Workcover and its agents, and particularly those who work for them ought to be deeply ashamed of themselves. Not only do they mess with the lives of injured workers, but they are also experts in wasting a huge amount of money….Perhaps what really needs to be fixed in the first place is nothing but the workcover claims handling practices!
Recently a friend of a friend told me the story of a workcover case manager (the friend of the friend of the friend) that she managed to get one of the best ever IME reports and successfully closed a prolonged workcover claim. Oh my, she was so so excited about it.
Apparently she started raving that she had the best ‘permanent impairment assessment’ report produced by some well-known (dodgy to us!) Independent Medical Exam doctor, a “General Surgeon” in his 80’s who is WorkCover approved/trained to undertake permanent impairment assessments of injured sods. She laughed and said it (the Permanent Impairment — or WPI —report) was perfect in just about every way imaginable.
The said octogenarian workcover insurer doctor’s WPI report assessed an injured worker with a severe forearm injury (loss of just about all function in wrist, hand and basically the entire dominant arm) 12% WPI (Whole Person Impairment) but with an “adjustment” of a whopping 70% for an (alleged) pre-existing (or degenerative?) condition in that limb. Hence the true WPI is assessed just under 4%.
According to this pea-brained (sorry) case manage, this injured worker’s claim had been going on for almost 130 weeks (cut off mark for weekly pay —a bonus again for the case manager), BUT it took 36 weeks alone for the case manager to approve the injured worker’s treating specialist’s request for surgery to his forearm (how familiar, not?).
Upon reading the octogenarian “General Surgeon” Impairment Assessment report, the case manager’s friend found that it clearly stated that this poor injured worker had no ‘strength nor grip’ in his hand and wrist and that the injured worker was unable to grasp things or lift/carry things with his right hand (and arm).
According to several treating specialists reports, the injury and ultimate surgical outcome was ultimately much worse because of the delay of the required surgery.
The injured worker said and showed heaps of evidence that he had been trying to call his/her case manager for over 5 weeks with NO response – no return calls, no messages, no letters, zilch, adding to his (and his treating specialist’s) frustration. mainly regarding the ridiculous delay for the surgery approval.
According to the case manager she tried “to approve the injured worker’s surgery earlier” but ‘needed to discuss the reasonableness with the injured worker’s own specialist(s)”. She also had to discuss the ‘reasonableness’ of said surgery with another IME to whom the injured worker had been sent some 20 weeks prior. Now, don’t laugh, the case manager said that she tried to call that IME, and gave “evidence’ (X 2) that she could not get hold of that IME to discuss some stuff in his report. The recording states: “Our office (or clinic/appointment) hours are from 8:00 am to 5:00 pm Monday to Friday. Please call back during our normal operating hours.”And her calls ( x2) were recorded as having occurred at 8:29 AM (x1) and 8:34 PM (X1). WTF.
Also the injured worker’s treating specialist says he has been trying to return the case manager’s call for over 4 weeks with no response!
Eventually, after the ‘paperwork’ was done, the injured worker was made a settlement offer for $14,000. The injured worker’s counter offer was $28,000 (double). The claim was eventually settled for 20,000 (out of court).
The hilarious part is that the total cost of this poor injured worker’s claim is/was $130,000 and that the case manager had set aside (reserve) $55,000. The claim was eventually settled 69 weeks after the injured worker’s surgery.
NOW let’s have a good look at what’s wrong with our workcover system
- 36 weeks – two thirds of a year, or 9 months – just for this poor injured worker to obtain approval for his surgery and post-op treatment; are you kidding me?
- 4%(four) percent permanent impairment (WPI) for a mostly useless right dominant hand and arm? Insulting!
- No communication from the part of this case manager- which part of workcover claims management did that case manager miss?
- No communication from the doctor – who’s he working for, and for what $ reason $ ?
- 135,000 incurred losses on the workcover insurer’s books, and that’s because it took 36 weeks to approve appropriate, recommended, necessary and reasonable medical/surgical treatment, and another 69 weeks of messing around bickering about $14,000. Is this the workcover insurance company built on a profit plan?
- $55,000 in reserves? All treatment has been done, weekly pay is no longer available, and the injured worker wants $35,000 less that what is/was held/set aside as ‘reserve”‘ (for potential treatments, payout etc). I know I’m only an injured worker but even I can do that calculation, duh!?
Listen guys – this is complete claims shenanigans to say it nicely, and demonstrates how workcover case managers (et.al) are their our own worst enemies.
Want to “fix” the work-over system? Just approve the treatment that a proper Medical Doctor says is reasonable and necessary, and proceed with the resolution of the claim immediately, once the injury is stable. Quit fluffing around with peanut settlement issues and pay the fair permanent impairment benefit to close the claim.
The perpetrators of this mess should be publicly ridiculed and ultimately fired for perpetuating bad claims handling that generates such (vast numbers of) poor outcomes.
They should all be ashamed.