Why is it so hard to get help from doctors when you are on workcover


We recently received the following question from an injured worker: “why is it so hard to get help from doctors when you are on work cover?” Many doctors are just fed up with the extremely time consuming ,“ridiculous” amount of paperwork required by WorkCover, for which they are most often not paid, and with the constant harassment, interference and pressure from case managers.

Why is it so hard to get help from doctors when you are on work cover?

Unfortunately more and more doctors (GPs and specialists alike) are shying away from treating patients who are in the workcover system.

Many doctors (including my own) state that they are just fed up with the extremely time consuming and “overwhelming”, “ridiculous” amount of paperwork required by WorkCover, for which they are most often not paid.
In addition, GPs and specialists are extremely frustrated with the bureaucracy, red-tape and drawn-out processes they encounter when dealing with WorkCover. Injured workers’ treating doctors are also not remunerated properly (read: Paid) for consultations (fixed fee), for phone calls or for filling out lengthy forms and find the processes extremely convoluted.

GPs and specialists have indicated several reasons leading to the decision not to treat workcover victims, these include:

  • Constant interference and pressure on the treating doctor by the workcover insurer (case manager)

In other words: injured workers’ treating doctors lose their capacity to practice medicine without interference from the workcover insurance company.

As we highlighted in our article ” Workcover case manager: It is time to put care back in the hands of the doctors“, The injured worker’s own doctor must be able to manage care and be able to override caseworker cost containments! But nowadays, the primary injured worker’s GP or specialist is not in charge anymore of the patient.

For example: an orthopeadic surgeon stated that if he sees an injured worker patient with a rotator cuff injury, he is not allowed to send the injured worker for physio (or very limited) and surgery is denied. A pain specialist’s prescription for nerve pain medication (ie. Garbapentin, Lyrica etc) is denied by the medically uneducated case manager who believes this to be ab ‘epilepsy’ pill.

Case managers will delay, deny and refuse proper care that is being requested by the treating doctor/surgeon, thus tying that doctor/surgeon’s hands, so s/he is unable to treat his/her patient the way s/he knows best.

  • Injured workers’ doctors face increased harassment from insurers and rehab providers
  • Injured workers’ GPs (and specialists) who treat injured workers have to invests above average time commitment on forms or (telephone) meetings with case managers

Our treating doctors have to put up with an ever increasing/overwhelming need for ongoing paperwork and report writing, endless forms, endless requests to have basic parts of treatment accepted (i.e medication, surgery), and many of these duties are not paid for.

  • There is significant bureaucracy and red tape and the burden of commitment needs to be reduced so that particularly GPs and others can engage with WorkCover patients without compromising other parts of their service delivery.

Some doctors that treat injured workers can spend up to three hours out of a 10-hour working day on paperwork for WorkCover, as well as attending three-to-four hour long meetings per week with case managers or rehabbers (either via telephone or in person).The case managers tend to want copious amounts of reports which eats into the time the doctor and treating medical teams have got to do their real work. WorkCover can really take too much time for a whole medical practice making it impossible for small GP clinics with already long waiting lists to treat injured workers.

  • The red tape and potential court hearings involved with WorkCover are also deterrents

Some GPs and specialists have refused to deal with  WorkCover because they are fed-up with endless red tape and poor processes associated with treating victims of road accidents and workplace injury.

As far as GPs or other specialists go, to attend court to be an expert witness … adds a whole level of complexity that doesn’t match the day-to-day working of a GP.

  • There is also the false belief that there is tendency for a workcover patient to exaggerate their injuries, that they may not comply with things like ‘rehabilitation’; and that there is anecdotal evidence that for example, injured workers don’t recover well after surgery

Unfortunately these are the main reasons why it is so hard to get help or even find a doctor who is willing to treat you, the injured worker.

Saying that, we do of course acknowledge and THANK those few(er) medical and allied practitioners who still treat injured workers, who genuinely care for their workcover patients, even though they are paid lowly by a faceless, convoluted, adversarial and extremely bureaucratic party.

4 Responses to “Why is it so hard to get help from doctors when you are on workcover”

  1. Yep, that’s what the system is doing – pushing all the honest THPs out, to leave all the Dr Frauds, who are willing to fabricate, embellish or do whatever it takes to keep their employers happy and not jeopardise those lucrative referrals!
    Just look at the bias in scheduled fees! The scheduled fee WorkSafe Vic sets for initial IME Reports by a psychiatrist, is just under $1000, which is the going rate for reports regardless if the “assessment” took only 10 minutes and the report is typed by someone else (and is full of errors). Regardless if you spent more time waiting for the appointment than with the IME! Yet the same report for a THP psychiatrist is scheduled at around $320, no matter how involved, so why the discrepancy? Why do THPs have to waste their time trying to negotiate a higher and more reasonable fee with insurance case teams? The way it stands, it is not a fair or transparent arrangement, it just encourages corruption and greed! It slowly forces the good, honest practitioners to leave the system! So it’s OK for ex-hitmen to come over to Australia, photoshop their qualifications and get paid over $1M over a ten year period doing assessments in workers comp & TAC, but no, THPs cannot be paid the same rates, because apparently paying THPs the same for their reports may encourage dishonesty! Well I suppose it is remiss of me to say the ex-hitman that finally got discovered as having no qualifications, when you think about it, was actually more than qualified working as an IME – aren’t most of them paid “hit men”! It’s also frustrating for THPs to have all the pressure placed on them to return their patients to good health, when Workers Comp and all its’ minions, and particularly the adversarial and self defeating actions of the insurers, only exacerbate existing injuries or cause secondary ones! It’s as if the whole system is set up to cause, maintain or aggravate depression, frustration, and mental disorders (for all involved)!

    fix workcover July 20, 2015 at 6:01 pm
  2. I had a Doctor firmly refusing to treat me, he said: “I don’t deal with Workcover, it is too much headache”!
    Clearly there is a conflict of interests, the ingredients are: the politicians, the insurance companies, the money!

    xchangingvictim July 18, 2015 at 6:23 pm
  3. Very, very true. The whole system is like trying to negotiate a maze with huge spikes in it, where even if you reach the end of it, you are half dead from the obstacles. Deliberate roadblocks are set up like demanding monthly certificates, that is a total waste of money if you have been deemed unfit for work. Management plans that have medical procedures required for improvement are totally ignored by them, not you. They also try to drive a wedge between you and your doctor, misquoting what they have said and driving them insane by the ridiculous requirement that they see you every month when others in the same situation are allowed three months. There is no consistency, no accountability and no reimbursement for GPs and the ultimate insult is the use of incompetent GP IMEs to counter the expert opinion of your specialists. Damn this system to hell and all those who profit from it.

  4. And that’s how the system wants to keep it. We need an ICAC inquiry into the workers comp system and injured workers need to be called on to give evidence.

read-before-u-commentThis is a statement pointing you to our seriously injured but esteemed and honourable Social Networking Sites Warning and our comment policy. A must read in the context of a very adversarial workcover system! Remember to mention in which state you reside if you seek advice.

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