Archive by Author

Do I have to attend an Independent Medical Examination with the doctor chosen by work cover?

A few months ago, I was asked by my case manager to attend yet again an independent medical examination (IME), with the same doctor I had seen 6 months before.

My experience with this “independent doctor” was so traumatic that I refused to be examined again by the same doctor. There was no way on earth I would ever go to this independent doctor ever again.

Being fearful of loosing my weekly earnings (read: being well aware that if you do not attend an IME your weekly payments may be suspended or ceased), I decided to consult my lawyer on this rather delicate matter.

Well, I am very pleased to let you know that we (my lawyer) were successful! I did not have to see that same, rotten (excuse my language) independent doctor but was given permission to attend the IME with another doctor (specialised in the same area). Oh boy, what a difference this made 😉

Keep this in mind if they send you to some previously seen horrible jerk of an ‘independent medical doctor)!

Got any tips and tricks? Please share them with your fellow workcover victims – and let’s try to make our lives a little bit better!

 

 

Request for MRI under workers compensation

What is a Magnetic Resonance Imaging (MRI)?

Magnetic Resonance Imaging (MRI) is a radiological investigation to create cross- sectional images of the body.  These detailed clear images are used by medical practitioners to diagnose and investigate a range of conditions.

An MRI service requires a referral and consists of imaging, reading and providing a written report by a radiologist.

 

Referral for an MRI from a surgeon, registered consultant physician or specialist

If your surgeon, consultant or specialists refers you for an MRI, you do not need prior approval from work cover (your case manager) for the MRI.

However, some Radiology facilities (i.e. Olympic Park Imaging) will require an approval letter from workcover for any MRI, even if it has been prescribed by your surgeon or specialist.

In this case, simply ask your work cover case manager to write you a letter addressed to the Radiology facility, stating that the MRI has been approved and will be paid for by work cover. Your case manager should be able to do this immediately. However, make sure you tell (or write/email) your case manager in “child language” what it is you are after (because they don’t understand plain English!)

Example (true story):

My surgeon referred me for an MRI. I sent the MRI request form (from my surgeon) through to my case manager and asked her for a letter of approval stating that the radiology department had requested one and will not undertake any MRIs without a letter from work cover, detailing that the MRI has been approved and will be paid for. After a few days I did not hear back from my case manager. My GP, whom I happened to visit a few days later, wrote a letter to my case manager, stating that my surgeon had requested an MRI and could she please ensure prompt approval as I was in great pain. This letter was faxed to my case manager, again with the request to provide me with a simple letter for the radiology department. Well, about 3 weeks (!!!) later I contacted my case manager and her Team Leader and told them that I was still waiting for that letter for the radiology department. They told me that the request for the MRI needed to be reviewed by their in-house doctor before making a decision whether or not they would approve the MRI  (- which was requested by my surgeon, and made urgent by my GP-). A few days later (we’re now waiting 25 days) my GP tells me he had been contacted by the work cover insurance ‘house doctor’ to discuss the need for the MRI!

28 Days after having sent the urgent referral from my treating surgeon to my case manager, I finally obtained that 2 line letter for the radiology clinic, stating that the MRI had been approved and would be paid for by work cover.

My case manager insisted she had 28 days time… in-spite of me writing to her that I would hold her personally liable for any additional damage I would sustain and that I would rely on our correspondence in a court of law.

NO- she did not!!! An MRI requested by a surgeon does NOT need prior approval ! Needless to say how frustrated we (me and my surgeon) were. Imagine, you are in f***** agony, have done some serious damage to a body part, your treating surgeon and your GP feel that you need an urgent MRI, and they make you wait (inappropriately) for nearly 1 month before writing a 2-line letter! WTF!

What is wrong with these people? Are they illiterate? Are they just trying to wear you down until you give up? Or are they plain stupid?

Extract of WorkSafe’s policy regarding MRI’s

Is prior approval required for an MRI service? An injured worker may be referred for an MRI service by a consultant physician or specialist recognised for this purpose by the Commonwealth Health Insurance Act (1973). In these cases prior approval from a WorkSafe Agent is not required. It is recommended that the referring consultant physician or specialist contact the WorkSafe Agent to confirm that their patient has an accepted claim and that the region to be scanned correlates with the region of the accepted injury.

Read WorkSafe’s Policy here

Request for an MRI by your treating GP

WorkSafe will consider a request for an MRI service by a treating medical practitioner other than a consultant physician or specialist, where access to consultant physicians or specialists is limited and provision of the service would be expedited by a referral from the treating medical practitioner.  In these cases prior approval by the WorkSafe Agent is required.  The treating medical practitioner should provide a written request that includes a working diagnosis, an outline of examination findings and a clinical rationale for the MRI service.  A medical practitioner at the WorkSafe Agent will review these requests on a case by case basis.

I would love to hear about your stories!

 

 

Funny and weird work injury claims

We surfed the web and found some rather bizarre and funny work cover injury claims. Have a laugh!

[sws_blockquote align=”left” alignment=”alignleft” cite=”” quotestyles=”style01″] I got my right hand first finger in the saw while helping Mike and staying out of his way. My finger bled and it affected my mind. [/sws_blockquote]

[sws_blockquote align=”left” alignment=”alignleft” cite=”” quotestyles=”style06″]Hot grease splashed on me and fried my thumb. [/sws_blockquote]

[sws_blockquote align=”left” alignment=”alignleft” cite=”” quotestyles=”style01″]My head injuries have created a permanent increase in libido which has led to two affairs and has ruined my marriage. [/sws_blockquote]

[sws_blockquote align=”left” alignment=”alignleft” cite=”” quotestyles=”style06″]I chipped my tooth on a cookie while visiting a customer. [/sws_blockquote]

[sws_blockquote align=”left” alignment=”alignleft” cite=”” quotestyles=”style01″]While on duty, I was hit in the face by a hand. My glasses were broke and something hit my eye. No one believes I was hit but it hurt!  [/sws_blockquote]

[sws_blockquote align=”left” alignment=”alignleft” cite=”” quotestyles=”style06″]Carrying roll roofing, I caught my toe on a piece of tin that was froze in the ground. The tin flipped against me causing me to trip, letting the roofing fall into the bucket of tar. Tar splashed out, burning my arm, and causing me to jump back into the ladder which fell against me, knocking me into the building, breaking my tooth. Thus I burned, bumped, and broke me. [/sws_blockquote]

[sws_blockquote align=”left” alignment=”alignleft” cite=”” quotestyles=”style01″]The guy I work with went ape s4%t. He hauled off and punched me in the jaw and then tried to rip my throat out. [/sws_blockquote]

[sws_blockquote align=”left” alignment=”alignleft” cite=”” quotestyles=”style06″]The fumes were so bad I was taken by them and went to bed with the doctor. [/sws_blockquote]

[sws_blockquote align=”left” alignment=”alignleft” cite=”” quotestyles=”style01″]I dropped my head on my foot when someone pushed their guts across the table without calling out (from a slaughterhouse employee). [/sws_blockquote]

[sws_blockquote align=”left” alignment=”alignleft” cite=”” quotestyles=”style06″]I slipped and fell and hurt everything in me. [/sws_blockquote]

[sws_blockquote align=”left” alignment=”alignleft” cite=”” quotestyles=”style01″]Falling off the truck, I dislocated my pelvis and other male organs. [/sws_blockquote]

[sws_blockquote align=”left” alignment=”alignleft” cite=”” quotestyles=”style06″]Sustained back injury due to car accident which is part of his job. [/sws_blockquote]

[sws_blockquote align=”left” alignment=”alignleft” cite=”” quotestyles=”style01″]I fell down in the Fotomat booth while dislocating my knee. [/sws_blockquote]

[sws_blockquote align=”left” alignment=”alignleft” cite=”” quotestyles=”style06″]I didn’t know water was where I fell. [/sws_blockquote]

[sws_blockquote align=”left” alignment=”alignleft” cite=”” quotestyles=”style01″]Gears smashed thumb while holding air cleaner, while putting nipple on with right hand, while balancing air cleaner with left hand, while holding end with left hand away from right hand. Gears were not covered. [/sws_blockquote]

[sws_blockquote align=”left” alignment=”alignleft” cite=”” quotestyles=”style06″]The doctor gave me a disease for my occupation and said I must change jobs. [/sws_blockquote]

[sws_blockquote align=”left” alignment=”alignleft” cite=”” quotestyles=”style01″]I overasserted myself and got a hernia. [/sws_blockquote]

[sws_blockquote align=”left” alignment=”alignleft” cite=”” quotestyles=”style06″]In order to avoid a person, Betty lost her balance and fell down. In one hand she had a ketchup botttle which broke on impact, cutting her hand. In the other hand she had her thumb. [/sws_blockquote]

[sws_blockquote align=”left” alignment=”alignleft” cite=”” quotestyles=”style01″]Acting on behalf of my employer, I hit another automobile. [/sws_blockquote]

[sws_blockquote align=”left” alignment=”alignleft” cite=”” quotestyles=”style06″]I inherited this occupational disease. [/sws_blockquote]

[sws_blockquote align=”left” alignment=”alignleft” cite=”” quotestyles=”style01″]I was removing a blouse for a customer and which time I injured my back. [/sws_blockquote]

[sws_blockquote align=”left” alignment=”alignleft” cite=”” quotestyles=”style06″]Customer thought she needed the brakes adjusted. She drove the car into the station, could not stop the car, came through the door and pinned claimant against the cash register. [/sws_blockquote]

[sws_blockquote align=”left” alignment=”alignleft” cite=”” quotestyles=”style01″]A gate hit my foot while my back was turned, closing the other side. [/sws_blockquote]

[sws_blockquote align=”left” alignment=”alignleft” cite=”” quotestyles=”style06″]That night I done something I shouldn’t-a done and now my back hurts. [/sws_blockquote]

[sws_blockquote align=”left” alignment=”alignleft” cite=”” quotestyles=”style01″]I hit my arm against the hopper, and got flea bites. [/sws_blockquote]

[sws_blockquote align=”left” alignment=”alignleft” cite=”” quotestyles=”style06″]I sprained my ankle the same way I sprained my ankle before. [/sws_blockquote]

[sws_blockquote align=”left” alignment=”alignleft” cite=”” quotestyles=”style01″]I looked into the hose to see why the water did not come out. It came. [/sws_blockquote]

[sws_blockquote align=”left” alignment=”alignleft” cite=”” quotestyles=”style06″]I was proving that I could carry an air compressor and I strained my back. [/sws_blockquote]

[sws_blockquote align=”left” alignment=”alignleft” cite=”” quotestyles=”style01″]In performing the job of which I am capable, I didn’t know the machine was on and was showing my new helper what not to do and did. [/sws_blockquote]

[sws_blockquote align=”left” alignment=”alignleft” cite=”” quotestyles=”style06″]This is for the cut on my hand, but I took the stitches out myself. However, I am filing on account of the watchdog biting me and on account of a hurt I got in a fall in the paint shop. [/sws_blockquote]

[sws_blockquote align=”left” alignment=”alignleft” cite=”” quotestyles=”style01″]The patient was going to fall for me. I could not let this happen. In so preventing this, I caused myself damage to my knee. [/sws_blockquote]

[sws_blockquote align=”left” alignment=”alignleft” cite=”” quotestyles=”style06″]I was assaulted and attacked by a vicious employee because he didn’t like me and I know it. [/sws_blockquote]

[sws_blockquote align=”left” alignment=”alignleft” cite=”” quotestyles=”style01″]I ran down the steps and when I got to the end, my feet wouldn’t stop. [/sws_blockquote]

[sws_blockquote align=”left” alignment=”alignleft” cite=”” quotestyles=”style06″]Accident unnecessarily occurred on account of a misjudgment. [/sws_blockquote]

[sws_blockquote align=”left” alignment=”alignleft” cite=”” quotestyles=”style01″]I was working on my job and got a pain at the the end of the week. [/sws_blockquote]

 

How to obtain household help or home help under workcover

If you are no longer capable of doing house work (or your share of the house work),you are entitled to household/home help under workcover.

In order to obtain your household/home help you first need to visit your medical practitioner (i.e. your GP will do) and discuss those needs with him/her.

Your medical practitioner will have to write a letter to your work cover insurance (your case manager) and request household/home help.

Of course, and as usual, workcover (i.e. your workcover insurance company/your case manager) will make it very difficult for you to obtain the necessary help.

Tip

Get your Medical Practitioner to write in his/her letter the reason(s) why you need home help – that is: he/she needs to detail the “clinical justification“. It doesn’t matter if you have a gigantic medical file with workcover, hundreds of medical reports detailing your incapacity/impairment or plenty of supportive ‘evidence’. They will still need the “clinical justification” from your doctor before they will consider approving a home help assessment!

For example (true story): my GP agreed with my need for household help and wrote a brief letter to my case manager stating something along the lines (hey- here’s trying to stay anonymous!) “… the worker has a severely painful and severely unstable joint…needs house hold help as part of her/his medical treatment…”. This is NOT sufficient!

According  my case manager there was/is  “no clinical justification” that I need home help! Wow!  So, obviously the words ‘SEVERELY PAINFUL’ and ‘SEVERELY UNSTABLE JOINT’  do not fall under ‘clinical justification’! Maybe we (workcover victims) should send a pair of magnifying glasses and a dictionary to our case manager with each medical request 😉

So,basically, your medical practitioner (who is very busy and has to deal yet again with an enormous amount of unpaid paperwork!) needs to write in his request for home help letter the specific details why you need the home help. Think of it like a letter addressed to a 6 year old , for example: “… has a severely painful and severely unstable joint…needs home help.. BECA– USE when she/he tries to mop the floor her/his joint comes out of its socket (as in dislocates), following which he/she is in even more severe pain and following which more damage is incurred to the already damaged joint…”. Don’t laugh, this is  a TRUE story!

Only when there is “clinical justification”, your case manager will approve a home help assessment.

 

Your workcover insurance agent / case manager will then refer you to XXX  for a home help assessment and they do not need to provide  you with a choice of three service providers for these assessments!
(i.e. you do get 3 choice providers  for Occupational Rehabilitation). So it doesn’t matter who they send to your home to undertake the ‘assessment’, you have no say and must cooperate.  Bear in mind that workcover will always have the cheapest contracts with the worst possible companies/people…
Anyway, I recently had my home help “assessment” and I believe that in our next meeting, I will need to “try out various mops, vacuum cleaners, brooms and whatnot” – hey they want you to be “independent” after all (read NOT pay for a cleaner or gardener). It doesn’t matter to them if you can’t even write – you just have to try to mop your own floor, even if this means that you have to crawl on all four and lick the floor!
I will keep you posted on how the “trial” went 😉
Share your stories here!!!