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.

resraining-your-work-cover-case-manager

Can I put a “restraining order” on my work cover case manager?

Is your work cover Case Manager driving you nuts? Is he/she calling you multiple times a day? Do you feel harassed? Are you becoming scared of picking up the phone? Do you feel that she/he is aggravating your emotional/psychological state and/or recovery? Sounds familiar? Well, here is some good news for you:

Yes, you can stop your case manager from contacting you directly!

 

I personally was inappropriately harassed by a Case Manager for a number of weeks. I was receiving up to 10 phone calls per day and the nature of those calls were really making me sick.

One one occasion, shortly after having been (illegally) sacked by my employer based on “impairment”, I was extremely upset and depressed, to the point where I felt that I would be better of dead… Well, this Case Manager kept phoning me to tell me that “I should work” and that “she knew I could work” and that “she would be sending me to occupational rehabilitation/retraining” and “make sure I would return to work”.

Given that I had been sacked a few days before – and that my horrible employer terminated my long standing employment (we’re talking 6-7 years after the injury/accident) based on “impairment” (read: refusing to make some ergonomic changes to my work place before and after my latest surgery), I strongly felt that it was most outrageous that my case manager could behave like that. I mean he/she (work cover) was certainly also responsible for my sacking as they failed (for many years) to ensure that I would be accommodated in the work place with the medically requested and reasonable tools. Moreover, I had just been certified unfit for all work by my GP and treating psychiatrist.

So, I get sacked because my employer basically says that I can’t work (I am too disabled – mind you I was not too disabled up to 3 days before the last surgery and did the same job in a much worse physical state!), and I was doing office work for God’s sake! I plunged into a very severe depression and had been certified unfit for all work by my treating GP and Psychiatrist . So, here I was, devastated and receiving all these inappropriate calls from my case manager. I was starting to feel really sick when he/she called and at one point had a nervous breakdown on the phone.

Anyway, to cut a long story short, I consulted my lawyer and asked if it was possible to put some sort of restraining order on that case manager. Well, the answer is yes! I am not sure exactly on the legislation involved but it is about your civil rights.

Here is an extract of some correspondence with my lawyer at the time (and I am pleased to say that I have never received a phone call from my case manager since ;))

 

resraining-your-work-cover-case-manager

click to enlarge

So, don’t put up with any s**t from your ‘case manager’!

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!!!