We Support Vic Ombudsman Investigation into Workcover Insurers

VIC-Ombudsman-workcover

The recent announcement by the Victorian Ombudsman -Ms Deborah Glass– to investigate the management of Workcover claims is definitely very worthwhile initiative. For years, injured workers and their representatives have faced workcover Insurer representatives who just say “No”, no matter what!

This often means that the injured has to go through a prolonged process of legal proceedings before finally receiving their proper entitlements. This can mean no income for months and in some cases, even years.
And , of course many injured sods are scared by the prospect of going to court and the financial risks involved. The workcover Insurers obviously use this fear to their advantage. Their big pockets allow them to become big bullies indeed!

Diary of a Workcover Victim Supports Vic Ombudsman Investigation into Workcover Insurers

aworkcovervictimsdiary welcomes the Vic Ombudsman investigation which we believe, but certainly hope, will help injured workers recover earlier with the help they so much need and deserve.

Media statement as per Ombudsman:

The Victorian Ombudsman has commenced an ‘own motion’ investigation into the management of workers compensation claims in Victoria.
The investigation will look at whether WorkSafe agents have unreasonably denied liability or terminated entitlements for people who have suffered injuries in the workplace; and whether agents did this for financial incentives offered by WorkSafe. The investigation will focus on agents’ use of Independent Medical Examinations. Whether WorkSafe is providing effective oversight of agents and their claims management will also be reviewed.
The investigation is the result of many complaints about WorkSafe agents to the Ombudsman: 370 complaints in the 2014-15 financial year. The most common related to claims decisions and processes, including failures in decision making and failure to consider evidence. The second most common complaint related to payments, with complainants registering dissatisfaction with issues around decision making.
The WorkSafe agents include Allianz, CGU, Gallagher Bassett Services, QBE and XChanging.
The Accident Compensation Conciliation Service annual reports for the last three years have shown increases in the number of requests for conciliation of 13.6 per cent (2012-13), 5.2 per cent (2013-14) and 0.2 per cent (2014-15).
Ms Glass is not available for interview.
[Post dictated by WCV and manually transcribed on her behalf]


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32 Responses to “We Support Vic Ombudsman Investigation into Workcover Insurers”

  1. A great start and I congratulate every injured worker who lodged a complaint. I just wish the same would happen in NSW, but with our nasty government here I cannot see it happening. Good luck anyway and I hope the results lead to a shake up in the scheme.

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    • Just a thought but most of us have proof of the lies and harassment we suffer from the case managers so why don’t we find a legal firm who is interested in a class action .
      It may not help us much but would make a difference to those unfortunate to be a workcover victim in the future .
      I have also become aware of another possible scam of theirs that the fed govt may not like involving bulk billing of doctors visits instead of them going to the insurance co .
      Is it possible that most docs do this because they suffer the same runaround that we get so its easier just to bulk bill Medicare instead ..

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      • Geez thought the name was hidden , this is going to cost .

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        • @Robert, Contact Admin asap and get them to take it down asap! Never use real names or let anyone else post stuff under a real name on any of these forums. Doubt they could prove it was u tho anyway. That idea is a good one and ur not the first to think of it. The only problem with all of this is there is never any REAL action. The Ombudsmans investigation here in Vic is going to just be a whitewash. I had lots of evidence which they dismissed bc it was over 12mths old and they cannot investigate matters where a person has an option for it to be heard in Court. They didn’t seem terribly interested in much and I doubt it will prove anything. Remember this is the Gov investigating the Gov and the biggest financial winner from WorkCover is…..u guessed it, “the Government!” Perhaps I’ve been in the system to long to hold any hope anymore. I also spoke to Maurice Blackburn about a Class Action and u need to prove loss of $30million dollars before they will even look at it. So around and around we go on the merry-go-round to nowhere.

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  2. Anytime I am asked to do a survey I tell it straight. No love lost wit me and cgu

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  3. Hello, this is truly great news about the Ombudsman, i was injured in May 2010 , i was given Rosemary Dean from Allianz as my case manager , my injuries are back , neck , and shoulder injuries , my back injury case was settled in 2014 , but my shoulder injury is ongoing , to cut a long ( very ) story short , i proved to Allianz complaints dept , that Rosemary Dean , concealed vital evidence about my shoulder injury ( as in a incident report ) and lied to them ( complaints dept ) about instructions to IME George Wilson about my shoulder injury I made complaints about this case manager to Work safe , Ombudsman , Allianz , and all i ever got from them was the runaround !! may be this time Karma will tag her .
    kevin

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  4. Don’t get too excited people, the Ombudsman HAS NO POWER TO DO ANYTHING! The best she can do is make a report to Parliament. This ain’t going to FIX anything.

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  5. Sadly Donald may be right. If you recall the May 2011 Investigation in record keeping by WorkSafe Agents, CGU got fined a few million, and it exposed how badly the system is being administered. What’s really changed? As long as the Government keeps getting a nice kickback $$$$ from the agents, it allows them to get away with far too much. Nothing will change until the legislation does. At least the investigation will expose a few things so that they’re no longer in the closet, which by the way, is where CGU hid all those unpaid receipts during the last investigation!

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    • @pp, I think you’re wrong! They were shredding the evidence weren’t they 😀
      Anyway, it’s not just the incentives they get from the VWA it’s also the way they get remunerated by having the largest employers on their books, makes them do all sorts of crazy shit to get and keep the business of the larger employers. I know QBE colluded with my ex-employer to cover up their negligence and to avoid other repercussions of breaches of other laws to avoid liability. I have it in writing. The twitts gave it to me under FOI!

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      • I commend the Ombudsman to investigate insurers. I believe the same initiative should be taken in South Australia. In my instance, it took two years to have my WorkCover claim accepted (and many more months to see the first sign of any entitlement).

        More recently, my entitlements were contested yet again. The dispute raised by the Claim’s Agent was based on the legal opinion of an incredulous IME whose report turned out to have questionable medical merit as well.

        Although the Claim’s Agent eventually conceded on the third day at Tribunal, the experience cost me a lot of unnecessary emotional distress, thousands of dollars of legal expenses, and some 16 months without entitlements. This has left me very bitter.

        Continual challenges initiated by the same organisation that is supposedly responsible for assisting me return to work has not helped my rehabilitation. Nor do I believe that financial kickbacks offered to the Claim’s Agent to rid of long-term injured workers from the liability ledger is in the balanced interest of all parties. The practice is too open to abuse.

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        Another Victim of WorkCover November 21, 2015 at 5:16 am
      • Bonnie I’m right. CGU had them locked away. Check out paragraph 3 of this ABC Report, http://www.abc.net.au/pm/content/2011/s3228087.htm
        “A report by the Victorian ombudsman has uncovered a series of problems with the agencies that manage work cover payments for injured workers.
        The ombudsman’s investigation found the agencies had manipulated incentive schemes, delayed payments to workers and mismanaged files.
        In one case it found that the insurance company CGU, which had the contract, had hidden 10,000 overdue accounts, in a locked cupboard.”

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        • @pp, the bloody system is a disgrace. Can u imagine if an injured worked pulled that sort of crap and defrauded the Insurer or VWA!!!
          I know I read somewhere one of the Agents got caught shredding documents so that they could meet their bonus quota’s. And why do they continue to do it, bc NOTHING gets done by the Government!!! I don’t have words, makes me so damn angry

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  6. I think everyone should submit a complaint to the ombudsman. The more added the more has to happen surely. I have been on the workcover journey for 4 years. Despite trying so hard to maintain my career I had my duties withdrawn!!! any way moving on I have secured a position by myself with the same company ( hah) have been maintaining my full time hours. But will the insurers hwlp with treatment requests…..no. The sad part is I have a great pain consultant who gives up himself with waiting for workcover approval and puts me through as a public patient. But this is so wrong. Its not up to the tax payer to fund this its the insurance company. and the procedure works, gives me quality of life and enables me to work full time with no sick days!!! So why would the insurer decline the request and ask for an IME which probably costs more than the procedure. I am now considering withdrawing my claim as they have worn me down. The system sucks

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  7. Don’t let the barstards win , I think of it as a game and decided that I would be a squeaky wheel .
    Just keep playing keep complaining keep annoying keep in touch with the case manager and the case managers supervision , it will take awhile but eventually they will get sick of the sqeak and maybe stop playing games with you .
    Have not got to that stage yet but think I’m close .

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    • Bret, I love your enthusiasm, however when nearly 4 years pass and no one does anything really because they are afraid of going to court, you take matters in your own hands!!! I cut off my own leg because no one would fix my back and the nerves had basically died!!! It’s all a farce , its political policy to make people feel good about themselves doing “the right thing ” !!!

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  8. My Lord there are horror stories out there , must admit I was close to what you have done but doc wouldn’t consider it .
    These dictators rarely go to court ,they settle just before the due date ,you need a trustworthy solicitor who has not been bought and who takes no crap from them .
    If your claim is genuine you will win if they have accepted liability you should win ,just look up the court lists and see what some people have gotten away with in court .
    And compare your own situation .
    Don’t be afraid to go to court ,don’t settle on a piddly sum ,under 500k if your circumstances are right .
    The insurance company’s don’t like going to court because they mostly lose especially if genuine work injury .
    Why do you think they have non disclosure agreements ? They don’t want everyone knowing what a particular injury could payout ,so they can keep offering bargain basement offers knowing you will settle rather than going to court.
    Every case will be different but it’s vital to change your mindset , get angry let your solly know your pissed off and won’t settle under $x if your not happy with your solley tear them a new one tell them what you expect and what you won’t put up with .
    Yes it takes time to go through the system mine was about 4-5 years before settlement /agreement but it should not take any longer in straight out cases if your solley is doing their job .

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  9. Honestly there needs to be a royal enquiry into this issue. I’ve been so harshly and unfairly treated by this current system they have in place. The NO LOW IS TO LOW TO MAXIMISE PROFITS system. I’ve been left spinning, questioning reality and asking myself if i could really be as crazy as this IME report is making me out to be?! Having never in my life even seen a medical report then staring at pages of things written about myself that i don’t remember saying from an interview that only lasted about 10 to 15 mins from my memory. Being accused of having such a serious mental illness not related to employment at all. Countless referrals faxed from doctors office, posted in and emailed to the agent that they just never seemed to received. Besides my GP the only doctor i was I’m going to say given permission to visit was their IME. Anyway only when asking myself how can this be happening to me? and thinking the system is meant to help injured workers and could i really be this mentally unstable and not even know what I’m doing and saying or remember it most of the time? …. If you read what i did and being an injured having no one else to turn to or talk to, to even ask. You might not have done too much better than me.
    Only while questioning how can this be happening to me at all I came across this site and started to learn I’m not alone and the truth about how and what the system really is. It’s a money making machine owned by the government that by whoever’s fault it is (that’s more of a for legal purposes whoever!) turns around and treats employees who’ve been paying tax to the government (i know employers pay for Workcover insurance) like dogs with the plague when they’ve been injured in the line of duty and it’s their time to give something back. By give something back I mean help and allowing for appropriate medical services instead of being kicked down pushed into a corner when you don’t even know what your rights are.
    After being through the work cover system I view it as nothing more honourable than the tax on cigarettes and poke machine, speeding fines and the GST. It’s only there to make money and they’re always needing more. Now they’re talking about a possible GST increase and with the price of cigarettes and the amount of speeding cameras around i would imagine I’m being told a fairy tail by anyone would claim that the work cover profit machine isn’t feeling pressured to pump a little more up the ladder.
    Good luck to all being treated unfairly by the system, don’t just give in.

    (if this gets read before posted delete this part please. I’m not sure if i said what i wanted to say when i started writing this. Either way post it or don’t no stress. Your site has been a lifesaver to me and without I would of fallen over and been defeated so long ago by these people. Also feel free to edit this in any way you seem appropriate. Thanks again)

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  10. Was finally cleared to RTW FOR 3 hours 3 days a week but my arsehole employer has sacked me yesterday lucky I am a etu member cause these fucktards sacked me over the phone and there reason was it would be an injustifable hardship to make necessary changes but the stupid fucks have already provided me with a stand up workstation and an ergonomic chair so they dont have to do anything to accommodate my return stupid fools looks like I have got a good chance of unfair dismissal and a good case for discrimination

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    • Cloud
      I may be wrong but yes you can be sacked while on workcover and it’s usually justified by saying you have missed too much work .
      Which in most cases anyone injured at work would miss a few days here and there if not years , the system you will find is weighted against anyone injured at work .
      You are by default a criminal and treated as such for trying to fraud the insurance company profit margin .
      It all sucks and can get people down , as I’ve said fight it all the way .

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  11. Interesting that four corners has exposed similar practices in comm insure insurance to what we have suffered , just not quite as aggressive or widespread as what we go through .
    Maybe if enough of us with stories and evidence send emails to four corners they may just look into it for us .

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  13. I managed to get the certificate for pain and suffering but the defendant lawyer refuse to give me an offer and my lawyer done a lousy job from day one and it seems to me my case is finished, going to court will cost a lot if I lose and also if I win, is any suggestion, can you help me what to do, is it possible to take action against this defendant lawyer (work cover) or is it possible to sue my lawyer, your help will be appreciated

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  14. Some ambo chasers are useless so it would not surprise but need a better background to be sure if you have a shonk , if in doubt get a second opinion from one of the big players .

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    • They do usually wait till just before the trial before they make an offer and be careful they have messed with your head and have you where they want you mentally so you will accept the first offer even your mouthpiece may say settle but from what I’ve seen they usually give an offer half of what they are prepared to pay .
      In most cases and I know nothing about yours they don’t want to go to court anymore than you do .

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  15. I’m unsure of your exact circumstances so it’s hard to give definite opinion just a general one , you could ring the law institute of your state and maybe check out if alls well or maybe find another solely for a second opinion , like maybe Malouf and partners or another big name but you will have racked up a payable account with your current firm anyway .
    Just be careful before you jump if you do .

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