We recently received an email from an injured worker stating that s/he feels that s/he is being harrassed and bullied by his/her workcover case manager. The injured worker wonders if there is anything s/he can do about this behaviour, besides engaging a lawyer.
Workcover case manager: it’s all about influence and pressure on treating doctors
I am currently under work cover for a XX injury. I feel that I am being harassed and bullied by my case manager even though I am fully covered by a medical certificate until late October.
Aside from engaging a law firm, are there any other steps that I can take, as my GP is now changing his original view, and is siding with work cover after considerable and daily communication from them.
We so often hear from injured workers that their workcover case manager often calls their treating doctors and even their treating specialists (i.e. specialised surgeons, specialised pain doctors, psychiatrists etc). We also hear a lot from injured workers in states that appoint “nurse case managers”, that they insist on attending injured workers’ medical appointments, claiming they have the injured worker’s “best” interest at heart. Many ignorant injured workers also allow their rehab service provider to attend their medical appointments. Injured workers should never ever allow this!
As posted in our article “The case manager’s 10 commandments”, commandment 9: You (as in the case manager) shall not pretend to be a doctor! This is very important. Please don’t tell injured workers who have suffered a primary and/or secondary psychological injury “that they do not need to see a psychologist or psychiatrist but can talk to you instead”. Please do not harass, intimidate and bully injured workers out of their legitimate medical and like services. You are not a doctor, you are not a psychologist, no psychiatrist, no surgeon, no neurologist or other medical specialist. Do not gamble with injured workers’ lives!
Simply tell your treating doctors (i.e. GP, Surgeon,Pain doctor, Psychologist, Psychiatrist, Physio etc) that you feel it is a violation of your PRIVATE doctor-patient relationship.
Also, make sure you write a letter to your case manager requesting s/he explicitly refrains from contacting your treating doctors by telephone, and that you refuse anybody from the insurance company (i.e nurse case manager, rehab provider) to attend your medical examinations/appointments, highlighting privacy breach.
Obviously the Workers Compensation Act (in all states) allows the workcover insurance company access to medical records in support of billing and liability matters, since this is necessary to allow the carrier to determine whether the treatment is related to work injury, etc.
In particular direct and private telephone calls by workcover case managers with your treating doctor(s) are an extreme violation of your privacy, the more because they are not recorded, and also NOT PAID for by the insurer.
We know of countless cases where this routinely happens. workcovervictimsdiary.com’s author’s themselves have and are experiencing this illegal privacy invasion. We believe that our pathetic case managers are stupid enough to believe that their back-handed calls are not relayed to us, injured workers, by our very own treaters, who, more often than not, have been greatly disturbed, if not gob-smacked by such under-handed calls.
We know of one particularly disturbing “incidence” of such a “call”, where a case manager actually belittled (really!) the treatment plan and opinion of Victoria’s top upper limb surgeon! The surgeon in question was bewildered and shocked that a mere “clerk” who wouldn’t know the difference between a supraspinatus and an infraspinatus tendon would undermine and argue with the expert in the field. He told the injured worker that this “case manager was quite something” and that he felt “sorry” for the injured worker, now fully understanding what he had to “deal with” on a daily basis.
Its’ all about influence and pressure
Meanwhile, s/he will act like your best friend and swear she is helping you to get the care and treatment you need; this is particularly true for the nurse case manager or the appointed rehab service provider.
We would go as far as changing doctor (in states that permit it) if your doctor(s) continues to permit the involvement of a case manager (or nurse or rehab provider) in monitoring and controlling your care, despite your wishes.
Most decent doctors know the dirty tricks and tactics behind case manager’s calls (and faxes) and will simply ignore them; especially if it is also your wish. Don’t get fooled and don’t get threatened.
Case managers (et al.) are only allowed to make written requests for information from your treating doctors, such as an updated medical report (which needs to be paid for) – they do not have permission to invade your doctor-patient relationship by calling your treating doctor “to discuss” matters behind your back and off the record.
I write to you in relation to your recent telephone conversation(s) with my [doctor(s)] over the last couple of days/weeks/months but most particularly [today’s date] at approximately [2.10pm.]
You may or may not be aware that telephoning [my treating doctor(s) is a violation of my PRIVATE doctor-patient relationship. Therefore, I will stipulate and remind you of those privacy violations at this time [yet again].
[Insurer] [was] and now we remind and direct [insurer] that ALL communications with my [treating doctor(s)) are only to be made writing . That is should [insurer/case manager] require additional information from my [treating doctor(s), such as an updated medical report, the request must be made in writing – and [insurer/case manager] does not have permission to invade my doctor-patient relationship by calling my treating doctor “to discuss” matters, “coerce” or pressurise my [doctor(s)] off the record.
From this date forth, I (name) direct [insurer/case manager] not to communicate with my treating doctor(s) – names) directly in any way shape or form, no telephone calls, no emails, not even messenger pigeons NONE WHATSOEVER, with the exception of standard written requests for further information, such as an updated medical report.
You have been put on notice and failing which I will have no other alternative but to apply for an Intervention Order against any personnel from [insurer] that tries to contact my treating doctor(s) in any way, shape or form other than standard written requests.
In addition to the above, you can stop your workcover case manager from harrassing and/or bullying you directly, by requesting s/he does NOT ever communicate with you directly. You can request your case manager only communicates with your treating doctor in writing (i.e a psychologist); only communicates with your lawyer; only communicates with X (your friend, souse etc); and that all communication is in writing. It does work miracles! See sample letters.
Also, as state on the Injured Workers Support Network (NSW), in an article titled: Five things you should tell your doctor:
2. The Work Capacity Certificate is the most important document in the entire system.
It is entirely the considered medical opinion of the treating doctor, not the insurer, not the employer, not even the employee. No One else can Change a Work Capacity Certificate. Though a Injury management consultant can suggest changes the Work Capacity Certificate is wholey the professional (and legal) responsibility of the doctor who wrote it.
Therefore: It should be as accurate as it is possible to be. Using medical terminology, accurate workplace restrictions Including required testing for accurate diagnosis where the diagnosis is unknown, and a treatment/injury management plan.
The Work Capacity Certificate is important, but it is not static. The Doctor can, after consideration extend, or restrict the capacity as they see fit in their medical opinion
3. The Doctor controls who comes into their surgery and asks the patient first.
Rehabilitation professionals are allied health, not medical doctors and are not qualified to alter a medical certificate. Insurance clerks don’t even need their HSC, in no way are they qualified to suggest any medical treatment or change, Employers are in the same boat.
Your doctor controls how these three groups talk to them, they can choose (as many good GP’s do these days) to consult with them over the phone, or through an email exchange after the Doctor receives the questions in advance. The Doctor does not have any responsibility to have them in the room while they are in consultation with you.
The doctor can not be sanctioned by anyone in they system if they refuse to have anyone apart from you in their consultation rooms.
There is a reason why the rehab, insurer, employer want to get in the door of the consultation room. It’s a professional tactic and its not to benefit the patient.
4. Reasonable access to patient records is not an open slather.
An insurer has the right (with a patients written consent) to access that patients medical records. The legislations says that this has to be REASONABLE. Asking for everything is not reasonable. Asking for your children’s records, your fathers records, those scans from your broken ankle or the letters from your psychologist about your divorce when it has nothing to do with your injury is not reasonable. It has to be related to the injury you are claiming workers compensation for.
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