Common issues

Common WorkCover insurers wrong-doing

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This is what some injured workcover victims have reported

  • injured workers being told by their workcover insurance to ‘just work through the pain’
  • discrimination against certain types of injuries such as  chronic stress
  • cruel and abusive psychological treatment of injured workers by workcover insurance case managers and employer
  • false and under-rated diagnoses
  • manipulation of facts, evidence, dates, medical words and expressions
  • concealment of facts and evidence
  • recurrent use of avoidance or distraction techniques
  • multiple medical reports for the same visit/intervention
  • excessive use of independent medical examinations (i.e. 5 per year)
  • coverup of wrongdoing that caused physical harm
  • putting intentional and inappropriate emphasis on the injured worker’s psychological status rather than addressing physical origins or causes of injuries
  • inappropriate psychological profiling
  • denigrating/vilifying the injured worker’s character
  • workcover insurance (though IME) falsely accusing the injured worker of having a family history of alcoholism, even when this is refuted by an independent psychiatrist’s report
  • violations of trust leaving the injured worker feeling “emotionally raped”
  • workcover case managers who disregard doctors and specialists who say the injured worker is unable to work – compensation, weekly payments and/or benefits are cut off anyway
  • injured workers unable to eat properly and relying on food hampers, charity
  • injured workers reporting that they feel they are “fighting for their life”
  • workcover insurance refuses diagnostic tests such as MRI despite request of multiple specialists

According to a report by the Victorian Omubsman released in May, 2011 injured Victorian workers are facing a system in crisis, with privacy breaches, lost documents and delayed payments stemming from poor record keeping by insurance firms, according to the findings in a report by Ombudsman George Brouwer tabled in Parliament in May last year. The report slammed the performance of Worksafe and the six big insurers it authorises to manage workplace claims.

The Ombudsman’s investigation was sparked by a nearly 30 per cent increase in complaints it had received over the past three years about WorkSafe and its insurers.

The report reveals many failures in the management of Victoria’s 56,000 active workplace injury claims because of poor record keeping. Bad file maintenance, inadequate understanding of the law by managers and outdated computer systems have all contributed, the report found.

“Many of the complainants who approached my office raised concerns about having to repeatedly submit the same documentation to the agents and delays in service this was creating,” Mr Brouwer said.

In one case, an injured worker had to wait months to receive more than $20,000 in back pay, because Xchanging lost her documents and maintained only minimal records of her claim.

In another case, a worker who required a kidney transplant because of a work-related illness, and was unable to walk to the bathroom, had to wait more than a year for Gallagher Bassett to act on a claim for the costs of home modifications.

Mr Brouwer’s investigation found the agencies had manipulated incentive schemes, delayed payments to workers and mismanaged files. Insurer CGU was found to have hidden about 10,000 invoices in a locked cupboard in order to obtain lucrative WorkSafe incentive payments.  CGU has since been fined $2.8 million and ordered to repay the $2.5 million for the manipulation known as ‘gaming’, which Mr Brouwer said was “clearly improper”. Mr Brouwer’s investigation uncovered evidence that CGU staff, including managers, were manipulating the scheme, benefiting by $2.5 million before the practice was detected.

During interviews with the Ombudsman, workers from CGU admitted some files were binned if they lapsed the due date for payment, because there was no system in place for recording when the account was lodged. This meant the agent would wait for a duplicate account to arrive to process that within the allocated time period, avoiding a fine by WorkSafe and claiming a bonus payment for processing the payments on time.

“If I was a person punching accounts and I have to hit a certain level, that’s checkin in that day, and the timeliness is really thoroughly checked and it’s a tight measure…I could throw a whole batch of those in the bin, walk over to the security bin…and they’re gone,” a manager at CGU told the ombudsman.

WorkSafe has six authorised claims agents – CGU, Allianz, Gallagher Bassett, GIO (no longer an approved agent), QBE and Xchanging. WorkSafe  has committed to modernising its IT systems and holding its insurance agents to account

Allianz, CGU, Gallagher Bassett, GIO, QBE and Xchanging are the insurers WorkSafe uses to deliver services such as weekly payments and medical treatment, with the authority paying the six about $212.5 million in fees last financial year.

The report found that each insurer’s files, apart from GIO and QBE, were in inferior order, lacked contemporary notes of conversations and meetings and were secured poorly. All insurers use a computer system more than 25 years old, while managers showed ”limited or no knowledge” of the Public Records Act.

The report revealed one woman did not receive weekly payments worth more than $20,000 for 18 months until this year because Xchanging repeatedly bungled her case. It also showed 222 reported privacy breaches – including medical records emailed to the wrong address.

Former facilities manager Alex Nicholls, who dealt extensively with Allianz after suffering nervous breakdowns due to workplace bullying, said he was not surprised by the findings.

Mr Nicholls, whose son was suffering cancer at the time, said after his first breakdown forced him to leave his job in December 2009, Allianz did not return phone calls and tried to make the process as difficult as possible.

After his claim was approved, they failed to ensure he was receiving weekly compensation, leaving him without adequate payment for three months. When he suffered another breakdown last year, they again did not ensure he was receiving the right payments.

”They were atrocious,” he said. ”You are dealing with someone’s livelihood.”

Allianz did not respond to questions on these matter.

WorkCover Minister Gordon Rich-Phillips said the government was concerned by the developments but would not say if it showed the WorkSafe board was incompetent.

The Ombudsman has made sweeping recommendations to fix the problems, including annual audits of insurers’ record keeping and the introduction of a modern computer system….

 

 

 

23 Responses to “Common issues”

  1. To do the same thing over expecting different results is termed “madness”.

    We need a new system.

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  2. hi,

    I injured my back in late 2011 and was diagnosed with bulged disc L5,S1. I put a claim in and was denied on my first attempt. I appealed and with perseverance and hopefulness, won at the conciliation. Some time later I received my payment but something didn’t look right. The numbers didn’t add up and I was positive I was under payed. I left it alone because I was just happy and relieved to receive my compensation, but about a month later when I was around the house looking for something to do, I did some research into the money owed and called the insurance company (Xchanging) taking care of the payments and low and behold they under payed my by 2 and a half thousand !! what a joke, these people are ridiculous, this whole system needs a reboot because its just so unfortunate that people who need it, have to fight to the teeth to get whats theirs. Im currently experiencing some workplace problems and am suffering from terrible stress, lost 18 kgs since january. daily struggle to get up every day

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  3. Why is there no investigation into these practices? injured in 1998, i`ve suffered through most of them.

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    victim of workcover January 1, 2014 at 10:26 am
  4. As someone who has worked for a workcover “TPA” eg. Gallagher Basset, Employers Mutual etc., I would like to give my 2 cents worth. Your average GB or Employers Mutual employee is massively over-worked, has extremely demanding KPI’s, and is largely unable to put sufficient time into each of their 100+ injured workers to make them happy.

    From day one we are swamped with far too much work from every direction. Whether through phone calls, faxes, emails, mail, management, colleagues, new claims etc. We are f’ing swamped and we work free overtime many days of the week, for no extra pay, and our pay sucks.We still can’t keep up.

    We’re abused daily on the phones by horrible bogan bludgers while we should be spending time on the genuine injured workers and those suffering horribly due to work place injuries who want to get their injuries sorted and get back to work. We can tell who’s who, so if you’re genuine then don’t worry, we want to help and we talk to each other about you and how bad we feel for you (serious)

    If we don’t call you back, we want to, we just don’t have the f’ing time and we feel guilty about it but we have to go home at some point, we’re tired and drained.

    we’re not the victims,the injured workers are, but seriously its a hard job so go easy on us if u can

    cheers

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    Steve Workcover Employee February 5, 2014 at 7:15 pm
    • Another thing, here’s some free advice. If a work cover case manager has 10 people wanting call backs, and only has time to do 5 call backs, who do you think they’ll call back? The angry a-hole who abused them? Or the decent bloke who didn’t get abusive, who stated firmly yet in a friendly way that their situation is serious and they need a response?

      At the end of the day, who do you think you’re talking to? You’re not talking to a hot shot who profits from you, or someone who earns much or who has a passion for approving invoices and surgeries or requesting medical reports, and getting yelled at by people who are pissed at the worker’s compensation act, they’re just people trying to make a crust, pay their rent, eat food, drown their sorrows at the end of a miserable day at work. They follow the Act.

      Just be pleasant, persistence is ok, just don’t swear and abuse, and you’ll get more call backs

      cheers

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      Steve Workcover Employee February 5, 2014 at 7:25 pm
      • Hi Steve, you might be the odd one, because I can assure you I have great manners and I have been bullied by a horrible person from an insurance company, and I am surely not a bludger I have taken 1 week off after an operation and convinced my go to let me go back to work.

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        Enough is enough February 5, 2014 at 7:49 pm
      • I have yet to meet a decent case manager but that’s just my personal experience, what do I know?

        and as far as the phone calls that you mention from the “horrible bogan bludgers” are concerned that comment is wrong on so many levels!

        No-one chooses to live their life in pain sorry, but if you are being abused by so many “angry a-hole” as you so eloquently put it than maybe its you and the way you deal with people that needs looking at.

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      • Steve, I have a lot of empathy for any worker in your situation. Maybe all of you need to join a Union so that you can collectively bargain for better working conditions as it seems to me that you are being exploited by the insurance companies. It is unfortunate that within your workforce there are those case managers who take out their frustrations on injured workers, like deliberately not returning calls, e mails etc, not acknowledging medical certificates with the consequent messing up of weekly benefits, ignoring medical recommendations, being sarcastic to the injured worker and implying that all of them are ‘bludgers’. Case workers are NOT trained doctors! And this is the biggest problem, the assumption that an injured worker has somehow given up all their rights by becoming injured. It is obvious that insurance companies need to address their training of case managers to actually reflect the laws of this country. No, it is not ok to be dismissive of any injured worker whether you suspect they are being fraudulent or not, it is not ok to indulge in childish vendettas against any injured worker and it is not ok to deny medical treatment to those who desperately need it. I do not blame the case workers for this, I blame your employer. Stop believing their profit driven stance that all injured workers are ripping off the system, step back and fight for your rights too and treat your fellow human being with respect. In nearly all other industries, the customer is treated with some respect, we are not customers, but we are not objects (like wrecked cars) either.

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        • Bunny excellent post and one I can relate to…. the sarcasm from a much less qualified and less experienced Gen Y “Technical Manager” (whatever that means), being yelled at to “just forget about it – you need to get back to work” from a Claims Manager (on my birthday) within a month of my claim being accepted. Yep that’s exactly what someone with an injury needs. Some insurer employees think it’s OK to use fire as a case management tool on a burn victim and expect the burn to heal! Unfortunately insurance companies don’t really care about training their staff, it’s just about cutting claims and any means justifies the end.

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          • Thankyou sick and tired. I have been thinking about this a lot lately and even though I have been on the receiving end of abuse from some case managers, I think over all they are really no more or less than other workers. The culture that has been encouraged by insurance companies is really the problem, obviously there is no incentive to be humane and there are no disincentives to behaving like bullies and breaking laws (I am referring to anti discrimination laws and international laws on human rights which DO apply to insurance companies).Governments across Australia are also complicit in this as well. Sure I would love to smack T and M (female case workers who would be right at home as guards in Auschwitz) but time heals most things and I can now see that they were doing what they were told to do, their biggest problem was that they were cowards who did not challenge the fact that they had to harass me (I may be wrong though, they could both be psychopaths). Instead of encouraging those with an empathy bypass to be in these jobs, there should be better accountability by insurance companies to ensure that their own workers are treated better and with that should come better respect for their injured workers which should also be monitored rigorously.

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      • steve gallagher bassett is a killer.
        all you care is to kick out the seriously injured workers.

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    • At the end of the day,you applied for the job and if its not what you thought do something about it.Nobody holds a gun to your head and makes you stay.You can go home of a night and live your life you have a choice,we can not walk away from our pain and injuries and all we have to deal with we have no choice

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  5. There will be a story aired on tonight’s ABC Stateline programme highlighting the effects that the cuts made to the NSW Workers Compensation System are now having for injured workers and their families.

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  6. Thanks at a loss.

    Could you please put on a link for those of us outside the state, to watch afterwards?
    Thanks

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  7. Just watched it andrew constanse is a bigger boofhead than pearce and ofarrell put together, this bloke don’t give a stuff , and the proof is in the pudding we are all malingerers unless we need an operation of some sort, come and talk to me andrew mm na you couldnt be bothered ,return to work your a bigger fool than the retards at allianz ask them about return to work and what they’ve gotta do, they don’t fucking know like you and your boofheaded boss ofarrell why can’t we cut your pay and entitlements you wouldn’t have a bar of that you’ve got the same turd for a brain like the rest with their snout in the trough.

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  8. Thanks for posting the link.

    However unfortunately I don’t feel that this report has achieved anything.
    I feel it came across as a bit of ACA or Today Tonight fluff.

    Very shallow report – no delving into the real depth of the issue, which is understandable to a degree as there is no easy way to explain to the average Joe how corrupt and misguided the Workcover ‘system’ is, and this would take more than hours/days to even start to break it down in easy terms.

    A snippet here, a snippet there – just like what insurance companies do with their WPI reports. No cutting into the multi-layered cake that the Workers Compensation ‘system’ really is. Just a lick of the icing to show that it may taste sweet.

    Another report that again simply makes injured workers look like whingers, rather than getting into the nitty gritty as to how a massive ‘deficit’ has been turned into a sudden ‘positive’ in such a short time, without even gesturing on how the system has failed the people it was designed to protect, the direct effect of the ‘system’ itself and how its associated bureaucratic crap affects an injured worker during their claim, or the people (certain businesses) who are clearly making money out of this system at the sacrifice and expense of those unfortunate to be injured at work’s health, livelihoods and family units.

    Don’t get me wrong, as an injured worker, I appreciate any media attention for the cause (as there has been conveniently so very little) but again it is disheartening to see the real issues being again swept under the carpet – the real facts are all too heavy for the average Joe to care about – that is until they get hurt themselves, then it is too late when they find themselves unfortunate enough to be part of this disgusting bureaucratic machine that accepts their claim, chews them up then spits them out with no further thought.

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    • Steve the only time i would take your friendly advise or anyone else’s in the trough is when you and your colleagues took to street and say enough is enough but until then to me you are a person with a bleeding heart boo hoo .

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  9. fuk cgu I won they lost. they tried to fuck me for years and I won. and now 15 years after the day I was hurt they are still trying to fuck me. but believe me right now, be honest and hold your ground and you will win too. I wont say more I dont want to be identified. the life I have involves them still but I have control over how I feel about it and I dont give a fuck, their employees come and go but im still here so i am far far more patient than they could hope to ever be. I got on with my life still suffer pain but changed career to office work and only part time, but I won they lost and I have more happiness than any one of their cfo ceo or lowly case manager mutha fukas could ever have my life is good and they continue to make efforts to make mistakes with paperwork and try to deny further medical but I won the big one and will continue to win the little ones, because im the righteous one they are the bogan bludgers fuck you steve you gay cunt. case managers all need a bullet in the head a robot could do the same job fuck you all cunts you will die before me. feel my hate and make me happy, and cry. I just want to squeeze every case managers face in with my fingernails until they pop open and spew out the evil inside. die die die

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    • Good on you cgufucker I to have had nothing but trouble trying to deal with cgu they have no idea how to deal with injured workers there only way is to deny deny deny im so glad you have had a win hopefully it will come my way soon cause things only seem to get worse got cleared to return to work part time and now my employer wont let me return

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    • @cgufucker, LOL, luv it! Know exactly where u are coming from. We need more good outcome stories like yours. Great work! Fight on dear friend and fuck em all 🙂

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    • I agree. Fuck CGU. That company sent me to an IME who straight out lied and made things up. In less than 6 months I hadd 5 different case managers. They closed down my claim on a false report. They told me me I had.NO right to challenge the decision. There’s more and it’s been nearly a year since the accident. I cannot work due to burst fat pads in my feet. Still waiting for CGU to sort their shit out. My lawyer says they are corrupt and the IME is corrupt. The worst part is because the IME said there is NOTHING wrong with my feet my doctor refused to believe that I was in pain. I had to see a different specialist who diagnosed burst fat pads in my feet, Sesamoiditis, Metalsargia and the dreaded RSD.

      FUCK CGU

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