Being on workcover is a nightmare! Dealing with your injury,the complex workcover system, your employer, the WorkCover agent, rehabilitation agents, doctors and even lawyers can be mind boggling and very stressful! Here we share few tips that can help you survive WorkCover!
Dealing with your injury- especially a permanent injury- and its after-effects can be extremely stressful. Negotiating your way around a very complex WorkCover system, dealing with your employer, the WorkCover agent, rehabilitation agents, doctors, so called “independent medical examiners” and even lawyers can be mind boggling and extremely stressful! Below are a few tips and tricks that can help you survive the WorkCover nightmare!Focus on your health and recovery
Your highest priority should always be your health and to maximise your physical and/or psychological recovery.WorkCover must pay for all reasonable treatment costs. We strongly believe that the most important issue is to ensure that you are getting the best quality medical treatment possible.
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- surviving workcover some more tips
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When you are seriously injured, you will have to make many important decisions about your future. To make the right decisions it will be critical to understand as much as you possibly can about the structure of WorkCover benefits, for example, how they interact with your other employment entitlements, and what all your entitlements really are.
WorkCover is an extremely complex system! The Act of Parliament which governs WorkCover alone is several hundred pages long and quite complicated. Trying to understand just what WorkCover does and does not provide is really important. There are many resources available to help you with this task.
The most detailed information, apart from the Act itself, is on the WorkSafe website which contains a very detailed publication called the ‘Online Claims Manual‘. This contains detailed instructions from WorkCover to its agents on how to handle claims. It also includes very detailed information about the calculation and payment of WorkCover benefits. Remember this information is written from WorkCover’s perspective only. Nonetheless this can be a useful resource for people who want detailed information.Try to deal as best you can with WorkCover
Dealing with WorkCover and -especially- your case manager can be extremely stressful.Following a few simple guidelines can make dealing with WorkCover, and your case manager (and rehab providers) a tad easier.
- The most important thing is that you keep good, written records. For example, if you want to claim travel expenses you need to submit details of all your trips to and from doctors, incl train, bus, tram, taxi and parking receipts. If there is an argument about your weekly payments because WorkCover feel you are not looking for work, keeping a record of all your attempts to obtain work can put you in a far better position.
- We advice all injured workers to only communicate/correspond in writing, either via email or via letter/fax. You do have the right to refuse telephone contact and you also have the right to request that all correspondence/communications go through your legal representative, one of your doctors or an advocate. You can even put a “restraining” order on your harassing, bullying and/or intimidating case manager (see our workcover tips collection for sample letters).
- It’s also very important that you keep a copy of all your documents. For example, when you receive a certificate of incapacity, the original should be provided to your employer but ensure you make a copy for your own records.
- Ask under the Freedom of Information Act or the Workers Compensation Act, for a copy of all your medical reports, including independent medical examination reports.
- When submitting your medical certificates ensure that you complete the section on the back of the certificate about your work activities. If you don’t it will delay your payments and the form will be sent back to you. It may also be useful to try and ensure that your certificates expire on a Saturday or Sunday to make it easier for WorkCover or your employer to calculate your weekly entitlement. This enables weekly benefits to be paid in whole weeks.
- Sometimes (well dare we say “often’) the decisions that a case manager makes can be extremely frustrating. Losing your cool can backfire as you will run the risk of being type cast as difficult or as suffering from a psychological problem! Whilst you are entitled to acquire an explanation of a case manager’s decision and to discuss the decision freely with them, but it is important to ‘keep your cool’ with the case manager. (also see things that annoy the sh*t out of case managers)
- If you don’t agree with a decision from your case manager, and it appears that they’re npt adhering to the “guidelines” (including the case manager standards of practice) you can ask them to identify their superior (aka Team Leader) and request to discuss the matter with them. If you still disagree with the decision, you should dispute the decision by referring the matter to conciliation. Many WorkCover decisions are overturned at conciliation. Note that you will need a “rejection letter” from your insurer regarding a particular issue (i.e. denial home help,ceasing physio, denial surgery, denial transport etc).
- If you believe that your claim has been seriously mishandled, of course you can complain to the State Ombudsman. This can be a major step so it is important to ensure that your attempts to resolve the issue through other channels have failed (i.e. formal complaint to the insurer, formal complaint to WorkSafe etc).
Dealing with rehab and return to work issues.
The WorkCover system is – in theory- strongly committed to rehabilitating injured workers and providing assistance to enable a return to work. In fact you will soon notice that your case manager wants only one thing: to get you back to work at any cost!
Rehabilitation, however, means different things to different parties. Some employers are genuinely committed to rehabilitation and a proper return to work, however many (if not most) others, have no interest in returning an injured worker to meaningful work and will provide only minimal assistance in order to keep WorkCover happy (and to avoid penalties such as premium rises). These employers will often use phrases like “we don’t have light duties” or “don’t come back without a full clearance certificate”.
Many employers also make only meaningless or demeaning work available. Sadly, in these cases, a return to work can be like a ‘guerilla warfare’ which is, ultimately, aimed at sacking the injured worker.
Chances are you have seen how your employer has treated other people who have been injured at work.
Following some simple tips may make the extraordinary difficult situation of returning to work, a little easier:
- It is very important to try and understand as soon as possible whether or not you will have any capacity for work in the future. In the early stages of your injury, it can be very difficult to work out what your long-term capacity for work is going to be. It can also be difficult to assess what commitment (if any) your employer will make to assist any return to work. It’s important to discuss this with your treating doctors. Questions to ask include: Do you have a capacity to enable you to perform your current work? If you can’t perform your current work – what kind of restrictions will there be in the work you do? If you have to change the nature of your work- what type of retraining will you need? Don’t rush into making any decisions about your future – you need to have an answer to all those questions first. For example, there’s no point changing careers or requesting re-training if you are likely to completely recover from your injury. Also, for example, if you had a desk job (i.e. accountant) and you have a serious leg injury, there should be no need to retrain as you may still be able to undertake desk work with a leg injury; however if you are a nurse and you have broken your shoulder in a permanent manner, you will need to consider retraining as hands-on work in a ward will no longer be possible for you.
- WorkCover will become extremely “proactive” (read harassing) about returning an injured worker to work. The case manager will -very quickly- send you a list of three occupational rehabilitation providers in order for you to choose one to “assist” you in returning to work. This contact can often seem premature and somewhat pushy in the stages of recovery. This might be based solely on the uneducated views of the case manager or on the assessment of WorkCover’s doctors (aka IMEs) who may have a less sympathetic view or may be frankly biased about the effect of the injury on you. If it is likely, or even possible, that you will have some capacity for work in the future it can be very important to choose a rehabilitation provider carefully and communicate them your willingness to look at return to work options when your doctor considers it appropriate.
- It is extremely important never to refuse an offer of rehabilitation or alternative employment (suitable duties) outright, as this could be used against you to terminate your WorkCover benefits at a later date. The best approach is to indicate your willingness to consider a return to work plan or proposal after a discussion with your treating doctors about the issue.
- Often, a rehabilitation provider will delay any consideration of looking at alternative employments or training courses as the focus of the rehabilitation consultant is usually and solely on returning you to your former workplace. This may be inappropriate or a short-term fix! It can, therefore, be very useful for you to identify the jobs you think you may be suitable for, and what training courses may be necessary to become skilled for them. Having done this, you can then discuss these options with your rehabilitation provider. You can formally request, preferably in writing, that they approve specific training courses. Remember, WorkCover’s response to training courses is likely to be affected by the length and cost of any course. The longer or more expensive the course – the less likely they are to approve it. If you were to identify a reasonable course that you wish to undertake which is then rejected by WorkCover, you are fully entitled to refer the matter to conciliation or resolution of the dispute.
- If you do return to work make sure that your progress is properly monitored and assessed. If you return to work and are having continued difficulties you should attend your doctor and explain what those difficulties are. This is very important because the doctor’s notes will record the fact that you are having difficulty returning to work, which will make it easier to obtain a weekly payment if you are again forced to stop work. If you have difficulties in returning to work either because the return to work program is not appropriate or because your employer is not adhering to the return to work program, you should contact your rehabilitation provider and relay your concerns to them about the situation. Remember to keep a note about the details of your employer’s failure to adhere to the return to work plan and your discussions with the rehabilitation provider. If necessary, you should ask the rehabilitation provider to contact your doctor or to attend at your workplace to meet with you and your employer to discuss the matter.
- If your employer is refusing to provide appropriate work, failing to adhere to a return to work program or in some other way sabotaging your return to work, you can report the employer to a return to work Inspector at WorkSafe. WorkSafe can, in some circumstances, prosecute an employer. However, before prosecuting an employer, WorkSafe will attempt to negotiate a resolution of the situation.
- Again, keep a copy of all documents, including emails and try to keep all communications in writing (email is OK). If you had a “meeting”, always follow up in writing (i.e. email) and confirm what was said and decided at that meeting.
When you suffer a permanent work injury, it is likely to have many financial and life changing effects. It is important that you obtain legal advice so that you can be prepared for some of the issues that may emerge as your condition progresses. If you obtain legal advice early, you will be better prepared to deal with many of the challenges that can emerge in the course of your claim. Also, your insurer and case manager (and employer) are likely to treat you with a little more respect if you are legally represented.
Almost all injury lawyers offer an initial free consultation – use it. Most operate on a no win no fee basis.
Make sure you select a reputable lawyer / law firm specialised in personal injuries.
If you don’t know where to start we suggest you give [popup url=’http://www.shine.com.au/ ‘]Shine Lawyers[/popup] a go. They’re the only law firm that is supported and trusted by Erin Brockovich, because they really do stand up for the little guys, like you and me.
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