Workcover case manager does not respond – what to do

case-manager-unresponsive

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

  1. Start by writing a formal, registered letter to your Case Manager, his/her Manager (e.g Team Leader)
  2. 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!
  3. 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.
  4. 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)
  5. Letters sent to the workcover Authority and the (managing) Director of the insurer should always be via registered post
  6. From experience we do know that a well-documented letter is generally answered pretty quickly (3-5 days).

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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]
Claim No:
Date of Accident: March 1, 20__
Your employer

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,

[Your Name]

cc:
Mrs. Dollar Focussed
Mr. Cannot Help
WorkCover Authority

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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5 Responses to “Workcover case manager does not respond – what to do”

  1. I had some really good case managers, after being told by psych to make a connection with them. I explain my case to them and keep emailing, phoning etc.
    I was really lucky with mine, esp the last 3. So when my newest one resigned, and email bounced, I contacted the last one and the manager aboves by email.
    If you have no reply – make sure you make a call to the group – asking who to contact as your calls and communications are not being returned. I found that this helped lots. My reasoning was that I needed the help they could give – and if they did not assist me, how was I to recover. Once I came to the realisation that I was legitimately sick (even if it is mental), work caused it and now I needed help.
    I used the approach, that they have their set blocks – after 10 weeks – cancel claim – go to Concilliation – get reinstated with backpay.
    Next – delay payments for doctors, medication etc – they lost your bank account details, etc. So email all information and also to the manager, just incase. Remember to get an email reply/acknowledgement – you can do this on email sent.
    I keep all my emails and the receipts of emails.
    Remember keep it polite- but also trust that you are the one that has to be helped. You deserve to be helped. you are legitimate injured person.
    Hope that this helps.

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    bulliedteacher March 16, 2015 at 1:34 am
    • Dear WCV
      Could you run a post about Case Maggots and how often they are changed ie moved resign sacked etc and how many someone has had during a claim before it’s settled.
      Myself I’m up to 58 in 3 years good bad and some complete arseholes.
      Warm regards Harry.

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      • @Harry – You make us laugh 🙂
        Case managers change like undies, especially at the beginning of a claim and at the end. Many burn out before they even start and many are so rude and incompetent they’re asked by injured workers to be replaced.

        Remember our post Where do case managers go? (before they die)?

        -Is it possible they come to their senses, simply realising they’re not helping injured workers at all and leave?
        -Are they shipped off to Willy Wonka’s Chocolate Factory and recycled into Oompa Loompa’s (and I mean this for the real dudds)?
        -Are they sent down a chute to a laundry brain wash and dispatched into the world again with new hope?
        -(This is the scariest of thoughts) Are they promoted?
        -Do they continue working in the field hoping they’ll become the WorkCover Minister?
        -Do they run off to a monastery or vow they’ll do voluntary work to repent their sins for the rest of their lives?
        -Do they reform and go back to study law so they can represent injured Australian workers?
        -Do they transition into more lucrative jobs (see picture?). Perhaps the SM version?
        -Start work in Indonesian cattle slaughter houses?
        -Do they end up filing a workcover claim for loss of their voice/hoarseness from yelling?
        -Do they end up filing a workcover claim for repetitive strain injuries (repeatedly yelling, phoning, writing the same denial letter over and over again)?
        -Do they file a workcover claim for mental injuries?
        -After they file a workcover claim, do they get sacked, like we do?
        -Do they commit suicide?
        -Do they become serial killers?
        …..
        We’ve got some more interesting articles about CMs
        For example:
        http://aworkcovervictimsdiary.com/2013/03/workcover-case-managers-the-good-the-bad-and-the-ugly/
        http://aworkcovervictimsdiary.com/2011/11/a-former-workcover-case-manager-spills-the-beans/

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  2. Can someone help. So I have had my payments re instated after the 130 weeks cut off, as I am working 15 hours. After only 2 months they have decided to cancel my payments as apparently I am not earning enough money. Mind you, I can hardly leave the house due to well documented anxiety and now work from home doing bookwork. There reasoning is I have the capability to earn more money WTF. They are just going to cut me off again. I am so worried as I have a mortgage and am a single parent. The stress CGU is causing me is making my condition so much worse. Not sure how I am going to get through this whole workcover thing.
    Anyone had similar circumstances
    Suzie Q.

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    suzanne jordan June 1, 2015 at 11:27 pm