Work Cover-An Insurance Company’s Dream

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Hello,

This is for all people who have, or have had, a Workers Compensation Claim, in Western Australia, whose employer is insured & whose Insurer supposedly “disputes” liability, yet has NOT issued a statutory regulations form 3B-Insurers Notice That Liability Is Disputed (pursuant to s57A (3)(B) of the WCIMA, W.A.).

The first thing you should know is this…

“When an Insurer disputes liability for a workers compensation claim under the Workers Compensation and Injury Management Act 1981, they are required to issue a form 3B- Insurers Notice that liability is disputed.”

Above is a direct quote from the Attorney General of W.A. himself, Hon Michael Mischin, on 13 August 2013  (please see attached Hansard).

Allianz & Work Cover themselves agree (see attached).

If your Work Cover claim is said to be “disputed” yet the Insurer has NOT issued a form 3B (pursuant to s57A (3)(B) of the WCIMA of W.A.), then your Legal Rights are being unlawfully violated and not only by the Insurer but by Work Cover, as they are KNOWINGLY neglecting their duty, their obligation, to ensure compliance under the Act & we are all being denied our right to a fair & just process.

This is all about the Big Time Insurance Company’s ignoring & abusing Australian Workers Rights, Laws & Regulations & for reasons that can only be speculated…Work Cover W.A. is turning a blind eye and allowing them to do so.

SO, IS IT REALLY THAT BIG OF A DEAL IF THE INSURER DOESNT LODGE A FORM 3B?

ABSOLUTELY! This is a Statutory Regulations form for a reason. It is NOT without purpose, quite the opposite. It cannot be stressed enough – This form is VITAL because it requires the Insurer to answer a deliberately selected set of questions, advising as to why & on what grounds they are disputing liability of a workers injuries and most importantly, of which
provisions of the Workers’ Compensation and Injury Management Act 1981 they intend to rely on to dispute liability in relation to your injury.

This information is required so that the Grounds and or Basis to ‘Dispute Liability’ is clear and defined. Oh, and to make sure that Grounds for Dispute actually exist!

By example:

An everyday working Australian, who I’ll call Gary, was injured whilst at work. Injured solely due to the employers blatant neglect to address ‘an accident waiting to happen’, despite these concerns being raised with management over 10-12 times (three of which were done so via email) – the employer did nothing, until…..
Surprise!…A worker was injured!!

The Work Place was not in accordance to Safe Work Regulations/Practices & this ‘Big Time’ employer outrightly & knowingly put they’re employees in a highly hazardous & unsafe work environment.

So, this Worker Gary (who was actually a Supervisor) is injured at work, & has no choice but to make a Work Cover Claim against his Employer – who’s Insured.

BTW, After an injured worker lodges a claim, the Insurance Company has a certain amount of time (weeks, not Months & certainly not years) to (pursuant to Section 57A (3) of the Workers Compensation & Injury Management Act (WCIMA) W.A.) lodge one of the following notices:

(A) – Insurers Notice that Liability is Accepted

(B) – Insurers Notice that Liability is Disputed

(C) – Insurers Notice Where No Decision of Liability

So, the Insurer issues Gary a form (C) of which the cover letter states the following:

“(Insurers Name)…reserve the right to make a decision on liability until further information is obtained, including a medical report from your treating GP as well as a statement from yourself.”

Important word there being UNTIL.

Then there’s the form (C), which is a WCIMA Statutory Regulations Form to be filled out by the Insurer, which basically read as follows:
(Q=Question, A=Insurers Response)

Q – Reasons why no decision on liability
A – Further medical & factual information is required

Q – If further medical info is required to make decision, state nature and substance of medical information
A – Full report requested of GP

Q – Specify other particulars that are required to help make a decision about liability
A – (Insurers Name)..reserve the right to have the claimant undergo an independent medical examination with a provider of their choice

EVERY QUESTION ASKED ON THAT FORM IS TO SIMPLY OUTLINE WHAT INFORMATION IS REQUIRED BY THE INSURER…SO THEY CAN THEN.. MAKE A DECISION ABOUT LIABILITY.

Once they receive all the relevant information that they require, they then MUST make a decision about liability by lodging either form (A) – Liability Accepted or (B) – Liability Disputed.

Gary attended an appointment with a medical examiner of their choice & despite that Doctors great effort to find anything or anyone else to blame for Gary’s injury, ultimately he could not deny that Gary had suffered a Work Place Injury. He did and supplied everything that was asked of him.

Gary had multiple GP reports, Psychologists reports, witness/fellow staff reports & even the Insurance Companies own Doctor report, all in favor, that yes he had suffered a Work Place Injury. The insurance company could provide nothing to the contrary… Not even some Far-Out hypothetical reason to dispute liability. But to really top it off Gary even had copies of those 3 emails he sent to management advising them how unsafe the work place had become and requesting that they do something about it.

So, after the insurer had obtained all the relevant information that they had requested on the form (C) (so they could then make a decision about liability), they then did what…? Nothing!!!

Why’s that!?!  Well…if you were an Insurance Company who’s not in it for the little guy, or for the regular working Australian you would be more than happy to simply avoid, ignore, drag-out & neglect as many “small” claims as possible hoping people like Gary will just go away, as most do, and they know it..

So, the insurance company is left with two choices, lodge a form (A) or (B) Accept or Dispute Gary’s claim.

Accept? Hm..not unless, or until, they absolutely have to!

Dispute? How could they..? They couldn’t reasonably dispute liability with all the mountains of evidence in Garys favor. If they “Disputed” Gary’s claim they would have to fill in the form (B) which would then require them to answer a deliberately selected set of questions, such as, Why they dispute the claim & on what grounds… What could they possibly write, they had no evidence or even a reasonable suggestion, to dispute the claim.

But Work Cover never requested the Insurance Company make a decision about liability and lodge the relevant form. This is so important because there NEEDS to be a basis/reason for dispute..in order to dispute a claim, i mean c’mon! And further, the appellant is entitled to know why they dispute it..in order to disprove it. How can Gary debate/disprove/argue their case if they never even put one forward. Surely this is just 101 stuff when it comes to being a Judge, a lawyer or ruling on a point of law!!

Gary’s case then goes to Arbitration..then to the Dispute Resolution Directorate. What a joke. Every Work Cover Arbitrator & Director that was involved in Gary’s case, had all the relevant information they ever required and requested, they had Gary’s statements, claims, Reports, Emails (the list goes on) and the insurance company’s lawyer….NOT ONCE…Was required, by Work Cover WA, to provide any reason what so ever, as to why they were “disputing” this claim.
WORK COVER W.A=PLEASE EXPLAIN!!!????
I write “disputing” like that, because..the claim is supposidly disputed, but NO Stat Reg form (B) – Insurers Notice that liability is disputed, was ever lodged.

21 MONTHS, is how long it dragged out before liability was accepted. How much was achieved or obtained by WC WA in that time between collecting the information requested on form (C) to Gary’s claim Finally being accepted..? Basically Nothing. They, WC & the Insurance Company had everything they ever asked for or needed in order to make a decision on liability 21months earlier.. Explain that Work Cover. THEY THOUGHT GARY WOULD JUST GIVE UP & GO AWAY. & YOU CANT BLAME THOSE WHO DO..

Most everyday people simply cant afford the fight..the physical, financial, emotional stress becomes too much. The actual injury can sometimes only be half the battle.. The emotional toll It takes on loved ones, on families, on personal relationships, on their children. Marriages Breakdown. Loss of Friends because most people cant really understand unless they’ve gone through it themselves. Selling belongings, selling homes. Trying to make ends meat. Explaining to your child why. Isolation. Depression. Pain. Doctors Appointments. Medication. More Doctors appointments & medication. People lose what they’ve been working for their whole lives, some even lose their lives.
It consumes people..  And I’m not sure what’s worse..the fact that (in this case at least), the injury could have been completely avoided, or the extreme lack of conscience, compassion, empathy, decency and humanity of these people (who are fellow Australians) running the Insurance Company. That’s truely Dissapointing, but unfortunately not all that surprising.
I think the worse part is that Work Cover WA, knowingly, sits idly by while multi-national, multi-billion dollar companys ignore Australian Laws & Regulations so that they may successfully rip-off, abuse, neglect, consume & rob hard working Australians who have been injured at work, many of times, through no fault of their own.
Work Cover was made to protect everyone, it is suppose to act as a mutual body. It’s duty, its responsibility, its obligation is to ensure a just & fair process for Employers & Employees, its an Australian Right & was fought hard for. Work Cover is there to uphold the WCIMA and to act, according to the law & in the spirit of which it was written. Its doing a disgraceful job!

NOT ISSUING A FORM 3B IS A DELIBERATE (UNLAWFUL) STRATEGY USED BY INSURERS…GARY HAS SACRAFICED ALOT TO FIGHT THIS FIGHT & IT GOES FAR BEYOND PERSONAL…IT IS ABOUT PRINCIPLE, IT IS ABOUT WHATS RIGHT, ITS ABOUT CHANGE, ITS ABOUT THE FUTURE & VUNERABILITY OF WORKING AUSTRALIANS AND LASTLY, ITS ABOUT THE FACT THAT THIS CAN HAPPEN TO ANY WORKER, NO MATTER HOW GREAT THE EVIDENCE, NO MATTER HOW BAD THE INJURY, INSURANCE  COMPANIES CAN LEAVE INJURED WORKERS HIGH & DRY…OR WORSE, JUST BECAUSE THEY FEEL LIKE IT..& DO SO FOR MONTHS & EVEN YEARS IF THEY WANT TO…BECAUSE WORK COVER LET THEM.

WE NEED YOUR HELP!

POWER IN NUMBERS!

THERE’S PLENTY OF PPL OUT THERE, WHO NEVER GOT A FORM 3C..!!

CLASS ACTION IF WE CAN

WHY EVEN PAY TO HAVE INSURANCE IF THE COMPANY NEARLY NEVER PAYS OUT??? WHERE’S THIS MONEY GOING?
IT DOESNT SEEM LIKE VERY MUCH OF IT EVER ENDS BACK UP IN PPLZ HANDS..BUT RATHER JUST THE ACCOUNTS OF OTHER COMPANIES.

WORK COVER WA…WHATS YOUR CUT?

2 Responses to “Work Cover-An Insurance Company’s Dream”

  1. You can file an application to resolve a dispute with WIRO or the Workers Compensation Commission. You case is solid because you identified the breach within accordance to the statute. Use you email correspondences as evidence in your application.

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