Workcover’s incompetency exposed

Workcover’s fraud, lies and cover-ups exposed

A true example of a workcover case manager’s incompetency, lying, scheming and just plain fraud

On 1 February 2010, my case manager from hell  decides to cease my psychology entitlements, for God-knows-what-reason, as I had just been illegally sacked at work and my treating clinical psychologist had recently referred me to a psychiatrist for treatment of my severe depression…

Here is the letter I received from workcover in February 2010:

I appealed workcover’s inappropriate decision to cease my psychology treatments successfully at the Accident Compensation Conciliation Service – the hearing was on 24 June 2010. The ruling states that I am basically entitled to as many psychology treatments as necessary.

Let’s now expose workcover’s fraudulent behaviour and at what length they’ll go to bluff their way into denying you what you are legally entitled to:

I received a letter in October 2010 from this case manager from hell, again stating that they (workcover) is not liable for further ongoing psychology serviced and she has the cheek to send me the account (over $1200) of my treating psychologist! More interesting was that their so-called IME psychiatric doctor had even written in his report that I was to continue with psychology treatments (…for the foreseeable future).

Needless to say how frustrated and angry I was and as you can see from my letter to workcover, I suggested my case manager use an interpreter or get some reading glasses 😉

Bloody idiots, lying, scheming thieves trying to make you (the victim) even more stressed and depressed – I reckon all they try is to wear you down sufficiently enough in the hope that you will just give up.

DON’T GIVE UP, FIGHT FOR EVERYTHING THAT YOU ARE LEGALLY ENTITLED TO!

After that letter, this stupid case manager had the guts to tell me that the ACCS ruling was NOT valid (bluff again!). I ended up calling the ACCS Conciliator and he then confronted workcover. Guess what, that case manager just fobbed him off by saying that “it was an oversight“. A phrase they always use! Nice try!

Common fraudulent activities used by workcover insurance companies

Workcover insurance companies will use various fraudulent activities, these include

  • inaction by insurer which contributes to fraudulent claims (1)
  • obtaining medico-legal reports (such as IMEs) who have a vested interest in providing reports that favour the insurer, or lack of duty of care in not presenting medical reports that favour the injured worker (2)
  • companies are able to buy self insurer status as a commercial transaction without scrutiny of good health and safety performance (3)
  • pressuring an injured worker to return to work before they are ready (3)
  • self insurers making it difficult for injured workers to make claims (3)
  • failure of workcover insurers to assist injured worker when employer does not report injury accurately (4)
  • cancellation of payments without warning (5)
  • doctor shopping and collusion between insurer and doctors they appoint (6)
  • delays in processing claims and allowing required surgery (6)
  • accepting documents not tabled before review for injured workers to see(6)
  • withholding financial entitlements (6)
  • use of standover tactics or interfering with witnesses for the claimant (6)
  • used video evidence that was false including cases where video was of someone other than the claimant (6)
  • inconsistencies in admitting liability but only paying partial compensation (6)
  • failure to advise people of their rights, providing false or misleading information and providing conflicting advice depending on which officer deals with the claim that day (6)
  • claiming that the staff officer who signed a form was unaware of what they approved (6)
  • providing wrong and misleading evidence to judge (6)
  • possible conflict of interest between the rehabilitation provider and the insurer (6)
  • failure to explain claims process to injured worker and making claimant sign papers without understanding the content (6)
  • not allowing time for claimant to get specialist reports (6)
  • failure to pay for services promptly making some service providers reluctant to treat injured workers
  • inaction by insurers and failing to return calls when claimant asked questions (6)
  • telling employers who employ claimants that their premiums will rise and that they will be audited, or outsourcing to agencies owned by WorkCover employees (7)

What I often do…

At a time when injured workers are at their most vulnerable they are suddenly confronted with a complex, often bureaucratic, system with delays that they do not understand, and the inefficiencies and incompetence are often not perceived as fraud, but they are!

References

(1) Australian Industry Group, Submission No. 53, p. 10.

(2) Mr Stig Hellsing, Transcript of Evidence, 16 October 2002, pp. 44, 50.

(3) Australian Manufacturing Workers’ Union, Submission No. 35, p. 9; Dr Deborah Vallance, Australian manufacturing Workers’ Union, Transcript of Evidence, 26 November 2002, p. 375; Ms Gwyneth Regione, Australian Manufacturing Workers’ Union, Transcript of Evidence, 26 November 2002, p. 276.

(4) Ms Leah Palazzolo, Submission No. 8, p. 2

(5) Injuries Australia Ltd, Submission 27, p. 3.

(6) Injured Persons Action & Support Association, Submission No. 69, Appendix 1

(7) Mr Mark Moore-McQuillan, Submission No. 16, p. 2 and Transcript of Evidence, 21 November 2002, pp. 295, 300.

 

Suitable or modified duties and discrimination under workcover

Federal and State Anti-Discrimination legislation makes it unlawful to discriminate against someone on the basis of a disability/impairment. However the occupational health and safety legislation (OHS) requires employers to provide a safe workplace  for their employees.

These obligations can be a fine line when an employer suggests/allocates “suitable appropriate duties” for  injured employees (i.e. workers who have pre-existing injuries, or who are injured at work and are then certified fit to return on normal or light duties).

Restricting working hours, denying overtime or varying work duties (‘suitable duties) can all potentially constitute discriminatory conduct.

 

remember this is also discrimination

 

For example, a court may find that restricting the number of hours an employee recovering from surgery is allowed to work is discriminatory conduct. However, this conduct can be authorised if the employer can show that because the employee could not safely for example manoeuvre heavy machinery, the restriction was necessary to comply with the OHS requirement of ensuring a safe workplace.

Real workcover examples

H J Heinz v Turner5 (2002)

The court held that a workplace policy banning employees on restricted duties from overtime was discriminatory, but was authorised by law as it was a regime of work practice designed to ensure the health and safety of employees in compliance with OHS legislation.

NSWADT in Higginson v Cargill6

In that case, an abattoir worker had major surgery to his knee and was warned that if he slipped or fell he could lose the use of his knee completely. Because of the greater risk for this employee, the employer did not allow him to return to pre-injury duties on the slippery abattoir floor. However, the Tribunal held that the employee was not at a higher risk of slipping than a non-injured employee and that his injury did not prevent him from performing his pre-injury duties safely. Consequently, it was held that the employer discriminated against the employee.

The employer argued that the conduct was necessary to comply with its obligation to ensure workplace safety, but the Tribunal adopted a restricted approach to the statutory exemption. Under this approach, the employer must establish that there is a specific requirement in the other relevant Act relied upon. It must also be shown that the nature of the work and disability, when viewed objectively, leaves no option or discretion but to engage in the discriminatory conduct in order to comply with the requirement. In this case, the Tribunal held that the conduct was not necessary.

French v Sydney Turf Club7 – no discrimination

The Tribunal found that the employer discriminated against an employee by restricting her shifts to four hours. However, as her work injuries precluded her from safely lifting, bending, twisting or lifting loads from below the level of her thigh, the Tribunal found that, viewed objectively, the employee could not safely work a full shift as a bar attendant either with or without reasonable accommodation. Consequently the employer’s decision to limit Ms French’s working hours was necessary to comply with OHS obligations and was lawful.

Perlidis v Brambles Security Service8 – discrimination

Mr Perlidis worked as a member of an armoured vehicle car-crew. He strained his back at work and subsequently returned to work with medical certificates stating that he could lift only restricted loads. The employer decided that based on these limitations, Mr Perlidis could not be a member of any overtime car-crew. The employer argued before the Tribunal that the discrimination was lawful, as, when working overtime, it is important for safety that all members are able to lift full loads. The Tribunal disagreed and found that this was discriminatory conduct. It was held that there were other overtime duties that Mr Perlidis could have performed and therefore it was not necessary to restrict his hours.

An employer’s honest belief as to the employee’s best interests or to the effect of other Acts will not be a defence.

Discriminatory conduct will only be authorised if the employer can show that, viewed objectively, they had no option but to engage in the relevant conduct

 

 

How workcover insurances settle claims: dirty tricks exposed

Did you know that the job performance of workcover agents (i.e. your case manager) is judged not only by how little of the workcover insurance company’s money they spend in claims and settlements but also by how quickly they settle claims. Most  workcover agents get between 50 and 100 new claims a month across their desks. They have to settle that many claims—known as “clearing” or  “closing” a claim file—each month just to stay even. Their performance is also rated on how many claims they can personally settle without having to involve supervisors or workcover insurance  company lawyers.

Interestingly workcover claims managers such as your case manager have no special legal or medical training, and they will often resort to improper tactics  as a way to get you to accept less than is reasonable.

How you act during  negotiations for what you are legally entitled to can go a long way toward making the process run smoothly and quickly, with a minimum of stress or aggravation for you, and with a satisfying settlement as the result.

Here are some of the basic rules about dealing with a nasty workcover case or claim manager

 

 

  • Be organised. This includes ensuring that you have copies of all your medical reports, if you have a conversation with the case manager, make a note of what was said or record the conversation with a dictaphone. If either you or the adjuster have said that you will or will not do a certain thing, or that something is to occur by a certain date, write a confirming letter and send it to the case manager. Keep a copy of everything you send. If you have agreed to provide the case manager with information, do it promptly.
  • Be patient. Although you may have already had to wait a considerable amount of time to get all your medical and other workcover related records, try not to be in too great a hurry to settle your claim and/or to agree with a decision (i.e. entitlement,benefit). One of the tactics workcover case managers use is to make a low offer (i.e. allow you only a certain number of physiotherapy sessions) or to deny you a benefit in the first  and see if you are too impatient to continue negotiating. They will wear you down on purpose to test your resilience and many injured victims will rapidly give up fighting for what they are legally entitled to. If you can stand to wait, do not jump at a first offers/ first decisions. Holding off  by ‘negotiating’  and appealing decisions at the ACCS will achieve wonders. After some time passes, it will be the case manager who will want to settle your claim or review a decision as soon as possible, and then you will be able to get the full value!
  • Be persistent.  Don’t let the case managers sit on your claim. If the case manager has said that he or she will do something—make you another offer, review your entitlement etc; or check with a supervisor—get a specific date by which it will be done. Put everything agreed upon in a confirming letter, and when that date rolls around, call and  politely demand a response. If you have asked for information or for a new entitlement, set a reasonable deadline by which you would like the response.
  • Be calm and straightforward. Case managers are just plain ‘donkeys’ or clerks; they are overworked and probably underpaid, and they hear a lot of stories every day. They are also supposed to be human which means they don’t respond well to abuse or to  hysterics. Even if you get an inconsiderate or  unsympathetic case manager, keep your cool and don’t get into a personal battle; there are other and better ways to deal with an uncooperative case managers. (See below.)

    Your job is simply to show the case manager that you know how the process works and that your claim is an honest one. .

Sometimes – quite often actually, despite your best efforts and your diligent attention to the advice in the above section, a workcover case manager will not budge. The case manager may insist on denying coverage or liability and refuse to give you what you are legally entitled to.

  • Always ask your case manager to give you a written explanation of the workcover insurance company’s reasons for claiming there is no liability,coverage, entitlement etc, including references to the specific policy and law provisions that limit coverage. This will reveal whether the case manager  is  just bluffing and will give you a chance to respond to the reasons more. Claims supervisors will not like such a letter in the workcover insurance company’s file. If you eventually go to the ACCS or file a lawsuit to pursue your claim, such a letter in the claim file would show the workcover  insurance company’s lack of  cooperation
  • Also ask the case manager to provide you with a copy of the workcover insurance policy and/or details of the relevant legislation (statute, rule, act,regulation—or at least the portions on which the case manager relies in  denying coverage/entitlement/benefit—so that you can read it for yourself. if the case manager refuses, write a letter to the case manager/supervisor/team leader confirming the refusal so that it  becomes a part of your claim file.
  • Some case manager like to get additional medical records just to snoop around in your medical history to see if there is anything they can use against you or use to embarrass you. If the request for additional medical records seems unreasonable—that is, is not related to the injuries you suffered in the accident—do not comply! Always ask the case manager to explain why the  additional records are needed. If the answer doesn’t convince you, politely inform the case manager that you do not believe the records are relevant to your claim and that providing them would intrude into your privacy.
  •  If the workcover company, through its case manager/claims manager/whatever, has engaged in outright lies or fraud or has  interfered with your ability to pursue the claim (such as by withholding evidence, or the like) contact WorkSafe, the ACCS and an experienced personal injury lawyer
  • Bad faith may exist if the workcover case manager/ injury adviser/whatever  has refused to give you any specific reasons for a very low settlement, a denial of an entitlement or benefit etc  or has said or done something which might amount to an “improper tactic”. if you believe the adjuster for your company is negotiating in bad faith, use the term in  conversation with the case manager/whoever you are dealing with. If you get no  satisfactory response, you may want to put your accusation of bad faith in writing in a bad faith letter to the insurance company, specifically refer to the conduct of the case manager/ adjuster/person you are dealing with that you believe amounts to bad faith. A written accusation of bad faith often gets prompt attention and, if justified, may rapidly provoke a change in the adjuster’s  position. If an insurance company is proved to have acted in bad faith, often can help nudge a reasonable settlement/entitlement/benefit offer out of an insurance company and you may be able to use the evidence in court!

Sample letters

Sample letter bad faith to workcover agent

Claims Adjuster Metropolitan Insurance Co. St. Louis, MO 00000

Re: Your Insured, Alice Mendoza Claimant: Alice Mendoza Claim No.: 93-HQ1234 Date of accident: january 13, 20xx

Dear Mr. Firth: This letter concerns the discussions you and I have had over the past several weeks concerning […] of the […] claim referenced above. You have made only one offer of settlement/benefit/entitlement in the[ amount of $500[ [or number of treatments]. This offer bears no reasonable relationship to my injuries, since my medical expenses alone total $1,550. Yet you refuse to provide me with any explanation for your position. Bla bla…

The only conclusion I can come to is that  Metropolitan Insurance Company is refusing to negotiate in good faith.

If no fair and reasonable [settlement] [benefit] [entitlement] [whatever] offer, or  explanation for the lack of such offer, is made by july 1, 20xx, I will be forced to take further steps regarding Metropolitan’s apparent bad faith.

Yours truly,

Sample Reply Letter to Unreasonably Low Initial Offer/denial treatment/whatever

Re: Your Insured, Richard Leonard Claimant: Angel Ruiz Claim No.: 93-HQ1234 Date of Accident: january 13, 20xx

Dear Mr. Rubinion: In our telephone conversation today, you relayed Rocky Mountain Insurance Company’s offer to settle my claim for $1,000/ pay for 10 physio sessions/whatever.  However, none of the reasons you gave for such [a low offer] is  supported by the facts.

You claimed that I was ….. You assert that I had a duty to avoid ….. This is assertion is not supported by the facts. Indeed, the medical report indicates that your insured had a […], and I had […]. Thus, I did not have a duty/whatever…

In addition, you claimed that I suffered “only [a soft tissue” injury], which did not justify either the physical therapy I underwent or my [settlement/whatever] demand. If you look at the record of my X-rays, you will see[ a narrowing of cervical vertebrae]. Therefore, your characterisation of my injury as “minor” and as “soft tissue” is completely unjustified.

Please provide me with Rocky Mountain’s response within 14 days after you receive this letter.

Very truly yours,

Sample Confirmation Letter

Claims Adjuster Great Lakes Insurance Co. Syracuse, NY 00000

Re: Your Insured, Robert Lee Claimant: Allen Wright Claim No.: 93-HQ1234 Date of Loss: january 13, 20xx

Dear Ms. Lavelle: This letter confirms our telephone conversation today during which you agreed to respond by july 1, 20xx to my s[whatever] letter, dated june 1, 20xx. I look forward to your  response by july 1.

Thank you for your attention to this matter.

Sincerely,

 

Hope this helps a bit 😉

Please consider sharing this post – this site needs to become more publicly visible!

 

lumpsum-workcover selective-evidence-workcover

Workcover only provides very selective material to independent medical doctors and medical panels

Workcover hides evidence

It is extremely important that you are aware that the workcover agent (i.e. your case manager/injury adviser) will only send very selective material in support for your injury(ies) to independent medical doctors and the medical panel.

Continue Reading…

Another workcover victim’s story

Jane Doe was injured while the office chair she was sitting on in the  office, ripped apart at the star based leg, causing her to fall and land with a twisted back and left leg and wedged between the desk and back of the chair, unable to move.

Little did she know that little fall started a workplace compensation nightmare that is still going on three years later.

“It’s cost me my career. It’s almost cost me my house and I am not married nor have children. I cannot imagine how tough it is for a [anyone] who is injured.  I am also dealing with a workers compensation insurer from hell!”

Jane Doe says workplace injury is a very tough nightmare for those  persons caught by a work place accident.

In Jane Doe’s words:

“When you are an injured worker, you are not a patient, you are referred to as ‘the worker’ and you are dealing with case managers who do not have any or very little medical training or knowledge. Yet they often make sole decisions on your injury health care.

They are not even required to have any medical health knowledge, or experience, except workers compensation legislation.

Your claim is not valid and is at every aspect will be considered fraudulent. Though they never really put this in writing, the worker is always accused of this at every opportunity. For me it was often and in quite writing. Be it the actual injury; the extent of injury; the cause of injury; and whose fault it was. Is it work related? Wages – are they real, or did I just make them up?

“ The injured worker have very little rights and no health, financial or personal privacy any more. At the end of the day you may very well lose your house, friends, car, and savings.”

Her case is still in process….

She says the constant, having to ‘prove herself’ to the insurer at all aspects of living went on and on.

“All because I sat on a cheap sub standard chair at work, and it broke”.

Jane Doe says her case is very complex with many complex legal glitches, but she says it is important to speak up because there are many people who have had their lives shattered and continue to live in silence because of their experience with work place injuries and the process of the workers compensation claim.

 

Have you been injured in the workplace? what are your experiences with workers compensation?

Share your experiences with us below!

 

Workcover and the high price of psychological injuries

Further to our hot discussion topic about being bullied and sacked, here is some more useful information about psychological injuries, workcover and the law.

Key Points about psychological injuries and workers compensation and the law

  • Workers compensation claims for psychological injury are increasing.
  • One recent case= $500,000 damages.
  • Employers required by law to provide safe workplaces, free from prolonged work-related stress.
  • Failure to have safe system of work is enough for employer to be prosecuted.

Workers compensation claims for workplace-related psychological injury have jumped in recent years and there is no sign they are on the decline.

Moreover, the cost of these claims is high when compared with other types of injury, with one employee in a recent case awarded almost $500,000 in damages from his employer.

Psychological injuries cost four times as much and take longer to resolve than other workers compensation claims.

The use of PEO companies to pool together resources to handle claims such as these are growing, as more and more businesses understand the importance of being prepared for any workplace injuries.

What is psychological injury?

Depression, anxiety and neuroses are among the most common psychological workplace injuries. They may result from prolonged or excessive exposure to demanding, stressful stimuli, such as work-related factors and/or critical incidents. And most psychological injuries develop over a long period of time.

When initially faced with stressful stimuli, the body releases hormones that increase the heart rate, blood pressure, breathing and muscle tension. These create a state of mental and physical arousal in anticipation of a response to the stimuli.

If stimuli are prolonged and excessive, the body attempts to adapt. If the adaptation is over an extended period it can create exhaustion and provide little opportunity for the body to recover from its stressed state. Over a prolonged period, stress can make an individual susceptible to psychological injury. Physical ailments can also occur, such as headaches, back and neck strain, nausea and constipation.

Not all employees respond to stressful stimuli in the same way. Responses vary depending on an individual’s expectations and their capacity to deal with demanding work-related factors. As a result, managers must avoid relying on their own personal coping mechanisms as a guide to how much stress employees can handle.

At the same time, not all stressful stimuli are negative. A certain level of stimulus may motivate an employee to creatively and successfully complete tasks.

However, while individual employee expectations and capacity to cope may determine the extent of a response, it is work-related factors that trigger the response. A combination of high job demand and low job control is one of the most common work-related factors put forward to explain the work-stress response. In particular, low job control is seen as a major source of stress.

Employer liability

Under Australian occupational health and safety (OHS) statutory law and common law, employers must provide safe workplaces. This includes taking practical steps to identify, assess and control reasonably foreseeable psychological risks.

Under OHS statutory law, a psychological injury does not have to occur for an employer to be in breach of OHS law. Failure to have a safe system of work is enough to be charged and prosecuted.

Under common law, an employee with a psychological injury may be able to sue an employer for negligence and be awarded damages.

The State of NSW v Coffey [2002] NSWCA 361, 7 November 2002 (Meagher, Heydon and Ipp JJA), is an example of how an employer’s common law duty may play out in Court. The Court of Appeal found employers have a responsibility to ensure the psychological health and safety of their workers.

A NSW Housing Commission caretaker received threats and abuse from tenants and had witnessed murders and suicides, which he reported to his employer. He also asked his employer to erect a security screen at his office counter, but the employer refused.

The caretaker resigned from his job after eight years of service with depression and post-traumatic stress disorder. The Court of Appeal held the risk of psychological injury was reasonably foreseeable, but the employer had failed to act. The employer could have considered rotating the employee into other positions, monitoring the employee’s coping ability and ensuring he received ongoing counselling.

Although the employer offered a counselling service, it was up to the employee to seek it out. According to the court, this was not sufficient to „absolve” the employer from its duty of care to provide a safe system of work. The employee was awarded $459,478 in damages.

Workers compensation laws

Under Australian workers compensation laws, psychological injury can be compensated if work contributes to the injury or aggravates an existing injury. The workplace does not have to be the dominant or the only cause, but it must be a substantial cause of the injury.

Depending on the injury, compensation may include benefits such as weekly payments, medical treatment, rehabilitation and lump sum payments for permanent impairment (as opposed to common law damages).

Employees who are awarded common law damages will have their access to workers compensation benefits ceased or restricted.

Injuries resulting from reasonable managerial direction, such as retrenchment or addressing an employee’s wilful misconduct are not covered by workers compensation. However, if retrenchment and other managerial directions are handled in an unreasonable manner then there could be grounds for a stress claim.

In Jaksic v WorkCover/Allianz Australia Workers Compensation (SA) Ltd (Konica Australia Pty Ltd) [2004] SAWCT 17A, the SA Workers Compensation Tribunal found the workplace contributed to an employee’s anxiety and set WorkCover SA’s denial of the employee’s claim.

WorkCover had argued it was a disciplinary interview that caused the employee’s anxiety; therefore the stress claim could be denied. However, the judge found other action, not just the disciplinary action, contributed to the employee’s injury.

The employee’s supervisor arrived at work one morning to find the warehouse gate had been left open by the employee and decided to teach the employee a lesson in securing the warehouse. The supervisor hid equipment from the employee then asked the employee to find it. The employee could not. The supervisor then revealed the equipment, indicating the workplace was not secure. The employee became anxious and left work. The employee had a history of not adhering to workplace policies and was in the process of being counselled over this. The employee also had a history of anxiety. The judge subsequently found that hiding the equipment had been unreasonable and the employer should have foreseen it would cause the employee to become anxious.

Disability discrimination laws

Employers must also understand their obligations under disability discrimination laws. An employer cannot use a psychological injury as the reason for dismissing an employee if the employee still can carry out the basic job requirements.

In Power v Aboriginal Hostels Limited [2003] FCA 1475 the Federal Court set aside an earlier Federal Magistrate’s Court ruling, which found an employer’s decision to terminate an employee suffering from clinical depression was reasonable. According to the Federal Court, the Federal Magistrate failed to consider if the employee was unable to perform his on-call duties.

Privacy laws

Employers should also have regard for privacy laws. Federal laws impose certain obligations on the collection, use and storage of certain information. Health information is considered sensitive under federal privacy laws. Employers must ask permission before collecting such information and do not have an unfettered right to use such information.

Preventing psychological injury

To ensure all workers are reasonably protected from psychological risks, employers should address stressful work-related stimuli, not just employees’ stress responses.

Specific stressful stimuli may include, but not be limited to:

  • controlling management style;
  • poor consultation;
  • blaming culture;
  • unclear job description;
  • inadequate training;
  • poor recruitment techniques;
  • unexplained constant change;
  • intense, fast-paced work;
  • repetitive and boring work;
  • unsupportive work environment;
  • interpersonal conflict;
  • critical incidents;
  • poor ergonomics;
  • lack of flexibility, poor salaries and poor working conditions.

Employers should also be aware of the substantial indirect costs of psychological injury. They can have a negative impact on a workforce’s productivity, morale, turnover, motivation, absenteeism and relationships.

Managers should take the lead and demonstrate the importance of preventing workplace psychological injuries at both the organisational and the individual level.

Questions to ask before signing up with a personal injury lawyer

Are you a victim of a personal work injury ? It is very important that you seek the assistance of an experienced and trained personal injury lawyer who can help you seek justice as well as due compensation for your injuries. In some cases, you may be owed a settlement for damages that you have incurred from the incident. A personal injury lawyer is trained and experienced to help you with cases such as this where you receive an injury at the fault or neglect of someone else. Personal injury lawyers can also handle cases of wrongful death or accidents that result in permanent damage to the person.

Questions to Ask Before Signing Up With a Personal Injury Lawyer

The questions you ask before signing up will help you determine whether or not a particular personal injury lawyer that you are considering is right for the job. This will help you determine their level of experience with cases such as yours as well as how committed they are to your case and helping you.

Here are some sample questions to help get you started on your own list:

  • How long have you worked as a personal injury lawyer?
  • What types of cases have you worked on?
  • What is your track record on your cases?
  • What types of settlements have you helped your clients get before?
  • How do you see yourself being able to help me with my case?
  • How will we communicate regarding my case?
  • Will you be handling my case or will another lawyer from your firm be handling it?
  • How long has your firm been in practice and how long have you personally been in practice?
  • Do you have experience with my type of personal injury case?
  • What fees do you charge and how do you charge for services?
  • What are my rights and how do I protect them?
  • How will the insurance company be handled?
  • Do I speak directly to the insurance company or will you handle this?
  • What information do you need from me to file my claim?
  • How long will my personal injury case take to settle?
  • What compensation am I entitled to?
  • What is the legal process?
  • How long do I have to file my claim?
  • How will you charge me if I do not get compensation for my injuries?
  • What types of experts would the lawyer use to prove your case?
Note: A reasonable contingency rate is around 20 to 30 percent of the monies that you’ll be paid at the end of a successful trial – so I am told…

What you will need before meeting with your lawyer

  • Copies of  all accident/incident reports (incl.police report if appropriate) detailing your injury
  • Copies of hospital, doctor and treatment records
  • Bills/accounts from medical care providers
  • Information regarding insurance coverage of your medical bills
  • Reports from doctors regarding your diagnosis and prognosis
  • Information about anticipated future medical costs
  • Information regarding work you missed as a result of your injury
  • A listing of all the ways your life has been affected by your injury
  • A calendar, with all the important dates (date of injury, dates of surgery or other treatment and so forth)
  • A description of any interaction with insurance companies
  • Copies of correspondence with insurance company
  • Copies of any claims already filed with your employer or an insurance company

 

Requests for independent medical examinations (IME)

Quite often, a claimant (you) and a workcover insurance “adjuster” (i.e. your case manager) will have widely different opinions about the seriousness of an injury. Most disagreements arise over long-term or permanent effects that the workcover insurance adjuster does not believe are as serious as you describe them to be or as your treaters (and yes, even other IMEs) have described them.

Often the workcover insurance adjuster will ask you  to be examined by a doctor, designated by the workcover insurance company, to provide (yet) another medical opinion about your injury.

Because the insurance company has to pay a doctor for such an examination, cost- conscious workcover insurance adjusters do not request them very  often. But, when they are desperate – as they are in my case – they can ask you to attend an independent medical examination far to often (in my case I have attended 6 or 7 IME’s over a period of 18 months!!!).

Although these second opinions are referred to by workcover  insurance people as “independent medical examinations” (IMEs), they are anything but  independent. The doctors who conduct the  examinations are chosen—and paid—over and over again by insurance companies because they almost never find anything seriously wrong with an insurance claimant!

An IME  is usually a bad sign and you are required to submit to an IME! The law (ACA 1985) unfortunately only states that workcover can submit you to IMEs at ‘reasonable’ intervals. What “reasonable” really means is difficult to define however most solicitors I have spoken to agree that we’re looking at 1 IME every 1 to 2 years.

In addition the case managers at workcover are not medically trained, and there is NO requirement for them to have any kind of medical or nursing training, yet they make decisions about your injuries and work capacity, MFG!

Dealing with a request to attend an independent medical examination

If workcover sets up an IME for you, you can do some things to protect yourself during the exam—and afterward, if the report the doctor submits is  inaccurate or harmful to your claim.

  • Ask your case manager for a COPY of their IME POLICY
  • Bring a friend. See if you can get a friend or family member to go with you. Explain to them ahead of time what the IME is about and what you would like them to do. Thy can take notes on  exactly what time the doctor begins and ends the exam, what medical history or other questions the doctor asked you, what tests the doctor performed and how long they took, and other details that you might not remember. This person can act as a witness if you later have an argument  about the fairness or accuracy of the examination (see below). Having another person present also sometimes keeps the doctor from being rude or  intimidating with you.
  • Counter a bad report. IMEs are conducted by doctors who regularly work for the insurance company. These doctors want to make the insurance company happy so that they can continue getting these lucrative exams referred to them. That means their reports to the insurance company tend to minimise the extent of work victims’ injuries. If that happens to you, there are several things you can do and say during your negotiations with the workcover insurance to counter the bad report.
  • Ask  for  copy of the report .You should  refuse even to discuss the report with your case manager until you have a complete copy—not just portions of it or the case manager version of what it says.
  • If the examination was in any way unfair -very brief or superficial, or taken without first getting a thorough medical history from you or your symptoms—then point this out to the case manager/workcover. And tell the them that the friend or family member who attended the IME with you can support your contention.
  • Point  out  to workcover any inaccuracy or  incompleteness in the report, as an indication of its unreliability as a true measure of your injuries. If possible, use material from your own medical records to point out the problem.
  • Contrast for the case manager the very brief extent of the IME with the much more significant time your own doctors have spent diagnosing and treating your injuries
  • If the IME report is extremely negative and the case manager is relying on it heavily in denying you a fair outcome (i.e. fitness for work  when you are not fit etc), you may want your own doctor—preferably a specialist who has been treating you—to write a response. Show your doctor the IME report and ask if the doctor would be willing to write a letter countering it. Be aware, however, that your doctor is likely to charge you for preparing a response. Find out in advance how much you will be charged so that you can decide whether what your doctor is willing to write seems worth the cost.
  • Ask  for information about the doctor’s relationship with the insurance company. Put in writing to the workcover agent/case manager a request for: the number of IME referrals the insurance company has given the particular doctor over the previous fve years; the amount of money the doctor is paid for each IME; how many IMEs the doctor has performed for defense lawyers over the same period. There is no way workcover will provide you with this information. But refusing to provide it may put workcover on the defensive a bit in relying on the report while negotiating a fair(er) outcome with you.

Additional reads: Article Extract Workcover legislation review in WA (posted by a visitor yesterday)