Let’s have a look at what’s wrong with workcover

kidding-me-workcover

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

 

  1. Are_you_fucking_kidding_me_by_rober_raik-d4clstk36 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?
  2. 4%(four) percent permanent impairment (WPI) for a mostly useless right dominant hand and arm? Insulting!
  3. No communication from the part of this case manager- which part of workcover claims management did that case manager miss?
  4. No communication from the doctor – who’s he working for, and for what $ reason $ ?
  5. 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?
  6. $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.

Perhaps what really needs to fixed in the first place is nothing but the workcover claims handling practices, which includes how doctors/IMEs behave, how case managers behave, how claims departments behave.

They should all be ashamed.



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7 Responses to “Let’s have a look at what’s wrong with workcover”

  1. Yes you’re right, they should ALL be ashamed. One big question still persist though, why are they getting away with it?

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    • Oh I’ve had the non communicative case manager and the long waits for approval of both surgery and emergency medical treatment

      Sounds very familiar. And then my medical professionals all state how workcover end up making us sicker.

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  2. I think we have all had a taste of the bullshit that goes on in these insurance companies, and yes I too want to see them held accountable for the life sucking cruelty they dish out to injured people. What I want to know the most is what do they gain by stringing things out, not returning calls and torturing people? Do they get more money or bonus’s? Do they drag their heels so they have something to do all week? Or do they just try to cause as much harm as possible hoping to send us to the grave?

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  3. Wow,
    I read ‘What’s wrong with…’ and huge chunks of it was like reading my own experience with Allianz and the WorkCover system. I know when I added up the times for approvals, IME reports ( late/ initially denied) and obtaining specialist appointments, up to 2/3rds of the 12 months limitation on medical treatment had been used up!
    There certainly should be full transparency on what the scheme agents cost the WorkCover system and what incentives they receive for minimising duration of claims, denial of liability, etc.
    I know I was shocked to my core by how I was treated- non-diclosure, bad faith, having to fight while in recovery to gain a just outcome for surgery I had to pay for because initially liability had been denied. Such machinations rob the injured worker of optimum recovery and support and place burden upon a physical injury with financial and psychological
    stress.

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    • Well it seems quite clear people. Whilst claims are denied or dragged out, with the ultimate intention (strategy) of people just dropping out of the system so payments won’t eventuate, the money is sitting in their piggy bank. They have this mass of money, invested and making more money, so whilst ever a legitimate payment is denied or delayed, they MAKE MORE MONEY. Why does this contiue to occur and why are they getting away with it I see someone ask….because this Scheme is a CASH COW for the Government! It’s all about money and power. What we need to do is to change this. If the moeny held by them is withheld by them based on bad medical or legal decisions then they are profiting at our expense. Yes they can argue their right to assess the legitimacy and make a determination BUT the key here is reasonableness, responsible, timely, transparent, independent and evidence based decisions. If anyone has documented evidence that they are not making payments because of unreasonable management actions and delays, no susbstantial medical or legal reasoning, then we would have a case aginst them. Let’s collect and document as much as we can. If we can PROVE this is occurring then we can allege that they are profiting from this behaviour. This kind of behaviour would be financially inappropriate for the Government (or an Agent) to be engaging in. Let’s get together and document this behaviour and go have a chat with the repsonsible Minister and Premier.

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  4. Yes it is quite the cash cow for the government of the day, but also for a huge range of professionals (legal, and medico legal) who make their daily bread from the system. The system is heavily infected with legal “conflicts of interest” that work against the injured worker. Basically it’s corrupt, and when there is corruption (think about what’s happening in publicly funded private training colleges as another example of this kind of corruption) then the true purpose of a system also becomes corrupted. Any courageous legal challenge would lay this corruption to rest, but with all the examples given here and on other injured worker sites, where are there any signs of adequate courage in the medico-legal sector that currently makes such huge incomes out of this negligent and arguably criminal system? While injured workers lives are stripped of their financial security, while their health conditions are aggravated by the actions of Claims Management and the very design of the System, while they lose hope and succumb to depression, anxiety and other mental health injuries, others involved in the system are making money from the misery of injured workers. Shame on all who help this System malfunction to such an extent.

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    • But it does come home in the end Pauline – a tree falling in a forest without ears to hear makes no sound yet it falls.

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