (e.g Allianz, CGU, Xchanging, Gallagher Bassett etc.)
Useful tips to write your letter
Our general sample letter is written in such a way that it removes all possible excuses that “the WorkCover Authority or the Insurance Co. Director” could come up with in order not to solve your (injured worker) problem today.
Note that the letter gives the Workcover Authority / Director of the insurance company the case manager’s phone number in the first sentence.
Also, the letter encloses copies of all your letters (emails/faxes/telephone calls etc) to the case manager for the relevant months. This is “hard” evidence that the case manager is in serious trouble. There is very rarely an excuse for ignoring anyone for two months.
Of note is also that our (and therefore your) sample letter explains and highlights the devastating consequences of the workcover case manager’s ignoring your phone calls, letters (etc).
Importantly, the letter uses the “YOU” standard. E.g., How would you feel if you were without a job, no money, no car, no food etc.?
Hope this helps a little!
[Post dictated by WCV and manually transcribed on her behalf]
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