Myths about workcover
Twenty-two widely believed workcover myths and misconceptions about our workcover system and must-know facts about workcover that everybody needs to know!
Workcover myth #1
The actual number of injured workers who are frauds are less than 1%. No one with any sense would choose to stay in what injured workers call workers compensation hell. We have a saying: Injured at work, disabled by workers compensation. In my workcover hell, I lost my dominant arm, my health, my savings, my income, my freedom, my car, my career, my hobbies and my dignity. Most of us, if given a choice, would much prefer to be treated under our regular health insurance. I’d almost give my other arm just to get those scumbags off my back!
Workcover myth #2
Most injured workers wait on average 6 months to 1 year before going to a lawyer. They only go to a lawyer after they are so frustrated by the workers compensation system because denials and delays in their medical care and benefits that they see no other option!
Workcover myth #3
Most employers will not work well with injured workers who return to work , especially those who return to work with restrictions. Many employers will not adhere to the medical limitations placed on the injured workers and in many instances they will force the injured worker to do more than the doctor has allowed, and many injured workers will experience serious aggravations of their injuries. It is not uncommon for employers to make plans to sack the injured worker as soon as they can. They will also often provide the injured worker with demeaning “suitable duties” or tell them that there are no suitable duties available.
Workcover myth #4
The average permanent impairment lumpsum (in Victoria) is around $10.000 for injured workers and, taking off the legal costs (around $5000 – $8000) in most cases this is not even enough to cover their accrued debt of having lost wages. Those rare, bigger, settlements (common law damages) like $300.000 are for a lifetime, though they are all computed as payouts in the same year the settlement is reached. $300.000. is the equivalent of $30.000 a year for ten years. That isn’t much to live on, especially when you consider that you may never be able to work again. Imagine living on that for even just a family of three? So forget the “myths’ about those ignorant people who think that because you have been seriously injured at work (and are entitled to a common law claim) you “will be set up for life” or “it will be like winning the lottery”. Wrong!
Also remember that if you go to Court and a Jury awards you, for example $500,000 (in very severe cases), the injured worker has to pay back all the weekly payments they have received from workcover (in some cases this can be more than 5 years worth, so let’s say you received $40,000 per year in weekly payments, time it by 5 years and, oops, you have to PAY BACK $200,000). This leaves you with $300.000. No wait, you also have to pay your legal costs and, if for example you case dragged on for 2-3 weeks in Court, you can expect to have to pay between $150,000 and $200,000 in legal fees alone, depending of the work involved (i.e. barristers, QC, expert witnesses etc). That leaves you with, WHAT I here you say? yes $100,000 to 150,000 in your POCKET.
If you received Centrelink benefits, you also have to pay those back, and, by God, you also have to pay back your initial permanent impairment lumpsum (this gets deducted from your awarded compensation).
So for those who believe severely injured workers get ‘set up for life’ or win the ‘lottery’, think again! There is no such a thing as a fair compensation payout.
Also note that the average compensation to Victorian injured workers is ONLY $80,000.
Workcover myth #5
If you had a family and you had to live on 2/3rds or less (60% – currently upped to 80%) of your previous income, how long would you stay out of work? It is a myth that it is easy to live on what you receive from workers compensation! Nobody in their right mind would want to stay an extra day on “weekly payments” – you gotta be joking! You are not only in pain because of your injury, treatments, surgeries, rehab etc, but you are also stuck at home and have NO MONEY for “luxuries” such a a book to read, or Foxtel TV, you can’t even go out with your friend because they have to pick you up and they have to fork the coffee/pub/meal bill too!
Remember too that if you are permanently totally disabled, that this equates to your full lifetime, leaving you not only broken physically, emotionally but also financially. Your ability to improve your financial situation has become impossible!
Workcover myth #6
It takes on average 6 months to several years to get medical benefits and income when the workcover insurance controverts the coverage/liability of a claim and the injured worker is thrown “into the legal system”. What happens to the regular Joe whose savings account is emptied while waiting for the legal system to wind its slow progress toward a solution?
And once your claim is accepted, your weekly payments start reducing quicker than you can bat an eyelid and you will soon be on 60% of you pre-injury average weekly income, you will struggle to feed yourself, let alone to keep the roof above your head. You will be desperate to return to work and many will attempt to do so long before they are ready (and in doing so will aggravate their injuries).
Workcover myth #7
On average, 80% of all injuries go through the workcover system without too much problem. These are the minor injuries such as a sprained ankle or a cut thumb that needs a stitch or two. The problem lies with the more seriously injured worker. In these ‘small’ cases, the worker may be off work for just a few days or a week or three and the medical bills will be paid for, that’s it. The injured worker may not have a ‘bad experience’ with the workcover system at all! I was fooled myself in the very beginning….until my injury proved a lot worse than expected!
In the majority of moderate to serious injury cases, injured workers have to fight for every medication, x-ray, MRI, CT, Physiotherapy session, counseling, medical treatment (including surgery), and any other benefit (i.e. home help, taxi transport, hydrotherapy etc.) that the law says the injured worker is entitled to!
The workcover insurance does what injured workers call deny and delay, gas-lighting, or starving you out (aka “SSS” Slow the process/Stall, Starve you, then “Settle”). The workcover insurance literally tries to break you emotionally, physically, and financially during this time to get you to settle out your medical and indemnity benefits for the lowest possible amount. During this process the injured worker often loses everything they own.
It is a widely known practice that they will push you to the limit, their main objective is a) that you GIVE UP (and no longer pursue that particular benefit you’re entitled to -hey: every little bit counts for them!) or b) that you are so sick and tired and frustrated that you go off workcover and get decent treatment under your normal Medicare or private health fund.
Workcover myth #8
There are plenty of laws in place today to protect the injured worker. The problem is that no one seems to enforce them!
Workcover agents for example will often even fail to comply with a Conciliation (ACCS) ruling or agreement they themselves signed!
Another beautiful example is the sad but true fact that we, workcover victims, NEED legal representation in order to obtain what is legally ours! I mean isn’t this ridiculous! And, thus, from the meager lumpsum some of us are entitled to (if we’re maimed enough!) some of that money must be paid in legal fees! Up to 25% (on average) from our common law damages claim goes to our lawyer(s)! So, should you receive $200.000 ( which may be the equivalent to $20.000 per year for 10 years if you can’t return to your previous income level!!!!), then up to $50.000 goes to your lawyers! That leaves you with $150,000 – see what I am saying?
If an injured worker has no legal representation, the workcover agent will taken even more advantage of that person -remember they hire their own lawyers like running parking meters and you will just be squashed like an ant in no time.
Workcover myth #9
There is no one that holds the workcover insurance accountable for internal mismanagement or poor investments causing losses (i.e. think about all the millions they spent on unnecessary surveillance, think about all the money they spend on flying in “expert” IMEs interstate). They never look internally to see where they can cut expenses. They always shift the burden to injured workers, employers, claimant lawyers, and doctors. No one holds them accountable for their deny and delay tactics that not only harm injured workers but also the employers and other state and federal agencies that have to carry the costs the carriers fail to provide. The workcover insurances have had their say for years now and have had laws changed to favour them, each and every time, promising that the changes would fix the problem and reduce costs in workers compensation. But, interestingly, it never does!
Workcover myth #10
Let’s face it, people freeze if you say the word cancer. There is never even a doubt as to the degree of the pain and suffering involved with this condition, even when the person looks okay and even though it is not something you can see with your eyes.
With injured workers though, if you look okay, then most people think you must be okay. And,of course, that you are nothing but a fraudster!
I have had 8 major operations to my shoulder for example, including transplants. On the inside of the shoulder it looks terrible, bits of bone missing, holes in the bones, big screws and plates, “itis” everywhere, missing ligaments, torn tendons etc., but on the outside – especially if I wear a loose, long sleeved top and keep my hand in my pocket- you can’t really tell that I have lost all function in that arm, almost all function in that hand, that I suffer from severe CRPS (RSD), that I have severe pain (rated 7 or 8/10) and have a botched reverse shoulder prosthesis. What about people who suffer unimaginable psychiatric injuries? Again they may ‘look normal’ but on the inside they’re very unwell.
This is also a problem with return to work, and maybe this is one of the reasons why many employers will often ignore the injured worker’s medical restrictions.
Workcover myth #11
For almost all injured workers you are assumed guilty until proven innocent. Your injury is not serious until a doctor says it is and then often that is not even enough for most workcover agents. Because that’s when they’ll start doctor shopping, to disprove it! Criminals, murderers, and even pedophiles are assumed innocent until proven guilty! What a strange world the injured worker lives in! And all this because we – like you – one day, minded our own business, and went to work, to earn an honest living, but got injured on the job (and often because of our employer’s fault!).
Workcover myth #12
Injured workers often lose the opportunity to choose their own doctor when injured at work. More and more reknown (good) GP’s and specialist doctors refuse to treat workcover patients because of the hassle involved.
Workcover agents send injured workers to multiple workers compensation doctors (the so called “independent medical examinations) because they don’t even believe the injured worker’s treating doctor(s), not even if they are super-super specialists in the field!
Moreover most of those workcover insurance doctors in the system are hostile towards injured workers, regardless of the type or severity of the injury; and their “recommendations” will be heavily biased towards the insurance company (isn’t there a saying “you don’t bite the hand that feeds you”?).
Even if the injured worker is “lucky” enough to be send to a (few) decent independent medical examiner, it is extremely frustrating when that honest IME’s recommendations are denied anyway.
Another level of frustration for us, injured workers is that, in many (if not, all) cases, the injured worker’s medical records do not get to the doctor before he sees the injured worker; it’s not unusual for the records the doctor receives to not be complete, making it impossible for the doctor to see the true picture of the injured worker’s injury.
A beautiful example perhaps was that I was recently sent for an “objective” surgical opinion (to a non-shoulder specialist surgeon of course), and the case manager had sent him only 1 report from my surgeon dated 2006 and 1 from my psychiatrist dated 2005. Considering that I had -at the time- undergone 7 operations and many complications, one would have thought that the case manager would at least send a complete surgical history, especially when asking for a surgical opinion?
It is worth mentioning that all workcover insurances do doctor shop! They can make the injured worker go to doctor after doctor until they finally get one who will agree that you’re not really injured or whatever it is they want.
Workcover myth #13
Most people believe that injured worker’s lawyers are paid regardless of whether they win or lose. The claimant’s lawyer is only paid if the case is settled or if the injured worker wins in court,as most firms offer only a no win no fee basis. This makes it impossible in some cases for injured workers to find a lawyer! On smaller claims or if the case could go either way, often a lawyer cannot be found to represent the injured worker. This is regardless of whether the injured worker has a legitimate claim or not.
So it’s basically not always easy for us to “just get a lawyer” to sort things out!
Workcover myth #14
Often an employer either will not take the injured worker back with or without limitations or will take them back just long enough for them to get off workers compensation and then sack them! This is well known!
Many employers will not hire a person who has ever filed a workers compensation claim despite this being illegal. This is the reality!
In my own case for example, soon after I was unlawfully sacked and (at the time) still had some (a little) work capacity, I applied for various, similar jobs in different organisations. On two occasions I made the selection process, but when it came to signing the contract they told me that unfortunately the OH&S department refused to employ me “because my workers comp injury would be a liability issue” – The whole issue basically revolved around “what if your injury gets worse whilst you work for us”, “who will be liable”?
Workcover myth #15
Anyone who believes that an injured worker cannot have a psychological injury from an on-the-job injury is misinformed. Any loss of function and earning ability, either temporarily or permanently, will cause a person to go into a depression of some degree.
Admittedly some people handle the psychological fallout better than others, but there is still a psychological component to every injury, work related or not.
Often it is the treatment the injured worker receives while in the workers compensation system that causes the most psychological damage.
Think of how you would feel having lost the function of a limb, or having severe chronic pain everyday. Think how you would feel if you had lost all your hobbies, your career, if you could no longer drive your car, get dressed alone? Think of how you would feel if you require surgery but workcover delays or denies it? Think of how you would feel when you are feeling depressed and feel that you need help, workcover will forbid you to attend or cease psychological counseling? How would you feel when your injury has deteriorated massively and workcover makes you wait for 6 months before they approve the prescribed MRI? How would you feel if you are really disabled and workcover denies you home help and you have to live amongst piled up dirty dished, unwashed floors, sleep in dirty linen because you are unable to change the linen or make the bed? Think of how you would feel if you could no longer provide for your family because you now only receive 60% of your income, or because they have cut off your weekly payments?
Workcover myth #16
If anyone would actually enforce the law, I think we would all be shocked at the level of fraud committed by workcover insurance carriers in the workers compensation system.
Workcover myth #17
In many cases a case manager becomes the injured worker’s worst nightmare. They are quite often rude and demeaning. They tend to over-ride our doctors’ decisions and deny the procedures our doctors and specialists order. They have our whole life in their hands and they know it. They are not medically trained in any way, shape or form, yet they can deny our medication(s), cut our pay, ignore our doctors’ requests, and send us to Independent Medical Examination (IME), after IME always being in control and selecting who, what, when, where and how you will be seen. They can make decisions that countermand the doctor’s orders without consulting the doctor or having permission to do so.
Workcover myth #18
An injured worker is often presumed able to return to work when the doctor is successful in “relieving the pain” (I refer to many so called IME reports who will state that “the patient will be able to return to work once the pain is controlled…”. What some people fail to comprehend is that just because the pain is temporarily gone, it does not mean the person can return to work. Often pain medication only mask the pain. One can easily forget their initial injury and cause further harm to oneself by trying to do more than you could do if the pain was there to remind you of your injury. Some pain medications also have unpleasant side-effects such as dizziness or nausea and vomiting. The other factor to consider is the pain medication itself dulls the brain and the injured worker’s ability to fully comprehend what is going on around him. In many cases the injured worker is impaired to the point of being considered intoxicated under the law!. They are not allowed to drive or operate dangerous machinery – it even says so on the medication boxes and leaflets!!! Do you really want to have this person even answer your phones if they are considered intoxicated under state law? Do you really want me to drive to work like this? Do you really want me to make life and death decision (i.e. when you work as an ICU nurse) like this? Do you really want me to make important executive decisions like this? Or perhaps you’d like me to manage your highest risk project like that?
In my example I am taking narcotics and opiates to the point that my pain specialist has prescribed regular ‘anti-tolerance’ treatment with METHADONE break, which is a drug used to replace HEROIN in drug addicts. The regular narcotics and opiates (with special authorisation) I take everyday make me sleepy and drowsy and I need frequent naps during the day. When I have ‘bad’ days, I can’t even sleep from the pain (and I mean NOT sleep, not even 1 hour) – so that makes me an ultra dangerous zombie during the daytime! But my case manager still continues her hot pursuit to find that IME that will certify me “fit for work”. Do they not care about the serious possibility of a second and third and fourth serious injury at work when working in such a state? I mean I am capable of falling of my chair, I have had near-misses where I nearly dropped a kettle full of boiling water over me, and I am at home. At least, when I wheel woozy I can go and lie down, but what if I were at work like this and was forced to stay ‘awake’ all day?
Workcover myth #19
For many (if not all) injured workers, every doctor’s appointment, treatment, imaging (MRI, CT), test or medication is questioned and litigated because workcover delays or denies everything. They often send the injured worker from “independent doctor” to “independent doctor” (IME) trying to find one that will say there is nothing wrong or that a certain treatment, test is not necessary or must be ceased. But, interestingly, when their own so-called independent doctors agrees with a treatment for the injured worker’s own surgeon/doctor, or supports additional treatments, the workcover insurance company will even then refuse or deny that treatment and will send the injured worker to yet another and another IME until someone agrees with what the workcover insurance wants! Talk about doctor shopping – there’s just no end!
And then, even if they do approve a recommended IME treatment/test/whatever, they will start the “process” all over again a few months later, in the hope to then be able to cease that treatment. And so the vicious circle goes on and on and on.
Workcover myth #20
Injured workers are terminated, laid off, or whatever you want to call it everyday in Australia and most often without just cause. And although it is against the law, many employers will find a way to squeeze the injured worker out of their employment in one way or another. This can be done by saying that no suitable duties are available, or by offering extremely demeaning suitable duties… many employers will use ‘constructive dismissal’ techniques too and the clever employers will sack you as soon as their “duty of care” is over (12 months) as to avoid potential penalties/prosecution.
Workcover myth #21
Most back and spinal injuries are not treated as serious and are actually often under-treated causing further injury! In my experience people are at the most risk of becoming permanently and totally disabled from this kind of injury. This is because by the time the injured worker secures the necessary treatment for this kind of injury, it is often too late for a repair to be successful. This is extremely sad because in talking with such injured workers, I have found that most of the permanently totally and disabled injured workers with back or spinal injuries, had a reasonably good original prognosis, which may have allowed them to return to somewhat modified work. Yet, because of the incomprehensible delays , courtesy of workcover, who consider all of us frauds and malingerers, those injured victims did not get treated in a timely manner and are now left completely disabled for the rest of their lives.
Workcover myth #22
Most injured workers never even know there is a rehabilitation program available, much less that they can get retrained. Even when they find out these programs exist, they are frequently told that the money is not there for them to attend a training program or that the particular course they’re interested in is “too expensive”.
Many injured workers are simply turned down. Many are told by workcover agents that they don’t qualify for them when if fact they do.
The other disturbing factor is that workcover will most often tell you that they won’t pay for UNI course but only TAFE courses or short courses. Don’t let them bulls*it you! Although I believe that retraining courses are capped to about $5000 (correct me if I am wrong), you can get funding for UNI! I did it!!! And why should you not? I mean, in my example, I had already a masters university degree (in advanced nursing), what am I going to do with a TAFE or short course? I challenged the decision of Workcover not to fund a uni course in Business management for health care professionals at Conciliation (ACCS) and I was successful- workcover was to fund half my post-grad business management course – there you go.
Vocational as well as educational programs should be offered to any injured worker and at ANY level to help them retain some kind of employment.
It seems to me this would be much cheaper than shifting the injured worker and his family into poverty, or Centrelink programs!
Top 5 Workcover misconceptions
See our article titled “top 5 workcover misconceptions”
More Workcover misconceptions and myths
Anyone who trolls the net (or a tabloid) will find a number of extremely disturbing (forum) posts, articles and comments from ignorant, brain-washed, pea-brained and/or biased, ahum, individuals, making faulty and, frankly, dangerous assumptions and comments about what “motivates” injured workers: cheating the system and malingering in order to get a “free ride” or permanent “welfare payments”.
False assumptions and statements are not only dangerous, but they have also led to the further erosion of benefits to injured workers. The logic behind? To provide a disincentive that prevents cheating the system and discourages malingering. We would argue that these are cynical and dismal views taken by certain individuals (incl. politicians) who are obviously poorly schooled in human behaviour and motivation, which encourage the development of systems that use punishment and coercion in order to motivate injured workers.
Research carried out on behalf of the Industrial Health and Research Foundation, in 2011, highlighted a number of false assumptions governing current systems:
Fraudulent claims are overstated
Despite research claims that false claims increase when larger payouts are available, these represent a tiny fraction of overall claims that are legitimate. Emphasis has been placed on minor increases without considering the fact that many legitimate injuries never reach the claims stage. The failure to detect false claims is systems issue. The current assumption is to treat all claims as though they are fraudulent rather than improving the system to detect the small amount of claims that fall into this category
The under-reporting of legitimate claims
Most reported injuries never make it to the claim stage – in fact, it has been found that many people persevere with injuries to the point of being forced to take time off work for treatment and recovery. If anything, legitimate claims for workers compensation are under reported. The current assumption seems to be that workers will make claims for false and or frivolous reasons.
There is no incentive to claim, for most workers
Most workers return to work as soon as their injuries have healed regardless of the issue of economic incentive (previous and more equitable entitlement available) or disincentive (reduced entitlements that reflect disadvantages of the current system). This suggests that the vast majority of workers are unlikely to make false claims, despite the assumption that false claim costs would skyrocket if larger claims are made available.
Poor claims and injury management process is a major issue
Other factors associated with poor return to work management need to be considered as a major reason for prolonging claims resolution. Failure by employers, insurers, providers and workplace health and safety all play major roles in successfully managing claim, however, injured workers and their families are routinely penalised by the current system.
Complacency about safety is a myth
There is no evidence to support claims that workers become complacent about safety when higher rates of compensation are available. Previous concerns have been based on false assumptions based on questionable research data. Most people simply do not ignore safety in order to qualify for workers compensation.
Adding insult to injury
The stepping down of workers compensation in recent years has exacerbated problems typically associated with injury management and recovery (financial distress, family problems etc). This has also given rise to secondary injuries (i.e. depression and anxiety) on top of many injuries that were initially physical in nature. This suggests the likelihood that many short to medium term injuries turning into long-term problems is substantially increased.
The moral hazard, taxpayers pay for negligence
Poor injury management ends up being paid for by taxpayers as more and more injured workers fail to make successful transitions back into the workforce. Employers routinely view many people who have been unfortunate enough to be on workers compensation as liabilities best avoided, which limits the potential injured workers (especially with long term injuries and psychological injuries) from ever returning to pre-injury employment status and earning capacity. Many long-term injured workers end up being forced onto unemployment benefits at taxpayer’s expense. Employers have limited liability and therefore little incentive to take the health, safety and wellbeing on injured workers seriously.
Interestingly, the research focused primarily on physical injuries – however, the growing concern is the increase in psychological injuries, both primary and secondary, resulting from the poor management of claims (not only by insurers, but employers who take a negative view of injured workers). Reductions in wages, financial pressures, and poor return to work management are all implicated. The real concern is that given physical injury claims should be relatively straightforward to manage – which it seems is anything but, because the system is more adversarial towards injured workers, in general. The rapid rise in psychological injuries in many workplaces only places greater pressure on the entire system, because the management of psychological injuries are significantly more complex and time consuming to manage than physical injuries.
The rising costs of psychological injuries
Claims data for psychological injury for Australian government organisations over recent years indicates a rise in these types of claims. Work pressure accounts for around 50 per cent of psychological injury claims. The next most significant category for Australian government organisations is harassment/bullying combined’ – which accounts for around a quarter of psychological injury claims. Of declining importance in recent years is ‘exposure to workplace or occupational violence’ which accounts for only about 10 per cent of psychological injury claims. ‘Exposure to a traumatic event’ (which includes witnessing a fatal or other accident) accounts for less than 5 per cent of psychological injury claims.
According to Comcare, Australia’s federal work health and safety regulator, claims associated with mental stress have risen 54% since 2006-2007. Work related mental stress is of concern in the Comcare scheme, especially in the APS. The number and proportion of worker’s compensation claims as well as the cost of psychological injury claims, has increased over recent years.
Over the four-year period to 30 June 2010:
- around 9 per cent of accepted Australian Government premium payer claims were attributed to mental stress; and
- around 35 per cent of total claim costs related to these claims.
However, the impact of mental stress is even greater when secondary conditions are taken into consideration. There are a number of cases where the initial claim was not caused by mental stress, but the injured worker developed a mental disease as a secondary medical condition. Taking these cases into consideration, over the same period:
- around 11 per cent of all accepted claims within Australian Government premium payers involved mental disease as either a primary or secondary condition
- around 43 per cent of the total cost of accepted claims related to these claims.
There also tends to be a limited view of the work capacity of people facing these problems. According to Comcare employers struggle to find suitable duties for people with a psychological injury claim. Those with a psychological injury do not return to work as quickly as those with claims for non-psychological injures. For example, during 2010–11, 49% of the mental stress claims from employees of Australian Government premium payers that involved 4 weeks lost time from work progressed to 26 weeks lost time. This compares to just 23% of all other claims that progressed from 4 to 26 weeks lost time during the same period.
Comcare. (2011). Comcare submission to the public hearing: House standing committee on education and employment inquiry into mental health and workplace participation. Australian Government.
Productivity Commission. (2004). National worker’s compensation and occupational health and safety frameworks. Final report. Australian Government.
Purse, K. (2011). Provisions of fair and competitive worker’s compensation legislation, University of South Australia. Research funded by the Industrial Health and Research Foundation.