Workcover Vic complaints

How to complain about WorkCover in Victoria

workcover-complaints

WorkSafe’s (aka WorkCover Vic) function

WorkSafe administers the Victorian workers compensation scheme through a number of authorised workcover insurance agents. These agents are supposed to provide compensation and rehabilitation to workplace accident victims.

WorkSafe monitors and audits the authorised agents.

The Ombudsman has jurisdiction over the six authorised workcover insurance agencies (Agents).

WorkSafe is also the regulator for occupational health and safety. This involves investigating workplace accidents, providing advice to employers on making their workplaces safe, investigating and prosecuting individuals and companies which fail to meet their health and safety responsibilities or defraud the system.

Complaining about WorkCover Vic

Contact arrangements

In general, complainants who have not raised their concerns with WorkSafe or the Agent, should be advised to do so in the first instance. If they remain dissatisfied they can go to the Ombudsman’s office with a copy of WorkSafe or the Agent’s response to their complaint.

Lodging a complaint

A person may lodge a complaint directly with WorkSafe or the Agent (the workcover insurer) responsible for administering his/her worker’s compensation claim by contacting one of the following:

WorkSafe
A WorkSafe complaints form may be obtained from www.worksafe.vic.gov.au

correspondence to: WorkSafe Advisory Service
Email: complaints@worksafe.vic.gov.au
Ph:1800 136 089
9641 1444

Allianz Australia Workers
Correspondence to: Customer Services
Email: N/A
Ph: 9234 3436
Fax: 8615 8180
 
Gallagher Bassett Services
correspondence to: Customer Feedback Co-ordinator
Email: customerfeedback_vic@gbtpa.com.au
Ph: 1800 446 062
Fax: 9297 9010
 
Xchanging (formerly Cambridge Integrated Services Victoria Pty Ltd)
Correspondence to: Customer Service Team
Email: customer.service@au.xchanging.com
Ph: Direct line:(03) 9947 3118
1800 801 070 – request to speak with a member of the customer service team
Fax: 9947 3340
 
CGU Workers Compensation
Correspondence to: Customer Feedback Team
Email: wcvcustomerfeedback@cgu.com.au
Ph: Direct line: 1800 635 635
8630 1000 – request to speak with a member of the customer feedback team
Fax: 8804 9417
 
GIO Workers Compensation (Vic) Ltd
Correspondence to: Audit & Compliance
Email: VICWCComplaints@gio.com.au
Ph: 1800 817 969
9860 3555
Fax: 1300 133 180
 
QBE Workers Compensation (Vic) Ltd
Correspondence to: Customer Service Team
Email: complaints@qbe.com
Ph: 1800 814 614
9246 2308
Fax: 9246 2044
 

Information to assist inquiries with the respondent

If you obtain the following information from a complainant, it will speed up the resolution by the respondent.

  • Full name of worker
  • Address
  • Date of birth
  • Claim Number
  • WorkCover Agent
  • Name of employer (company/business name not just individual’s name)
  • Complaint issues

These are provided as a general guide and are not intended to exclude other issues that may arise. If in doubt, contact the agency specialist or case manager.

WorkSafe advisory service versus complaint service

If-you-have-time-to-whine-and-complain-about-something-then-you-have-the-time-to-do-something-about-it

If you believe your workcover claim has not or is not being handled appropriately or correctly, WorkSafe vic (aka the Victorian WorkCover Authority) advises that you can contact the WorkSafe’s Advisory Service. However, fact is, many injured workers are not aware that there is a specific complaints service as well…namely the WorkSafe complaint service!

thumbs-upWorkSafe complaint service

 You can make a real complaint about your case manager or workcover insurer and that these complaints are taken very seriously by WorkSafe, which may penalise the insurer!

For example if your case manager has breached a conciliation ruling (not adhering to a ACCS outcomes certificate), you can and should make an official complaint (and no, not by writing to your case manager/insurer or by calling the WorkSafe Advisory Service!).

You can make a complaint about any wrongdoing/misconduct/ill-treatment by contacting the WorkSafe Complaint service- don’t be shy!

To do so you need to call (03) 9641 1555 and clearly state that you want to make a complaint and that you want the “complaints department” (and not the Advisory Service). You also need to ensure that you receive a complaint identification number.

WorkCover Assist (see below) is also able to make a formal complaint on your behalf!

Read more: WorkSafe advisory service versus complaint service

Common complaints about the Agents (workcover insurers):

  • Claims decisions: ceasing benefits with no reason communicated, delays, decisions not evidence based
  • Non-compliance to Model Litigant Guidelines or Accident Compensation Conciliation Service’s (ACCS) Code of Conduct or Ministerial Guidelines
  • Accident investigations and surveillance
  • Independent medical examiners – conduct and report content
  • Claims manager’s service delivery

Common complaints about WorkSafe:

  • Failure to prosecute an employer for an alleged breach of health and safety legislation or accident compensation act.
  • Failure to take action in response to a complaint about unreasonable actions/behaviour of an authorised agent and/or independent medical examiner
  • Unreasonable behaviour or actions by WorkSafe investigators
  • Imposition of penalties or unreasonable premiums on employers

Complaints about decisions: The Ombudsman

The Ombudsman generally does not investigate complaints about the merits of decisions where a merits review scheme has been set up under legislation. Exceptions may arise and should be discussed with the portfolio manager.

Where a person disputes a claims decision regarding liability for weekly compensation and/or medical & like services, they may:

  • request the Agent conduct a senior officer review before proceeding to the ACCS, or
  • apply directly to the ACCS for conciliation of the dispute.

Accident Compensation Conciliation Service (ACCS)

Where an injured worker disputes a decision relating to their workers compensation claim, they must attempt conciliation at the ACCS before initiating proceedings in the Magistrates or County Court. If the ACCS is unable to bring the parties to agreement, a genuine dispute certificate is issued. This enables an injured worker to appeal to the courts. ACCS is a free service.

Complaints relating to the ACCS, including the conduct of a conciliation officer, must first be raised with the ACCS by contacting:

Senior Conciliation Officer
Email:  info@conciliation.vic.gov.au
Tel: 1800 635 960 or 9940 1111
Fax:9940 1000

If a person is dissatisfied with the manner in which the Senior Conciliation Officer has handled their complaint, a complaint may be lodged with the Victorian Ombudsman.

Further information may be obtained from the website: www.conciliation.vic.gov.au

Note: Please contact WorkSafe portfolio managers before contacting ACCS for any complaints.

Support services for injured workers

thumbs-downWorkSafe Advisory Service

As mentioned above this “service” truly sucks!

A telephone based service, which assists claimants to understand decisions and processes relating to the accident compensation scheme as well as occupational health and safety matters. The WorkSafe Advisory Service will also handle complaints about an Agent.

 Note: although we rate this service poorly, some (but very few) individuals do go to great lengths to actually help sort a matter out.

Worksafe Advisory Service
Ph: 1800 136 089 or 9641 1444
E-mail: info@worksafe.vic.gov.au
http://www.worksafe.vic.gov.au/contact-us/advisory-service

thumbs-upWorkCover Assist

Is a free service which assists individuals who attend the ACCS in relation to workers compensation disputes. The service is funded by WorkSafe and falls within VO’s jurisdiction. In our opinion, this is the best service!

WorkCover Assist
Ph: 9941 0537
www.workcoverassist.vic.gov.au

thumbs-upUnion Assist

Further assistance in relation to workers compensation disputes may be provided by this free service set up and run by the Victorian Trades Hall Council. This service does not fall within VO’s jurisdiction.

Union Assist
Ph: 9639 6144
E-mail: info@unionassist.org.au
Fax: 9639 6155
http://unionassist.org.au/

Complaints about The Medical Panel

A 2007 Supreme Court decision (Nisselle v Brouwer) held that section 65(10) of the Accident Compensation Act 1985 and section 13(3)(a) of the Ombudsman Act 1973 means that the actions of the Convenor of Medical Panels do not fall within the Ombudsman’s jurisdiction. This means complaints regarding the administrative actions of the Convenor of Medical Panels cannot be investigated by the Ombudsman.

Currently there is — sadly—no independent body which oversees the actions taken by the Convenor of Medical Panels; however an individual may apply to the Supreme Court in relation to a Medical Panel matter. Individuals may wish to consider seeking legal advice regarding the options available to them.

Complaints about Conduct of Independent Medical Examiners

A WorkSafe Agent may require an injured worker to attend an appoint with an Independent Medical Examiner. Where a person wishes to complain about the conduct of an independent medical examiner, they should first complain to WorkSafe:

Manager – IME Service Branch, Rehabilitation and Medical Services Division WorkSafe
See website for postal address
 
 

Complaints against IMEs – WorkSafe Victoria (Online Claims Manual)

If a worker is concerned about the conduct of a s112 examination, they may make a complaint.

Complaints may include allegations of any of the following:

  • causing unnecessary pain in an examination
  • complaints of an examiner’s manner
  • incorrect reporting
  • inappropriate behaviour.

WorkSafe’s role

All complaints about IMEs should be referred to the IME Services Branch of WorkSafe (contact 03 9641 1757).

The nature of the IME complaint determines how the complaint will be handled. WorkSafe will only investigate administrative complaints. Other complaints in relation to the professional and ethical conduct of IMEs may be referred to either the:

Medical Practitioners Board of Victoria or relevant Allied Health Board or Health Services Commissioner.

Types of complaints

thumbs-downVerbal complaint

If a verbal complaint is received, the agent must:

  • register a complaint
  • advise the complainant that WorkSafe assesses all complaints about IMEs and that the complaint will be referred to WorkSafe
  • Notify WorkSafe immediately about the complaint by contacting the Health Services Group on 03 9641 1757.
  • The details to include are:
    complainants name (if not worker, please specify)
    claim number
    name of examiner
    outline of complaint.

Agents must not contact the medical examiner regarding the complaint or any matter related to the complaint.

thumbs-upWritten complaint

If a written complaint is received, the agent must:

date stamp the day of receipt
forward complaints within 24 hours of receipt to:

IME Services Branch
WorkSafe Victoria
GPO Box 4306
MELBOURNE VIC 3001

or fax immediately to 03 9641 1767

  • Include any relevant additional information in regard to the complainant or medical examiner, for example medical reports, IME referral letter correspondence previously received etc
  • place a copy of documentation on the worker’s claim file
  • notify the complainant that WorkSafe assesses all complaints about IMEs and that the complaint will be referred to WorkSafe.

Agents must not contact the medical examiner regarding the complaint or any matter related to the complaint.
Keep a register of complaints

Agents are encouraged to keep a central register to record the details of medical complaints against a s112 medical examiner, whether verbal or in writing. The details that may be recorded include:

  • date complaint received
  • medical examiner’s name and address
  • details of appointment
  • name of worker
  • claim number
  • name of employer
  • name of person or organisation making complaint, if different from worker
  • details of complaint
  • type of complaint:
  • verbal or written
  • administrative or medical
  • date complaint referred to WorkSafe
  • details of any action taken.

Referrals to s112 medical examiner who was the subject of a complaint

If the worker has lodged a complaint and specifically requested not to be referred to the IME again, agents should seek an alternative IME for future examinations.

Note: Only WorkSafe can remove a medical examiner from the approved list but agents can determine which medical examiners from the list are to be used.

Useful reads

3 Responses to “Workcover Vic complaints”

  1. Who is the best person to make a complaint in relation to return to work not being pursued?? I have attempted to discuss suitable or alternative duties with employer and insurance company and get shut down continually. Yet I keep finding out from colleagues that things I asked for to help return to work and was denied have been provided to other injured workers…… so frustrating.

    Thumb up 0 Thumb down 0

    • @Porsche47, have you tried workcover?
      Sometimes (well all the time really) our insurers /cm need to be reminded what their jobs entail…

      Thumb up 0 Thumb down 0

      • Dear Woowoo,i did tell one of my many case workers what his job wa s as I thought what do they pay you for,this case manager then proceeded to t reat me and speak to me like SHIT to the put I had to put in a written and verbal complaint my lawyer explained the laws of bullying etc it was given a new case mongrel sorry manager in a hour.

        Thumb up 0 Thumb down 0

read-before-u-commentThis is a statement pointing you to our seriously injured but esteemed and honourable Social Networking Sites Warning and our comment policy. A must read in the context of a very adversarial workcover system! Remember to mention in which state you reside if you seek advice.

Leave a Reply

Your email address will not be published. Required fields are marked *