About

Diary of a workcover victim

diary-of-a-wrorkcover-victim

Erin Brockovich and Lisa

Who are we?

First of all, we’re not going to misrepresent ourselves – that is aworkcovervictimsdiary- and tell you that we have special influence(s) with state legislators and even politicians. We don’t, and neither do some of the others, or we would already have meaningful, fairer workcover legislation signed into law to really help injured workers survive this ordeal known as workcover, work-over or workers compensation.

Our primary goal is to help, assist, educate, inform and empower injured workers  to better understand how to navigate through an ever complicated and convoluted workcover system and not become victims of overzealous workcover insurances and their investors (stakeholders). One way we accomplish this is through aworkcovervictimsdiary, a site that is more than just a ‘glorified’ blog, which provides very important information resources for Australian injured workers!

And we’re not after your money! Although it does cost us  to run this site, we never expect/demand any membership fees or monetary contributions. However we like to receive article/information contributions from injured workers and their supporters as every little bit helps to deliver the important message to the workcover insurance companies— that it’s not “Business As Usual” anymore!

And most of all, we’re not making or going to make promises to you that we know we can’t keep, just to get ‘your support’. That is just absolutely wrong!

We are more of an educational site. We HELP injured workers! We are advocates for the people injured and/or made ill at work. We go to bat for those falsely accused of workcover fraud by insurance carriers … by any means possible!

Another main goal of aworkcovervictimsdiary is to put an end to the rampant fraud and corruption perpetrated upon Australia’s injured workers by the insurance industry and their legislative friends. To help, support and assist those who are genuinely serious about bringing back some legitimacy to Australia’s Workers’ Compensation systems, a system that now is controlled by a corrupt and out-of-control insurance industry, that has our legislators pimping and pandering influence in exchange for their political contributions.

To stop the escalation of workcover insurer (and employer) fraud. This ‘White Collar’ fraud is a primary reason that our Workers’ Compensation systems are so dysfunctional, with insurance carriers hiding behind the fact that Australian law has not developed to the stage that there should be recognition of a new tort which imposes a duty of good faith on an insurer operating within a statutory workers compensation regime….to shield them from legal liability for their criminal acts, post injury!

Who are our our team members? Our team consists of  mainly (seriously) injured workers, including past injured workers (who have thankfully been able to leave the system), their families and carers and advocates. We also  have a few “professional” resources we can tap into such as pro-bono lawyers, and a few medical practitioners. Many of our folks are in the trenches and they know first-hand the obstacles and troubles that injured workers face. Others are those who want to see a real reform come to our Workers’ Compensation systems, and bring back some form of fairness and equity to this (supposedly) benefits delivery system that is so vital to every state. aworkcovervictimsdiary is also supported by Erin Brockovich.

We are in the 21st century, and injured workers need to use 21st century technology and tactics to get their voice heard by those who can help make the necessary changes.

We are NOT a political organisation. Political organisations are simply about money and power, plain & simple. They want your money and then they have the power, not you!  If you’re tired of playing “footsie” with politicians, then you’re the person we’re looking for. Injured workers need help and they need it now, not in 2 years!

You can read more about who we are and what we (aim) to do here>>

Help us help injured workers all over Australia, and bring some fairness and equity back to the WorkCover system.

A word from the founder of aworkcovervictimsdiary

Were you injured at work? So was I! I became a disposable inconvenience because I was injured at work!

Why is this site so important?

Someday you or a loved one may be face to face with the WorkCover system and their illegal activities, knowledge is your best defence.

This site will help you navigate through the murky waters of the workers compensation system, and whilst my experience with workcover occurred in Victoria (Australia), I sincerely believe that it crosses all states and even borders with respect to the insane challenges and nightmares that a workplace injury can create, within any workers compensation framework or scheme that I am aware of.

My message to injured workers (and their supporters)

My message is simple and that is that you have to do your own research into the workers compensation laws relevant in your state or country; you really need to keep well informed and remember at all times that people advising or assisting you are most often not working in you best interest.

From my own experience I found that “mistakes” and “oversights” occur all the time. Like you, when I was first injured at work I did not know my rights – they were certainly never given to me by my workcover insurer, and I was and am treated with utter contempt and disrespect by my workcover insurance company, and also by my (now former) employer.

Knowledge is your only power!

A Diary of a WorkCover Victim- kick-started by seriously injured “Workcovervictim” in August 2011.

This site was born out of my sheer frustration, anger and grief regarding the workcover system where all is not made clear, where the waters are very murky, and when the chips are down, the very people who are responsible for duty of care and support simply choose to ignore you, the injured worker.

Remember all stakeholders (i.e. independent medical doctor; insurance doctor; rehab service providers etc.) are accountable to and will perform in a way to please the hand that feeds them – yes, it is all about money.

I hope this site, our and many other injured workers’ stories will somehow help other injured workers navigating the murky waters of the workcover system, and , at the very least, be extremely diligent in finding out their legitimate rights, always questioning the “system” in order to keep some sort of control within the workcover system.

The workers compensation is – in my opinion- extremely adversarial and they use tactics to wear you down, to make you emotionally bleed out, to break you, all in order to weaken your position and to maximise their insane profits.

Because I had been seriously injured at work, I have – like you- become the “suspect” and the “enemy”. My own experience has thought me to fully distrust the insurance company or the case manager – their attitudes and behaviours has led me to realise that “humanity” is something that is not exercised nor understood by them.

Even though liability was accepted for my injury, I was and am still treated (like you) as guilty and with suspicion. So I knew (an you will learn) that it was and is up to me (you) to protect yourself and to treat everybody with suspicion and distrust in return. No one is there for my or your protection; except my/your lawyer! This is where the word Diary played a huge part when deciding the domain name for this Blog. The word DIARY is to it is to remind all injured workers to KEEP A DIARY! Why? To protect yourself !

In a workcover situation it is my experience and opinion that injured workers are treated as guilty by all parties – which is insane, given that in Australia even the worst criminals are afforded the right of being innocent until proven guilty.

I dedicate this site to all injured workers who have been abused by the adversarial workcover compensation system and/or the workplace. May they never give up, may they fight like warrior for their legitimate rights, and, most importantly, may they hold onto their dignity, self-respect, self-esteem and sanity; and may they WIN!

Lisa – Workcovervictim

aworkcovervictimsdiary and Lisa (aka Workcovervictim) are supported by Erin Brockovich

erin-brockovich-down-under

Click to read article

Disillusion yourself of any idea that the IME is independent

Read the article and memorise some valuable tips!

Rate an IME

A list of IMEs (Independent Medical Examiners) and you can rate them!

Come with us…

…on a walk through the Australian workcover back streets, where you get a chance to meet the system without losing your sanity. We guarantee, you won’t be bored – disgusted, humiliated, frightened, offended, outraged – anything but definitely not bored. Some of the stuff we write will make you laugh, some will make you cry but most of it will just make your skin crawl.
Our only hope is that the knowledge you gain from this site will help you survive the “system”.

Hi,

Since August 2011, our humble Diary of a Workcover Victim, based in Victoria, is one of the  most popular, free, supportive, educational, eye-opening and enlightening injured (and ill) workers’ rights and workcover benefits website/blog, authored by injured workers for injured workers in Australia.

We are proud to have empowered and helped zillions of injured workers (and their families) in their time of need and (c)overt abuse, providing them with easy, online support and access to much needed information about our adversarial workcover system.

If you are an injured, ill or disabled worker or a supportive family member, you know how difficult it is to find the help you need. The lack of resources and support can turn your life into a brutal nightmare. But you don’t have to fight this alone. We support and connect people who have experienced a workplace injury, trauma, illness, pain, and/or disability first hand.

We totally understand what you’re going through: the frustration, fear, and hopelessness. But here, you will unite with a community of fellow injured workers (and some advocates) who have joined together to fight back and to kick butt.

Our mission remains the same as it was when we began: reduce the difficulty of injured/ ill workers and their families searching for vital (and hidden) resources while increasing access to empathic support, workcover benefit information and the various – dirty- tactics used by the workcover insurers (and their allies) to deny, stall, and gaslight your claim.

Our site’s core function is the blog community support allowing injured workers to interact with other injured workers as well as other people who are also dedicated to our cause.

A workplace injury, illness, pain and/or disability doesn’t just affect our income; it also damages relationships within families and social circles, and simply drains the joy from our injured lives. The physical and emotional effects of this stress and isolation, combined with the -frequent- very brutal abuses of a very adversarial workcover system, very often lead to depression, anxiety and other mental illnesses. With no way to earn a living, and no real support for our cause, how are we expected to survive?

The world looks down on people who have been injured (made ill) at work, assuming that we are all lazy, malingerers or fraudsters, taking advantage of the workcover system. Workcover insurance companies, along with some politicians, and a biased media have shaped this stigma through decades of similar, unfounded claims and statements. As a result, injured/ill workers feel completely and utterly alone.

We do know what you’re going through and what you need to help you pull through, because we are seriously injured & disabled workers ourselves!

Get the help, support, understanding and the information you need to put some of the pieces of your life back together. Through the community of vital support and resources, you too can take a step toward change.

 

In Unity

A workcover victims diary is supported by Erin Brockovich

On 23 March 2012, Erin Brockovich, personally visited Lisa (aka Workcovervictim), the kick-starter of aworkcovervictimsdiary.com. Erin was moved with workcovervictim’s personal and most extraordinary work injury, and unimaginable ill-treatments received at the hands of the workcover insurance company, but she was also – and more importantly – most impressed with the work done by the humble aworkcovervictimsdiary.com!

Erin Brockovich’s message is clear and loud and that is that she is shocked that what I have experienced, (and still am experiencing) at the hands of my workcover insurance company. Erin and I (aworkcovervictimsdiary) strongly believe that there is a systemic pattern of misconduct and abuse, which seems to be the “norm” here and that this is unacceptable.

Erin Brockovich believes and told me that it is high time for all injured workers to YELL out loud and to share their stories.

She says there is no need to be afraid and to fear workcover insurance companies and case managers. You are the power! And together we can make the insurance companies very afraid of us!
Erin Brockovich has asked me to contact ANYONE who will listen and tell them my and your documented stories.

The fact is that many, if not all workcover insurance companies and their case managers treat us like criminals and in fact by doing so are negligent to the point of putting our very lives at risk. As is made very clear through our blog and its interaction with injured workers, the biggest issue is that YOU are not alone, which ultimately means that a pattern has been established by workcover insurance companies. In the interest of saving big money, insurance companies and their employees turn a blind eye to the treatment of injured people whose care is entrusted in them.

All the while many horrible case managers [and therefore workcover insurance companies] continue to do irreparable damage to you [the injured worker] with no regard for your safety, not to mention to the quality of your life.

To Erin Brockovich, the natural next step would be to file a class action lawsuit against what is a horrible, broken system.

Erin-Brockovich-signature

 

Making a complaint about workcover

Following yesterday’s rather popular post about “making (non)sense about IMEs” I have decided to lodge (yet again) a formal complaint with WorkSafe about the inappropriate behaviour of my case manager from hell. Whilst looking for the complaint form, I thought I’d just share some things about making a complaint about workcover…

What is a workcover complaint?

A complaint is any written or verbal expression of dissatisfaction with:

  • the service provided by, or
  • the conduct of the Victorian WorkCover Authority including WorkSafe Victoria, its WorkCover Agents, WorkCover Assist, self insurers, Independent Medical Examiners, Occupational Rehabilitation Providers, Legal Panel, Private Investigators or WorkSafe Authorised Certificate Assessors
  • Complaints about licensed or registered service providers are not included in the scope of this definition
  • A complaint also includes dissatisfaction with any aspect of the WorkCover legislation or scheme.

A complaint can include the following:

  • any claims issues (for example poor decision making, poor explanations, lack of/incorrect information provided, poor/inappropriate communication)
  • the performance of WorkSafe functions, or the way these functions and decisions are communicated
  • premium issues/objections
  • conciliation non-compliance
  • matters of conduct about an employee of the VWA or WorkCover Agent(s), including inappropriate behaviour
  • non-compliance or delays in complying with requests for information made under the Freedom of Information Act 1982 or the Accident Compensation Act 1985
  • inadequate or inappropriate handling of personal information, including potential breaches of the Privacy Act 1988  or other relevant acts
  • complaints about employers not meeting their obligations as specified in the Accident Compensation Act 1985, and associated VWA and Workcover Agent enforcement requirements

Who can make a complaint about workcover?

  • an injured worker, their representative or family member
  • Workers
  • Health and Safety Representatives or members of the public
  • an employer
  • a union official
  • healthcare professional treating an injured worker
  • Members of Parliament
  • Ombudsman
  • the Accident Compensation Conciliation Service

How can you make a complaint?

Complaints may be received in many ways: verbally (face-to-face or over the phone); written ;email (via the web or email addresses).

Download the WorkSafe complaint form

Read about the complaints process

Complaint about workcover staff (i.e. your case manager)

You need to lodge your complaint directly with us either by

If you need assistance to lodge a complaint, contact our WorkSafe’s Advisory Service.

How will the complaint be investigated?

Complaints will be investigated in accordance with the following principles:

•  All complaints will be investigated by an appropriately authorised person.

•  The investigation of complaints must be fair to both the complainant and the organisation or individual being complained about.

•  With the exception of complaints about WorkSafe Inspector Conduct which are referred to the WorkSafe Compliance Co-ordination Branch (CCB), complaints about the conduct of a VWA staff member are to be referred directly to the respective staff member’s Manager for investigation. Only the Manager will collect information about the nature of the complaint.

•  Any Whistleblower complaints will be investigated in accordance with the Whistleblowers Protection Act 2001. These complaints are referred directly to the Protected Disclosure Officer.

•  Complaints will be dealt with quickly and complainants will be treated courteously.

•  The complaints handling process will have the capacity to determine and implement remedies.

•  Where matters cannot be satisfactorily resolved by the complaints process the complainant will be advised of the independent external avenues to resolve the complaint.

Referral of complaints

•  Complaints may be referred to another area, in accordance with the following:Staff in the WorkCover Advisory Service will endeavour to resolve the complaint personally unless the complaint relates to Premium, an Independent Medical Examiner or the conduct of a VWA staff member. If this is not possible, they may refer it to their direct manager.

•  Any claims-related complaint that requires detailed investigation is to be referred to the Complaints Resolution Branch.

•  The Complaints Resolution Branch is responsible for investigating claims related complaints and any consultation with business subject experts.

•  Any Workplace Injury Insurance related complaint or objection is to be referred to the Premium Division for investigation.

•  Complaints about WorkSafe matters will either be handled by the WorkCover Advisory Service (OH&S Team) or referred to the relevant manager or the WorkSafe CCB.

VWA’s agents are expected to resolve complaints directly within their own complaints procedures rather than escalating to the VWA.

If the complaint needs to be referred to another organisation for investigation, the VWA will notify the complainant.

 

 

Making (non)sense of Independent Medical Examinations

I am desperately trying to make sense of the reason(s) why my case manager from hell has send me yet again to an independent medical examination (IME). Anyone able to make sense of this?

According to the Claims manual, If the information is sufficient to resolve the medical or treatment issues then a  s112 report is not required.

My case manager requests I attend a physical IME

22 May 2011

My case manager you wrote to me that “I note you have made several comments about your physical condition but I am only interested in assessing you psychiatrically“. WTF 😉

This after a) I underwent an MRI in March showing serious deterioration (ruptured ligaments) b) my treating orthopedic specialist knee surgeon requests approval for major surgery (which I eventually did not undergo because after numerous failed surgeries and many serious complications I am too scared). However, when my case manager requested I attend a psychiatric IME I asked her why on earth she was not sending me to a (more appropriate) physical IME.

9 July

I attend a psychiatric IME and the report states that I am totally unfit for any work for the foreseeable future. The report also stated that I must have taxi transport as I am unable to drive or take public transport without the risk of serious further injury.

10 July

“We are arranging a further physical assessment because it has been 12 months since your last assessment.” WTF 😉

18 July

“We will make a decision about your eligibility for taxi transport to and from medical appointments once we have reviewed both the physical and psychiatric independent assessments” A shrink assessment for taxi??? WTF 😉

19 July

“The physical assessment will be with Dr X – X Orthopedic Surgeon on the [date] @ [time]”.

26 July

“Mr X has called to advise he cannot consult on the [date] and due to the fact he was not available for some time we have arranged an appointment with Dr XX on [date] @ [time].”

“You will be sent a  letter with all Dr XX details. He is an Orthopedic surgeon and based on all the information you have been providing  regarding your injury we believe it is necessary to have the injury assessed based on my conversation with your specialist orthopedic knee surgeon.” WTF 😉

27 July

“Mr XX is a general Orthopaedic Surgeon whom I have requested to provide an objective clinical opinion, taking into account all the information we have available from your claim file and the information you and your treating doctors have been providing us regarding your injury and my conversation with your treating specialist knee surgeon.”

I replied as follows: ” you must provide me with a written request to attend an IME, and provide me with the reasons for the IME (with a surgeon who does not have expertise in knee injuries. You also need to give me (written) sufficient notice for the IME appointment  with date, location, explanation for the IME. As explained earlier I will undergo numerous scans and tests the day before which have many side effects such as vomiting and dizziness and there is a high possibility that I will not be fit to attend the IME the next morning. Can you please reschedule the IME.”

1 August

Please find attached a copy of the letter for the appointment with Dr XX on [4 days later] @ [time]. The appointment details are as advised in an email on 26.7.2011.
You have an obligation under WorkCover to attend IME appointments in relation to your work related condition. If you are unable to attend the IME due to prior a medical appointment, you will need to provide information from your doctor confirming this. WTF 😉 I told her!

When I looked at the “formal letter of IME appointment” …

The “reasons for the IME” were (WTF???)

In addition the letter states that Dr XX is an orthopedic surgeon (specialised in KNEES). However, Dr XX is NOT REGISTERED as a “knee” specialist, nor “shoulder & elbow”, nor “hand” specialist. He is not even registered as a “trauma” surgeon, but is registered as a GENERAL orthopedic surgeon.

Also, I  had  been scheduled to be reviewed/examined physically by the Medical Panel, on 16 August, just a week after the IME.

Questions

  • Why did my case manager send me to a physical IME? Considering that I was in any case certified unfit by the recent psychiatry IME for the foreseeable future.
  • The IME of 1 year ago, with no less than a BOWEL surgeon (I kid you not) detailed in his report that I had a catastrophic injury, a useless limb (this before the further deterioration) and had ‘no current work capacity” and – most importantly stated that “the worker needs to be sent to specialised knee surgeons for surgical opinions”
  • Why change the reasons for the IME like underwear? Why can’t they just be honest?
  • Why the need for an “objective assessment” of my knee after having personally spoken to my top knee specialist surgeon (who told me that this case manager had dared to challenge his opinion that a) I am totally unfit for work, b) I really need taxi transport and c) recent MRI’s objectively show the catastrophic damage/deterioration of my injury. How can they ask a general orthopedic surgeon- who is NOT specialised in knees- for an”objective assessment” of a highly specialised and advanced, very rare and devastating knee injury, in a young person,  that already required 9 operations and is deemed ‘at end stage’ (requiring prosthetic implant)
  • Why the need for an IME a week before a Medical Panel Examination (which overrules anything anyway).

Can anyone shed some light on this?

When I receive a copy of the IME report, I will share the real reasons for the IME (questions they asked) with you. I am curious!

Doctors refuse to treat WorkCover patients

More and more GPs and many specialist doctors refuse to treat workcover patients. 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.
GPs and specialists are frustrated with the bureaucracy, red-tape and drawn-out processes they encounter when dealing with WorkCover. GPs are not remunerated (read: Paid) for phone calls or for filling out lengthy forms and find the processes extremely convoluted.

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.

Also,  more and more Victorian surgeons are reportedly refusing to care for patients after initial injuries are treated at hospital emergency departments, leaving some patients unable to receive treatment for long-term complications.

It’s a common occurrence for  many workcover victims to be turned away for treatment or a medical assessment purely because they are  WorkCover claimants.

 

Real example:

My own specialist surgeon now also refuses to see/treat workcover patients. I am the only one left! He has made numerous comments about the ridiculous, unpaid amount of paperwork he has to deal with (in between his extremely busy theatre schedule – hey he is a trauma surgeon); he also states that very often he will encounter some really bizzare challenges, such as hearing is own expert opinion being challenged by some uneducated, non-medically trained case manager! In addition, he can easily see and treat 3 to 4 normal (private) patients in the same time as it takes to see/treat just one workcover patient, again because of the necessary paperwork, unpaid phone calls, repetitive reports etc.  He also finds it extremely frustrating that he has to wait for months before he can obtain approval for surgery for his patients, and that he has “to see them (their injury) deteriorate before his eyes and yet nothing can be done”.

He has – sadly- now also put a notice on his website that he does not see/treat workcover (and TAC) patients.

I have also tried desperately (upon medical advice) to seek a second opinion re the type of surgery proposed for my injury (after 9 failed operations) and was horrified to hear all of them (top specialists in the field) turn me away before I could even utter a word – because I am on workcover and doctor so and so’s policy is that he/she does not take on workcover cases.

This leaves us – workcover victims- most often with really bad (not reputable) specialists and it is no wonder that we suffer many complications and unsuccessful surgeries. This, of course, at Workcover’s ongoing cost…. who are too stupid to make a fundamental change to their policies to make life easier for those medical practitioners that still have a heart.

In a way I don’t blame those doctors for refusing to take us on (although it begs the question of how on earth they swore that they would heal the sick and injured, regardless of their race, religion, money etc). If you think of how much shit you (the victim) have to deal with on a daily basis, just multiply this by 30,40, 50 and that’s what the doctor needs to deal with, without receiving any compensation for it.

As an afterthought I think all people working for workcover should also be denied any (decent) medical treatment 😉

Doctors demand WorkCover review

Media Articles -Ann Bressington MLC

To my surgeon: thank you for putting up with WorkCover’s sh*t for so long, thank you for (still) treating me and for treating me like a human being. If it wasn’t for you, God knows where I’d stand by now…

To my case manager from hell: How dare you, pathetic, uneducated, bureaucratic, sad f***k , challenge the opinion of one of the best and most experienced surgeons in the state – on the phone! Get a life!

Workers’ Compensation and its Anti-therapeutic Effects

WorkCover loves to state that recovery from injury takes longer when compensation is involved and presents this as further evidence of an ‘incentives’ problem facing the scheme. Other studies report contrary findings (Gallagher et al 1995: 305)!

The WorkCover claim is quite misleading as it does not allow for other factors that can affect recovery and return to work prospects – it fails to compare like with like.   More particularly, it ignores the fact that workers’ compensation schemes can be highly adversarial, and glosses over the deleterious impact that an adversarial approach to injury management can have on workers’ recovery and return to work prospects.

The anti-therapeutic effects of workers’ compensation on injured workers have long been recognised in the international research literature.

Did you know

In Canada, delays in the handling of claims, excessive medical examinations and disbelief by claims managers of the validity of workers’ injuries have all been found to contribute to anti-therapeutic consequences (Ison 1994: 78-79).

This adversarial atmosphere in which workers are subjected to insensitive or uncaring treatment can lead to loss of self worth and depression, and is clearly counterproductive in terms of return to work outcomes (Lippel 1999: 542).

Similar effects have been reported for the United States.  One relatively recent study found that “many workers encountered suspicion, disbelief and sometimes surveillance by investigators.

Antagonistic relations with insurer claims representatives frequently involved delay or denial of benefits.  Many injured workers described the overall experience as demeaning and dehumanizing” (Strunin and Boden 2004: 338).

The fact that workers’ compensation schemes can be bad for your health has also been documented in Australia.

A Federal parliamentary report found that, a “slower than expected recovery is associated with the stress of the workers’ compensation system.  This frustration, bitterness and anger is due in part to workers feeling that insurers and providers show no real concern for the injured worker, and the belief that the worker is not being trusted by the employer” (House of Representatives Standing Committee on Employment and Workplace Relations 2003: 185).

A South Australian study of 85 long-term WorkCover claimants found that workers experienced a range of impediments in the “return to work process that created considerable stress and concern” (Roberts-Yates: 2003: 898).

The obstacles encountered included a claims management system that “is too rigidly process-oriented” and ignores individual differences in workers’ return to work needs (Ibid: 900).

A lack of trust in case managers, who were frequently “perceived as the principal trigger for conflict and heightened emotional responses”, was a related complaint (Ibid: 903).

Another fundamental concern was that case conferences frequently ignored the views and needs of injured workers.

As one worker summed it up “I just felt like a number with skin on” (Ibid: 900). Comments like this draw attention to the fact that injured workers are often regarded as little more than ‘claims’ by insurers, as opposed to employers who are typically regarded as ‘customers’.  It is also indicative of the old style insurance industry mentality that WorkCover still clings to and is underlined by its failure to appreciate the adverse impact that anti-therapeutic practices by workers’ compensation schemes can have on return to work rates.

This obsolete mentality is incompatible with the WorkCover legislation’s return to work philosophy and objectives; and must be addressed as a priority in any reform program concerned with improving the scheme’s return to work performance!

How to fill in your work injury claim form

If you have had an accident at work then you should make sure you follow some simple steps which will help make your personal injury claim a lot easier.

To begin with you should make sure you have reported your accident to someone within the company and then should have noted it down within the company’s book.

Although some people think it isn’t always important to note an accident at work it is no matter how small the injury should always be noted down and you should always alert the health and safety officer on site who will make a note.

Accessing and completing the claim form

A worker can access a Worker’s Injury Claim Form (Claim Form) from the following places:

·         their employer

·         the agent

·         an Australian post office or outlet

·         WorkSafe Advisory Service

·         a writeable PDF version of the Claim Form available on the WorkSafe website.

Where the worker chooses to access the writeable PDF version of the Claim Form they will have the choice to:

·         print the form off and complete it by hand by writing clearly with a pen

or

·         complete the form online before printing it off to sign the declaration.

The worker must sign the Authority to Release Medical Information and Declaration in the Claim Form for it to be considered valid.

What fields need particular attention

It is extremely important that you give as much information possible about the “injury/condition” you sustained.

For example: just writing “hurt my shoulder” whilst lifting a heavy box is not really sufficient, because later on, workcover may argue that any “additional/other injuries” you sustained (became aware of later) were not reported on the claim form and therefore they won’t accept liability. This becomes extremely important later on when you will claim impairment benefits under section 98C of the Act.

So it is best that you write as much information as possible about the ‘injury’; for example: “hurt my Right (or Left) shoulder and arm whilst lifting” – then add what exactly you felt, for example ” I felt a clunk in my right shoulder; I had pins and needles along the entire arm; my neck also hurts as well as the right side of my back…”. Here you have covered yourself for a potential injury to your shoulder,your arm, your neck, your back, a nerve.

Example of a “good injury claim form”

A fellow worker fell from a ladder at work and hurt his right shoulder. He wrote on the claim form that he had fallen off a ladder and landed on his right shoulder/right arm and felt pain in the right shoulder/right arm/right side of neck and right side of body. He not only had a fractured shoulder, but later on it was discovered that he also had a neck injury for which he had to have surgery. Whilst he only had a little bit of tenderness in the neck at the time of the incident (and nearly did not bother writing this on the claim form) he ended up with major surgery to the neck. Had he not mentioned the neck pain (however slight) workcover may have not admitted liability for his neck injury!

 

 

Medical and Like Services: Know your entitlements

Did you know that you are entitled to heaps of Medical and Like services under the workcover Act?

  • Acupuncture:

WorkSafe can pay the reasonable cost of acupuncture services at the request of a medical practitioner if those services are required as a result of a work-related injury or illness.

  • Aids and appliances

Workers are entitled to be compensated for the reasonable costs of personal and household services incurred because of the work place injury.

The definition of a personal or household service includes aids, appliances and apparatus.

To be eligible for reimbursement, these services are to be requested by a registered medical practitioner.

  • Attendant Care

The accident compensation legislation states that workers are eligible for reimbursement for ‘personal and household services’ and the definition of a personal or household service includes attendant care. The legislation also specifies that these services are required to be provided by a person who is approved by WorkSafe.

Attendant care is most often required:

to assist a severely injured worker who is dependent on assistance for aspects of movement, self-care, toileting and activity; to facilitate community access, assistance in social activities and vocational return to work; as part of a hospital discharge plan, which forms the basis of a structured holistic program.

Attendant care is provided to workers to assist with activities of daily living, including: personal care – showering, bathing, dressing, toileting, grooming, eating, drinking, preparation of specially prescribed foods, monitoring of medication, assistance with use of specialised equipment; program implementation – implementation of goal oriented programs, conduct of physical exercise, programs designed to increase skills of daily living; community access and recreation – providing 1:1 support for the attendance at and participation in events and activities;  respite – providing care for a worker to allow the family respite.

You can also request for friends or family members being paid to provide attendant care!!!

Will require medical evidence and support from the treating medical practitioner.

  • Burial/Cremation

WorkSafe can pay the reasonable costs for a burial or cremation incurred within Australia when a worker dies as a result of a work-related injury and there is an accepted WorkSafe claim for the death of the worker.

  • Car modification

WorkSafe can pay the reasonable costs of modifications to a car that are reasonably required as a result of a worker’s injury or illness to enable the worker to drive or to be transported safely (examples:non-functional arm: include a  spinner knob, t indicator extension, modified accessory controls; adjusted mirrors, seat belts, harnesses etc)

Where a worker’s car cannot be modified or the worker does not have access to a car, WorkSafe may contribute a reasonable amount to the purchase cost of a suitable car selected by WorkSafe.

  • Childcare services

WorkSafe can pay the reasonable cost of childcare services at the request of a medical practitioner if those services are required as a direct result of a work-related injury or illness and supported by an independent OT assessment as being necessary and appropriate.

For example, if  you are unable to provide childcare as a result of your injury or illness you can get child care services!

  • Chiropractic

WorkSafe considers chiropractic to be a primary contact service. A referral from a medical practitioner is therefore not required.

  • Community access

WorkSafe recognises that some eligible workers may acquire multiple physical, sensory and cognitive disabilities, which may impact on their ability to access and participate in their social and recreational activities.

Community access services are designed to assist eligible workers to increase their participation in the community by identifying and responding to their individual needs through Community Access Planning and Community Group Programs. These services may be provided to an eligible worker separately or in combination depending on the needs of the worker.

Community access planning is the services provided by a community access planner to an eligible injured worker which aims to: maintain and enhance peer support networks, and facilitate sharing of authorised support services; assess and review the support needed to enable a worker to participate in community bases social or recreational activities; link workers into community bases social or recreational activities; monitor a workers participation in community activities to ensure programs continue to appropriately address the workers needs.

Community group program is an individually tailored program of supported group activities which: is provided within community based facilities; is specifically designed for eligible workers who require support; to engage in social or recreational activities outside the home; supports the development of peer support networks, community living and social skills.

A referral is required from a medical practitioner for the provision of any approved health service with the exception of medical, physiotherapy, osteopathic, chiropractic, optometry, dental and podiatry services.

  • Dental services

WorkSafe can pay the reasonable costs of dental services (including oral and maxillofacial surgery) as a result of a work related injury or illness.

Note: Prior approval is not required for emergency dental treatment requests relating to a work-related injury or illness.

  • Dietetic services

WorkSafe can pay the reasonable cost of dietetic services at the request of a medical practitioner if those services are required as a direct result of a work-related injury or illness.

Note: WorkSafe will not pay for weight loss programs or food/meal replacement services, for example home delivered meal services such as Lite n’ easy or weight loss programs such as Weight Watchers or Jenny Craig.

  • Elective surgery

Elective surgery is clinically necessary, non-emergency surgical treatment (including surgical procedures) performed by a suitably qualified medical practitioner.

Prior written approval from the agent is required for elective surgery. You can have your surgery in a private hospital.

Note: Worksafe will not pay for services provided outside of Australia without prior approval from the agent

  • Equipment and related services

WorkSafe can pay the reasonable costs of equipment and related services to assist a worker in the rehabilitation of a work-related injury or illness, or whose work-related injury or illness has caused impaired function in any of the worker’s activities of daily living.

To consider paying for aids and appliances, WorkSafe requires the following information:

·         A current referral from a medical practitioner for any equipment and related services.  To assess a worker’s eligibility for equipment, WorkSafe also requires a written recommendation from the worker’s treating therapist or relevant healthcare provider

·         For wheelchairs, pressure cushions, beds, mattresses, powered conversion kits, scooters, standing frames, lounge chairs, customised toilet/commode/shower chairs or hoists, an Equipment Prescription Form must be completed by the prescribing therapist and submitted to the Agent.

WorkSafe can pay the reasonable costs of equipment and related services that are reasonable and/or necessary for the worker’s work-related injury or illness.

WorkSafe will take into account whether the equipment and related services will:

·         increase independence

·         facilitate a return to vocational, educational or leisure activities

·         improve mobility

·         relieve pain/discomfort

·         ensure a safe environment

·         aid communication/swallowing management.

Examples: taping – zinc oxide, fixomull, strapping, etc; bandages – compression, tubigrip, thera-band, gauze products; oedema control and dressing bandage;  thermal supports, pressure garments and gloves; soft collars; hand putty/thera-putty digiflex, exercise foam; walking sticks, triangular slings; plaster, ice packs, heat packs; hibitane, iso-wipes, skin-prep, applicators; adaptive cutlery; dressings aids (example, long handled sponge/shoe horn, toe wiper, sock aids, button hooks, elastic shoe laces); pick up sticks.

  • Exercise physiology

In order for WorkSafe to consider payment of the reasonable costs of exercise physiology the medical practitioner referral must be provided to the agent by the worker or healthcare provider.

  • External case management

External case management is a collaborative process with may include an assessment, planning, facilitation and advocacy for options and services to meet an individual’s health needs through communication and the utilisation of available resources to promote quality cost effective outcomes.

WorkSafe recognises that some eligible workers at certain times require assistance beyond the case management role of an agent or the role of treating health care providers. Case management services are a time-limited service that complements the agent’s role.

A referral is required from a medical practitioner for the provision of any approved health service with the exception of medical, physiotherapy, osteopathic, chiropractic, optometry, dental and podiatry services.

  • Gym and swimming programs

WorkSafe can pay the reasonable costs of a gym and/or swimming program at the request of a medical practitioner if those services are required as a result of a work-related injury or illness and to transition to a self-managed exercise program.

Written approval from the agent is required for a gym or swim program.

Example: You have injured your knee – you are allowed to attend gym to strengthen your upper body (arms etc)!!!

  • Hearing services and devices

WorkSafe can pay the reasonable costs of approved hearing services and devices provided by WorkSafe approved hearing service providers to assist workers in the rehabilitation of work-related injuries or illness under s99 of the Accident Compensation Act 1985.

  • Home modification

WorkSafe can pay the reasonable costs of modifications to a home in which a worker resides in Australia, where the modifications are reasonably required as a result of a work-related injury or illness and will impact on a worker’s access to and function within the home.

If a worker’s home cannot be reasonably modified for any reason, WorkSafe may contribute a reasonable amount to the purchase cost of a semi-detached portable unit or to the costs of relocating the worker to another home that is suitable for the worker or is capable of being reasonably modified.

Major Home modifications include: Any modification/contribution made by the agent for an amount greater than $10,000 where structural changes are necessary (eg moving internal walls or enlarging existing rooms) and/or extensive modifications in and around the house eg ramps, carports, bathroom and/or bedroom.

Minor Home modifications cost less than $10000 and include things like holding bars for the bath, different locks on doors; holding bar for toilet; rails etc.

Requests for home modifications can be initiated by any party, worker, family, medical and health practitioners, hospital but the actual home modification recommendations must be submitted by an Occupational Therapist (OT).

  • Household help

Household help refers to the provision of services for basic and routine common housework and gardening tasks that the worker performed pre-injury and are essential for maintaining the worker in the home.This also applies to injured workers who are living with a partner/spouse.

A referral is required from the worker’s treating medical practitioner. The treating medical practitioner must provide supporting evidence.

Note: WorkSafe will not pay for: the cost of cleaning materials;  food items; standard housework or household appliances; self care tasks including bathing, dressing or personal grooming; pet care; support of hobbies or personal lifestyle interests. For example: hobby farm, animal breeding or showing;  car care; home or furniture maintenance including window washing, cleaning or drapes blinds or carpets; home modifications including painting, renovation or modification; property maintenance or repair including painting, watering gardens, gutter cleaning or maintaining paving;  the cost of garden implements unless recommended by an OT as modification or assistive equipment for the  worker;  raw materials. For example: plants or mulch; fees for rubbish or grass removal.

  • Implantable pain therapy

Implantable Pain Therapy (IPT) is a procedure involving the use of an implantable device to address persistent pain and may be considered when a range of alternatives for managing persistent pain have been fully explored.

Implantable pain therapy incorporates:

·         intrathecal morphine infusion and other analgesic infusions (also known as intraspinal pumps)

·         neurostimulation techniques such as:

·         spinal cord stimulation

·         subcutaneous electrical stimulation

·         peripheral nerve stimulation

·         deep brain stimulation

·         motor cortex stimulation

·         other implanted neurostimulation devices for pain.

  • Medical practitioner services

The Act includes in the definition of a ‘medical service’, attendance, examination or treatment of any kind by a registered medical practitioner.

Note: WorkSafe does not consider it a reasonable cost to pay for the following:

·         letters of advice

·         the issue of repeat prescriptions when the patient is not in attendance

·         post mortem examinations

·         issuing of death certificate.

WorkSafe will not pay medical practitioners for telephone consultations, either to the worker or other related parties such as the agent, employer or occupational rehabilitation provider.Which I think is disgusting!

  • Independent medical examinations

Read more about workcover IME in our previous posts (just enter the word IME in the search box)

  • MRI

WorkSafe will pay the reasonable cost of an MRI service in accordance with the WorkSafe fee schedule for a worker where the service is:

·         required as a result of a work related illness or injury

·         referred by a registered consultant physician or specialist

Read more about MRI’s under workers compensation here

  • Loss and grief counselling

WorkSafe can pay the reasonable cost of loss and grief counseling services at the request of a medical practitioner if those services are required as a result of a work-related injury or illness.

Note: WorkSafe will only pay for the reasonable costs of family counselling services that are incurred in Australia, provided by a medical practitioner, registered psychologist or social worker approved by WorkSafe and provided to families of workers who have:  died as a result of an injury or suffered a severe injury.

  • Naturopathy

WorkSafe can pay the reasonable cost of naturopathy services at the request of a medical practitioner if those services are required as a result of a work-related injury or illness.

  • Nursing

WorkSafe can pay the reasonable cost of nursing services at the request of a medical practitioner if those services are required as a result of a work-related injury or illness.

Nursing services are services rendered by a registered nurse, other than at a hospital or as a member of the nursing staff of a hospital.

  • Occupational rehabilitation including training courses & ergonomic equipment

Occupational rehabilitation (OR) services are offered to a worker with a current work capacity (CWC) or a potential CWC to assist them to RTW.

Workers are entitled to receive an OR service from an approved OR provider of their choice from a list of at least 3 OR providers.

There are different types of Occupational rehabilitation services: RTW with same employer; RTW with new employer. See the online’s claims manual for more information (under “return to work”section).

  • Occupational physiotherapy

Occupational physiotherapists are physiotherapists with specific skills and experience in treating clients/workers and can help facilitate early rehabilitation and safe and sustainable return to work. Occupational physiotherapists collaborate with the client/worker, their employer, medical practitioner and other health providers. This includes conducting worksite visits, developing and implementing return to work programs and writing certificates of capacity.

  • Optometry

WorkSafe considers optometry to be a primary contact service.

A referral from a medical practitioner is therefore not required for the provision of optometry services.

A referral is required from a medical practitioner for provision of any approved health service with the exception of medical, physiotherapy, osteopathic, chiropractic, optometry, dental and podiatry services.

  • Osteopathy

WorkSafe considers osteopathy to be a primary contact service. Therefore a referral from a medical practitioner is not required.

  • Pain management programs

WorkSafe can pay the reasonable costs of Pain Management and Network PM Programs to assist workers in their rehabilitation of a work-related injury or illness.

Pain Management and Network PM Programs are multidisciplinary interventions which are designed to assist workers with musculoskeletal injuries and persistent pain to manage their condition and reduce the disability associated with their pain.

Pain Management and Network Pain Management Programs also aim to assist workers who are having difficulties: managing their injuries and participating in functional activities at home, work or in the community due to their pain or reducing their dependency on medications and allied health treatment due to their persistent pain.

A written referral from a medical practitioner can be sent directly to a Pain Management or Network PM Programs provider.  The agent will then consider the request for a PM or Network PM Programs assessment

  • Pharmacy

WorkSafe will not pay for medications and pharmacy items that:

·         do not relate to a work related injury or illness

·         are not provided on the request of a registered medical practitioner or registered dentist

·         are not provided by a registered pharmacist

·         are not provided at a reasonable cost

·         are prescribed as part of a clinical trial

·         were required prior to the worker-related injury or illness

·         are not invoiced according to WorkSafe minimum invoicing requirements

·         are not registered on the ARTG (except glucosamine).

Read more about medication entitlements under workcover in our previous post

  • Physiotherapy

WorkSafe considers physiotherapy to be a primary contact service. A referral from a medical practitioner is therefore not required for the physiotherapy services.

WorkSafe will also consider the reasonable cost of Gym and swimming program.

  • Podiatry

WorkSafe considers podiatry to be a primary contact service.

A referral from a medical practitioner is therefore not required for the provision of podiatry services.

  • Private hospitals

WorkSafe can pay the reasonable costs of private hospital services required as a result of a work related injury or illness.

Written approval is required from the agent prior to the provision of the service.

Note: Prior approval is not required for requests relating to emergency psychiatric inpatient treatment. If a hospital seeks prior approval, this must not be delayed.

A private hospital is a private hospital:

·         within the meaning of the Health Services Act 1988 or section 178 of the Health Act 1958

·         within the meaning of a law of another State or of a Territory

or

·         outside Australia if approved by WorkSafe.

A private hospital service means the provision by a private hospital of:

·         maintenance, attendance and treatment

·         nursing care and treatment

·         medicines, medical, surgical and other curative materials, appliances or apparatus

·         any other usual or necessary services provided by a hospital with respect to the treatment of the injury or illness of a worker.

  • Psychology

WorkSafe considers psychology to be a referral service. A referral from a medical practitioner must therefore be provided prior to commencement of psychology services.

  • Remedial massage

WorkSafe can pay the reasonable cost of remedial massage services at the request of a medical practitioner if those services are required as a result of a work-related injury or illness.

Remedial massage is defined as the application of manual massage techniques to treat musculoskeletal disorders or dysfunctions in a systematic way. Remedial massage is designed to improve the function of the injured worker in the rehabilitation process and achieve progress in return to work outcomes.

  • Removalist costs

WorkSafe can pay the reasonable cost of removalist services at the request of a medical practitioner if the worker is required to move as a direct result of a work-related injury or illness.

In order for WorkSafe to consider payment of the reasonable costs of removalist services the agent must be provided with the following information:

·  a current referral from a medical practitioner

·  at least two from quotes from removalist companies.

  • Respite care

Respite care services are services provided to assist workers with a work-related injury or illness who are being cared for at their place of residence (eg by family or household members) by giving workers and carers a short term break from their regular support routine. Respite care can be provided within a worker’s place of residence (e.g. by an attendant carer) or externally (e.g. accommodation facility such as an aged care facility, supported residential services, shared community housing, or a day program).

Respite care services are intended to assist the continuation of the primary informal support relationship between a carer and an injured worker whilst giving both the opportunity to rest and have a break.

To be eligible for consideration of respite care services, a worker as a result of their injury or illness must:

·  have substantial physical, psychological, cognitive or sensory disability which was sustained as a result of a work related injury or illness

·  require a significant level of ongoing daily/personal support (For example: hygiene, mobility, supervision etc)

·  have a family or household member who provides to the worker a significant level of ongoing daily/personal support

·  have been assessed by an occupational therapist and/or multi-disciplinary team, as requiring respite care.

A referral is required from a medical practitioner.

  • Social work

WorkSafe can pay the reasonable cost of social work services at the request of a medical practitioner if those services are required as a result of a work-related injury or illness.

WorkSafe considers social work to be referred service. A worker can access a referred service with a medical practitioner referral.

  • Speech pathology

WorkSafe can pay the reasonable cost of speech pathology services at the request of a medical practitioner if those services are required as a result of a work-related injury or illness.

WorkSafe considers speech pathology to be a referred service. A worker can access a referred service with a medical practitioner referral.

  • Travel expenses

WorkSafe can reimburse reasonable travel expenses incurred by a worker to attend medical and hospital services (this also includes physio, psychologist etc) required as a result of a work-related injury or illness in accordance with s99 of the Act. Travel and associated expenses incurred to attend an independent medical examination, impairment assessment or Medical Panel assessment can also be reimbursed as well as Conciliation (ACCS).

Requests for reimbursement must be submitted within six months of the date of travel.

Taxi travel is also possible, I will discuss this in a later post.

Helpful-Tips-workcover

Independent psychiatric examination (IME psychiatry): don’t get fooled

When can workcover send you to an Independent Psychiatric medical examinations (IME)

According to the Claims Manual, (under the ‘claims Management Segments) an s112 examination,aka an independent medical examination (IME) conducted by an IME psychiatrist may be appropriate only in the following circumstances:

  • the case manager, in consultation with the technical manager is not confident that the advice (from the IMA or Medical Advisor provides sufficient evidence (from the treating practitioner, worker and employer) to establish the diagnosis and/or casual relationship or
  •  the information (from the treating practitioner, worker and employer) is conflicting or inconsistent.

Whilst the Act clearly states that workcover (your case manager) should seek answers to her/his questions first via discussion with your treating GP, psychologist or psychiatrist, they will inevitably try to send you to an IME psychiatry as often as possible (i.e. every 6 months) in the hope to find a loophole.

Continue Reading…

My workcover case manager is making me sick

A few days ago, I posted “can I put a restraining order on my case manager“, and while the answer is YES, it doesn’t mean that your horrible workcover case manager will refrain from harassing and bullying you in a different way. In my case, we successfully put a “restraining order” on my case manager about 12 months ago – she was not allowed to contact me directly and all correspondence was to go through my solicitor and/or medical practitioner and direct contact with me was prohibited unless prior approval was granted.

Well, what can I say… Whilst this nutter of a workcover case manager ceased to phone me (up to 10 times per day), she soon found another way to make me sick by emailing me  constantly and several times per day on my personal email address. This in-spite of having emailed her personally that she was not to contact me via email (all contact was to be via letter) and that all her emails would be deleted unread.

In a way it’s good she persisted on emailing, because the contents of her emails can now be used as evidence of her disrespectful, uncooperative, dishonest, incompetent, harassing, demeaning and obstructive behaviour. On the other hand she is making me sick and I start feeling nauseated just opening my personal email inbox.

Some specific examples of my case manager’s emails

  • attempting to cease my psychology entitlements whilst I just had been referred to a psychiatrist (by my psychologist) for severe depression after I had been illegally sacked by my employer
  • stating that “I did not need to see a psychologist or psychiatrist because I could talk to her (WTF!)
  • ignoring the ACCS ruling entitling me to have as many psychology sessions as required (as per the Act) and in fact refusing to pay a psychology bill of over $700 (when confronted by the ACCS she stated that it ‘had been an oversight’
  • sending me to a vocational assessment whilst certified unfit for all work by my GP, psychologist, orthopedic Surgeon, Psychiatrist and independent psychiatrist
  • not providing me with a list of three choice service providers for occupational rehabilitation and making a direct appointment with her provider of choice
  • overriding a previously approved special orthopedic brace – i.e. we received approval for a brace requested by my treating orthopedic surgeon, purchased it (very expensive) and then one month later received a letter that the brace was not approved – again when confronted my case manager simply said that ‘it was an oversight’
  • ceasing my physiotherapy entitlements ‘because I am not improving” and failing to realise that when you cease physio on a severely damaged joint, the remaining muscles and tendons will also start deteriorating – which happened to me (for which I now have to undergo major surgery number 7).
  • making me wait 28 days to write a 2 line approval letter to the radiology facility where I was to undergo an MRI (the radiology facility insisted on having an approval letter),whilst 1) the request for the MRI came from my treating specialist (no prior approval is needed for an MRI in that case) and 2) my GP had sent an urgent fax as a follow-up requesting PROMPT approval for the MRI as I was in a very bad shape
  • when she was told that my injury had significantly deteriorated (MRI,report from surgeon and request for major surgery-approved by her!) she stated that “she was not interested in my physical condition, but only my psychiatric condition”
  • my case manager – whilst aware of the severe deterioration of my injury (request for major surgery etc) sent me to a shrink for an independent assessment because she needed to assess ‘my ability to engage in rehab and return to work…’ (WTF?)
  • my GP requested taxi transport as well as  my orthopedic surgeon but whilst my case manager allowed 1 taxi travel (to an IME) she stated that I should not assume that this (taxi transport) would be ongoing…. as she first had to have me assessed psychiatrically and physically before making the decision whether or not I would be allowed to travel by taxi. WTF – given that she had spoken to my orthopedic surgeon and has all the clinical evidence on file, including recent MRIs, emergency x-rays, requests for major surgery and the explanation from my surgeon on what was going on with my injury
  • why did I not tell her on the day that I had to go to the emergency department with a dislocated joint that I was going to the emergency department – WTF
  • sending me to a physical IME because she needs an “objective assessment of my injury” (of course by an IME who has no expertise in the field of this type of injury) after ‘having spoken to my orthopedic super specialist”… Can you make sense of that?
  • stating that there ‘is no reason why I could not drive my car’, whilst she had just received the emergency department x-rays (showing dislocated joint), MRI results and requests for major surgery… WTF?

Anyway, there are lots more examples… but just recalling them makes me fully sick. Is your workcover case manager also treating you like a criminal or a piece of s**t?

I have now instructed my solicitor to ‘deal with her’ and have her immediately replaced, for I will not tolerate this kind of treatment any longer. Life is hard enough as it is at the moment and I don’t see why I should be constantly insulted on top of it all.

[dictated post – apologies for spelling mistakes ]

Independent Medical Examinations (IME) under WorkCover

About Independent Medical Examinations (IME)

Independent medical examinations are arranged primarily to determine whether a worker is entitled to compensation, or if the worker has a continuing entitlement to compensation. So, it’s not about you or your health, but about cutting off any benefits such as your weekly payments, ceasing your physiotherapy, psychology entitlements, or simply to find a loophole in the most corrupt system to get some IME to certify you fit -even if your own medical treaters, even super specialist deem you unfit for all work.

read more about IME’s in the Claims Manual

 

When can WorkCover send you to an Independent Medical Examination?

When should the Agent send you to an IME

“When assessing whether a (s112) IME examination is necessary, the agent should consider that the examination will:

  • strategically contribute to the management of the worker’s claim, and/or enhance RTW opportunities by addressing specific identified medical and/or treatment issues, and/or identify future medical/treatment management needs
  • provide required specialist advice not previously held or available via alternative sources, including the worker’s treating practitioner or specialist “

(Extract from the online Claim’s manual)

Note the word ‘strategically‘ … this simply means that the workcover agent  (your case manager) is (getting) desperate with all the overwhelming evidence (in your favour) and is in panic mode to send you to an (often inapproriate) IME to find a way to cut off your benefits and/ or to have you certified fit.

Interestingly the Claims Manual also states that your case manager should consider an IME when the IME will provide “required specialist advice not previously held or available via alternative sources, including the worker’s treating practitioner or specialist”.

In  2009, the revised Guidelines state that referral for an independent medical examination is only appropriate when information from the treating medical practitioner(s) is inadequate, unavailable or inconsistent and where the referrer has been unable to resolve the issues related to the problem directly with the practitioner(s).
If an injured worker submits a report from an assessor of permanent impairment regardless of whether they are the worker’s treating medical practitioner and questions regarding that assessment arise, they are to be posed to the assessor in the first instance. If the response from the assessor is inadequate, unavailable, inconsistent or not received within 10 working days, a referral to an independent medical examiner may proceed.

The Act also states that the IME needs to be specialised in the field of the worker’s injury (i.e. for a hand injury a hand surgeon).

Why are they sending me to an IME?

I find it extremely disturbing that (my) case manager only sends me to an IME,when she (as an uneducated, non-medically trained clerk really) is cornered by overwhelming evidence from my own treaters, and needs a way out!

Can you explain why case managers usually send you to IME’s that:

  • have nothing to do/are not specialised in the field/area of your injury
  • have far less experience in the type of your injury than your own (super)specialist

In my case for example, I have a purely and very specialized orthopedic injury which a general orthpedic surgeon is unable to treat (they referred me to a super specialist centre). So, why do you think that my case manager NEVER sends me to a super-specialist in the field, not even a general orthopedic surgeon, BUT to a general surgeon? General surgeons deal with guts! (i.e. bowel, gall bladder, appendix and things like warts).

What do they hope to gain by sending me to a general surgeon who has no clue about my injury?

On more than one occasion a very old (more than 75 years) ‘general surgeon’ told me that ‘he had never heard about the particular grafting methods used in my injury’ and ‘could not understand the relationship between my limb number 1 and my limb number 2- whilst I had tendons removed from limb number 1 to transplant in limb number 2. This is frightening and yet these people have to write a report about you and decide whether or not you are fit for work, you can or can’t do certain work, if the treatment you are receiving is appropriate and if they can cut off some benefits and entitlements.

On another occasion I received an email from my nasty case manager to say that she ‘…was not interested in my physical condition…’ after I had told her that my injury had taken a turn for the worst and after my super specialist had requested approval for major surgery.

She knew for a fact that I was unfit for all work from a physical perspective yet decided to send me to a psychiatrist ‘to assess my return to work and engagement in rehabilitation” DUH???? Assume I was certified fit for work from a psychiatric side, what f*** difference would it make, given that I am unfit for all work from a physical side?

More recently I was told by my case manager that I was to attend an physical IME. When I asked her why she simply stated that it had been 1 year since my last physical IME (with the bowel doctor). This is obviously not a sufficient reason.

I asked my super specialist (surgeon) to personally speak to my case manager to discuss with her any questions she may have and to ensure that she knew that I am currently unfit for all work, and that I need home help and taxi transport. He explained to her in what way the injury had further deteriorated and that my condition was very serious.

Right…

Next thing (2 days later) I hear (apart my super specialist telling me that he spoke with my case manager whom he said was a ‘nutter’ and ‘quite something’) from my case manager that I need to attend an urgent physical IME with a general orthopedic surgeon. She is still unable to give me a (valid) reason as why I need to attend and what it is she hopes to gain out of an assessment by a doctor who is not specialised in the type of injury I have.

I can only assume (again) that my case manager is not happy about my deteriorating condition and inability to work and hopes that a non-specialist might have the corrupt or bribed conscious to state that I am fit for work/some type of work, so that she can cut off some or all of my benefits.

Ironically there has been no need to send me to an IME  for a period of 5 years, in-spite of having deteriorated so badly that I have had to undergo 6 major operations to this injury. No-one questioned this, nor if I was safe and in a ‘suitable work environment’… I mean how do you explain 6 operations in 4 years? Well the reason it was not deemed necessary to send me to an IME was of course that I continued to work in between those surgeries…

I would love to hear your thoughts about the so called IME’s!

Medication entitlements under work cover

What medication is covered by workcover

WorkCover will pay the reasonable costs of medication prescribed by a doctor to treat your work injury or illness.

WorkCover will also reimburse over-the-counter medications (eg, paracetamol for pain relief) and other non-medication items (eg, bandages for wounds) that have been recommended by a medical expert to help you recover from your work injury or illness. (Note, a medical expert is a doctor, dentist, psychologist, optician, physiotherapist, chiropractor, podiatrist, occupational therapist, speech pathologist or osteopath.)

Did you know?

Many pharmacies will allow you to “bulk bill” your medications – that is you won’t have to pay for them upfront as the pharmacy will directly bill the workcover insurance!

Stop paying for your medications (it all adds up quickly) and stop waiting for the reimbursement of medications you purchased (it often takes yonks to be reimbursed!)

What pharmacy items does WorkCover  not  pay for?

WorkCover does not pay for pharmacy items that:

  • your doctor did not prescribe  (in the case of prescription medicines)
  • your doctor  or  other medical expert (such as your physiotherapist) did not recommend (in the case of nonprescription items). This sadly means that you also need an approval to buy some bandaids!
  • you  take f or injuries/illnesses not related to your work injury/illness
  • those prescribed as part of a clinical trial.
  • WorkCover will also not pay for pharmacy items where proof of purchase and other relevant details are not supplied – hence you’re far better off having your pharmacist bill workcover directly for all medications!

If your case manager (who is NOT a medically trained person) is unsure whether an item you are claiming can be reimbursed, they will ask you or your practitioner for further information if you are lucky. Usually you will just get some nasty little letter saying that medication A is not appropriate for your condition and will not be paid for.

True example:

I had been diagnosed with severe CRPS (Chronic Regional Pain Syndrome) of a limb (in addition to a severe injury to that limb). My pain specialist (read: an anesthetist who is specialised in the management and treatment of pain) prescribed an antidepressant as part of the medication for my CRPS. Well this (very uneducated) case manager sent me several letters stating that antidepressant X was not appropriate and had nothing to do with pain control. Yeah right… Here we go again… Many antidepressants are used effectively for the purpose of pain management/control. I.e some nerve injuries respond very well to antidepressants, as does CRPS and certain types of arthritis.

If the case manager finds the items are for your work injury they will reimburse the cost (which often takes long) however if they are not for your work injury they will not reimburse the cost. Please note, if you do not agree with the decision you are entitled to challenge it.

Am I entitled to reimbursement of nonPBS (private prescription) medications?

Yes. Your doctor should be prescribing PBS medications when clinically appropriate for treating your injury, but some medications are not in the PBS schedule or are eligible for the PBS subsidy for certain conditions only. In this case your doctor will write a private patient prescription and WorkCover will reimburse you the full cost of your medicine.

If however, a medication is available on the PBS and does meet the indications listed in the PBS schedule, and your doctor has written a private prescription without apparent reason, your case manager SHOULD ask you to get a PBS prescription from your doctor if further doses of this medication are required – and not simply REF– USE to pay for that prescription.

True example:

My medical practitioner had been prescribing Endone (Morphine) for several months on a private prescription. After about 6 months, I suddenly was told by my frustrated pharmacist that “they” (workcover) sent him a letter (of which I of course never got a copy,nor my prescriber) stating that the Endone would no longer be paid for as it had to be prescribed on PBS. How am I supposed to know this? In any case I was left high and dry for it was Friday afternoon when I ran out of my Endone and needed an urgent refill… I was not allowed to get the precription filled and was sent home for -what became a terrible- long weekend without any morphine tablets. Thank you very much again for making me suffer even more ):

Can I substitute my prescribed medication for another brand?

Yes you can!

How am I reimbursed for pharmacy items?

If you pay for pharmacy items yourself you must submit a completed Pharmacy items reimbursement form (a receipt that you get from your pharmacist) as soon as possible to your case manager and attach itemised receipts.

You are required to sign this form to verify the pharmacy item is related to your work injury or illness. Your case manager can give you copies of the reimbursement form or you can download it from www.workcover.com.

Case managers can make allowances for workers seeking reimbursement for pharmacy items at the beginning of a claim without having  a completed Pharmacy items reimbursement form.

You must attach each receipt to the reimbursement form.  The receipt must list:

  • date and place of purchase
  • item(s)  name
  • quantity,  strength
  • cost.

WorkCover will accept handwritten receipts from the pharmacy if the pharmacy cannot provide you with a cash register receipt.

If details are missing from the receipt or the reimbursement form, your case manager may ask you for additional information before reimbursing you if you are lucky – usually they will just NOT reimburse you.

Note:

You do not need to submit a Pharmacy items reimbursement form for hospital-related items (as from the Hospital pharmacy). Simply send the hospital pharmacy’s statement they provide you to your case manager.

Do I have to pay for the pharmacy items up front?

As mentioned earlier many pharmacies will happily create an account for workers and directly invoice the case manager, which means you do not have to pay for the cost of the items upfront. In this case, you do not need to submit a Pharmacy item reimbursement form but you may still receive so-called “enquiries” (to put it gently) from your case manager if they are unsure an item is related to your work injury.

You are far better of to set up an account at your pharmacy, so you don’t have to pay for medication. It all adds up very quickly and,if you’ve been incapacitated for a while,you will soon realise how poor you are and counting pennies is the only way to survive.