We’ve heard it a lot : “my workcover case manager calls me and appears to want to look after me”, “my case manager is super friendly..”… ” my workcover insurance case manager will take good care of me”. WRONG! Workcover insurance case managers are not your “good neighbour”, you are NOT in good hands, and they are certainly not your friend (even if they pretend to be)!
Your Workcover Case Manager will NOT take care of you
Workcover case managers are not your friends and you are most definitely NOT in good hands! As an injured worker you are actually at war from day 1, and at a pretty much sophisticated war.
The workcover insurance case manager is generally experienced and knows all the workcover laws, at least all the tricks. Make no mistake, his or her job is to save the workcover insurance company money.
Many workcover insurance case managers receive bonuses and other monetary or valueable recognition for saving their company (the insurance company) money. It is a no brainer that the easiest way to save money for the insurance company is to deny workcover claims and to pay the minimal amount possible. This is also why they will sometimes use a case manager to try to force your doctor (or even an independent medical examiner) to get you to return to work. This is where they surface at your medical appointments, or this is when you hear from your concerned doctor that a someone from the workcoer insurance has called to obtain private information, or to book an appointment together with you with your treating doctor! That is also why they hire private investigators to try to find any semblance that you may not be following your “doctor’s orders”.
One of the worst thing that workcover case managers often do is to deliberately delay or stall any claim (be a medical and lik expense, be surgery, be medication request , anything). They like to delay, delay, deny, delay, delay, and deny some more, enough to drive you nuts!. But this is their normal routine believe it or not! We actually came to call this tactic SSS – Stall, Starve, then Settle.
So don’t take it personal – they do it to every injured workr. They will delay making payments (a favourite), they will delay medical treatment, they will deny that MRI you so badly need (or some other medical test), then they will delay setting up your doctors’ appointments (eg. approval letter for your MRI, CT etc), and then they will deny medical treatment by setting up a second opinion with an independent medical examiner (IME). You surely understand that If they do this systematically with every case, they literally save billions of dollars for their insurance company (be it Allianz, GB, GIO, Xchanging etc).
Think about it, If the case managers delay paying out $1 million dollars for 1 month (30 days) with all the injured claimants that they have, they save $50,000 for one month of delays and denials in interest alone.
One of the more shocking types of delay is denying claims casually while knowing that an injured worker is under financial hardship, in order to try to get the injured worker to settle a claim for pcents on the dollar due to the injured workers”s financial situation. This forces the injured worker to choose between whether he should wait for approval to get medical treatment s/he needs or settle his/her claim in order just not to have his house foreclosed upon.A prime example of this egregerious tactic is that we see a lot of low ball settlement offers around xmas for example. Think about it, injured worker is poor, in financial hardship, has children, it’s xmas,… it’s tempting!
If there is any “grey” area in a workcover case, the insurance company will deny your claim.
Stay strong, don’t take it personal, stick it out for as long as you can, do not accept low ball settlement offers, be vigilant, abide by your doctor’s orders at all times (surveillance), ensure you keep harassing your case manager for all the entitled benefits you may have such as medication payment, surgery, appliances, home and garden help, taxi transport, anything. Follow up on everything and in writing!