Tag Archives: case manager

WorkCover denies taxi travel inspite of overwhelming medical evidence

What can I say but I am stunned! Today a friend of mine was denied taxi travel to and from medical appointments and treatments, which, by the way, had been officially approved in writing on 19 September. How’s that? Well, so they [the WorkCover Insurance Case Manager] tell my fellow workcover victim (who is seriously injured) that the reason for refusing the taxi transport is “because they need further medical evidence“…

Consider the following evidence in support of the taxi travel for the workcover victim

On the 26 of July the workcover victim’s treating doctor requests taxi transport:

After receiving the usual, routine run-around (read bullsh*t) from her case manager such as that there is no “clinical justification” that the workcover victim actually needs taxi transport; that there is nothing to say that the person can not drive a car (for God’s sake!); and that there is no reason that the person can’t take public transport; the workcover victim gets a second letter from her treating doctor with a clearer and more graphic explanation of the reasons why she can’t drive a car and can’t take public transport.

 

[I know the text is a bit small,so here is what it reads: “The requests provided by the GP were not really sufficient and he hasn’t actually provided clinical justification for providing taxi travel. There is nothing to say why you couldn’t still travel on public transport to appointments.” ]

Next, the case manager starts the process with the usual delay tactics and eventually writes a 2 page fax to the workcover victims treating orthopedic surgeon; who eventually even speaks to the case manager directly to explain in detail why the person needs taxi transport.

email extract from my friend's case manager

 

[“We have faxed a request to your treating surgeon to provide information with regards to taxi travel and are waiting on a response. The issue with taxi travel will be addressed in due course”.]

OK, done. Wrong. Now comes the need for the independent medical examinations, right. The first email my friend received was to say that she needed to be – hold your breath – psychiatrically assessed- in order for the case manager to make a decision whether or not my friend would be entitled to taxi transport.

email extract 17 August

[“We will make a decision once we have reviewed both the physical and psychiatric assessments”.]

The psychiatric “independent assessment” took place on 8 August 2011 and the report clearly states that:

[ Does the work-related psychiatric condition preclude the worker from travelling by means of public transport or car? If the answer is yes, please explain how. She indicated that there was considerable pain, and fear of being bumped. In my opinion, taxis are needed for her.”]

So now we have support from the shrink, good. On the 6th of September 2011 my friend is sent to an “independent”medical examination with a general Orthopedic Surgeon and he writes in his report:

[“Regarding her restricted function in the right upper limb, her dominant arm, I think the patient would be dangerous driving a car. Travelling as a passenger in a motor vehicle would be the best option. Travelling by public transport, with the jolting and jarring inherent in such transport would be a use of pain for her, and therefore I would think the appropriate form of transport for this patient is by taxi, or being driven by another person.

In general summary,this patient’s traumatic episode with reference to her right shoulder originally, has led to a high level of permanent impairment with very unfortunate results for her social, domestic and employment future, for which she had high expectations prior to the accident”.]

Note the last bit: “high level of permanent impairment”! And he clearly writes that my friend really needs a taxi.

WorkCover denies taxi travel to sriously injured worker in-spite of overwhelming medical evidence showing the need for taxi transport

So in summary here we have as medical evidence for taxi transport:

  • Treating GP
  • Treating Specialist orthopedic surgeon
  • Independent Psychiatrist
  • Independent General Orthopedic Surgeon

What the f***k more does WorkCover NEED, for God’s sake? This women is in a terrible physical state and on top of access to public transport from her house is as good as non-existent, unless you want to first walk 20 minutes, take a bus to a shopping centre, then a tram to a train station, then a train, then another tram, then walk again… and go back home. Not to mention try to carry something when your arm is hanging out of it’s socket, try using the Myky with 1 hand, try holding on when no seats are available and hey, be bumped into slightly and not so slightly by the busy, hurried crowds!!

On 19 September my injured friend thought that at last she had finally been granted taxi travel to and from her medical appointments. She received an email from her case manager stating:

email extract 19 September case manager

[“Dr…suggests that you require taxi travel and now that we have a decision regarding transport we usually book taxis at 3 monthly periods. So we will need you to indentify how many trips will be required over the 3 months period , the name and address of the treaters you will be seeing.

If you could provide this information as soon as possible so these can be organised.”]

In addition, she received a formal letter from the Cab company detailing that workcover (insurance company) had requested taxi be provided to and from medical appointments and treatments.

Today, 27 September my injured friend was told that she was no longer able to receive taxi transport – she nearly fainted. The email she received today:

[“Please be advised that [insurance company] is still awaiting medical information and I am therefore unable to approve taxi travel at this time. on receipt of the relevant information,I will provide you with further advice by email.”]

A taxi booking was requested to attend a scan for her shoulder injury tomorrow morning. This had been requested already on 19 September.

Isn’t this just outrageous? Is is a case of sheer incompetence, mistake? Or do you reckon they realise that the taxi costs are adding up and are desperate for a way out, hence they are seeking further medical evidence – but from where????

I frankly think this is absolutely disgusting and unprofessional behaviour. My friend is now stranded, beside herself, and in tears… and just can’t see how on earth she is going to get to the scan tomorrow morning (for which she already had a special injection 2 days ago) and which cannot be cancelled or postponed. She has no money to pay for a taxi. Her partner is interstate for a week and she has nobody to take her to the test. How can they be so cruel? Why did they not even tell her a day or two earlier, given that they knew she was to travel already on the 19th of September?

Shame on you WorkCover insurance company!

 

A WorkCover delay tactic and sheer incompetence at work

The last couple of days have been HELL for me again. I need to vent!

Not only was I recently told by my treating specialist surgeon that a bone infection (chronic osteomyelitis) is suspected in my [limb joint],which would explain a series of 7 failed major surgeries, night sweats, some fever on and off, general malaise, ongoing severe pain in the [limb], suspicious looking recent MRI and, now also the development of an acutely painful, red and swollen finger in the hand (which may or may not be  a case of an infection that has spread from the [limb joint] to the finger).

What is chronic osteomyelitis?

Chronic osteomyelitis is an established bone infection that has been present for a period of months or even years. It is often seen in individuals that have sustained open (contaminated) fractures, undergone multiple orthopedic procedures or had chronic wounds.

Draining wounds that fail to heal or intermittently reopen are suspicious for the presence of an underlying chronic bone infection. Additional signs and symptoms of osetomyelitis include local pain, redness, swelling and bony instability.

A series of lab and imaging tests are available to help your physician make a diagnosis. X-rays, MRI scan and a nuclear bone scan may be requested. Blood work may be draw to look for evidence of immune activity and inflammation (WBC, ESR, C-reactive protein).

The most accurate method of verifying the presence of chronic osteomyelitis is a bone biopsy.

Chronic osteomyelits is difficult to cure but can often be successfully controlled.

The cornerstones of treatment include complete excision of unhealthy bone, well-vascularized soft tissue coverage and administration of culture specific antibiotics.

The treatment of chronic osteomyelitis includes meticulous debridement (surgical removal) of all infected bone and scar tissue. Multiple trips to the operating room are generally necessary to fully cleanse the wound prior to any reconstruction. Antibiotic beads are frequently left in the wound between cleanings where they release a high concentration of antibiotic locally,etc etc.

WorkCover INCOMPETENCE exposed

My surgeon requests diagnostic tests, which are submitted to Workcover

My treating orthopedic surgeon started of (after the recent suspicious MRI) with a request for extensive blood tests, which I had done. The tests showed a few abnormalities including a raised infection/inflammation marker and severe Vitamin D deficiency.

Next, my treating surgeon requested a Technetium bone scan. This nuclear medicine whole body bone scan is used in evaluations of various bone related pathology, such as bone infection,  for bone pain, stress fracture, nonmalignant bone lesions, or the spread of cancer to the bone.

Because my bone scan (see picture) was positive, but because a bone scan cannot really differentiate between infection and inflammation (i.e. such as severe oestoarthritis), my surgeon requested I also undergo a Gallium body scan. In infections, the gallium scan is used to look for chronic infections.

Unfortunately at the time that my surgeon prescribed the Gallium body scan for the [limb] infection, my finger also had become red, hot and swollen and looked infected, so my surgeon also added onto his radiology referral form an x-ray for that hand.

After the Gallium scan I am to take a trip to the operating room and have bone biopsies taken in the hope to find the bug that is causing the infection, so we can start treatment with the right antibiotics before replacing the entire joint.

My case manager denies me the Gallium scan and the taxi transport to attend the test

I forwarded the radiology referral form to my case manager from hell sometime last week.

My stupid case manager told me that the request needed to be “reviewed” and that she would let me know of the outcome.

I explained to her that the Gallium scan is a standard test which is done after a positive bone scan when a chronic bone infection is suspected and that I did not see  why the request would need to be ‘reviewed’. I stressed the fact that a bone infection is a very serious matter and that delaying any investigation and or treatment will come at a great cost, not only for me,but also for the workcover insurance, because the longer you have the bone infection, the harder it is to treat, the more bone needs to be cut out, the more maimed I will be, the more impaired I will be and the more the workcover insurance will have to pay.

Right… On Friday evening, at 16:45 (COB), this stupid case manager refuses to pay for the Gallium scan and for the taxi transport to attend the scanning. Note that I was to have the Gallium injected on Monday (today – and I did) and the scan itself 48 hours later (on Wednesday).

She writes in her email of Friday (COB) that she had spoken to my surgeon who had told her that my finger has nothing to do with my workcover injury and that therefore the x-ray of the HAND (to see if there is an infection) and a Gallium scan of the BODY (to look for a chronic bone infection in the shoulder (site of work injury/body) will not be paid for nor the taxi to those appointments.

So, here is an UNEDUCATED, NON-MEDICALLY trained stupid case manager making decisions on her own based on twisted information, forced opinion, plain stupidity or to just delay my treatment(s). I mean how fu***ng stupid do you have to be not to be able to differentiate between a plain x-ray of a “reddened and tender” partially amputated finger (10 years ago) and which indeed has nothing to do with the work-related injury (UNLESS of course it is a case of spread bone infection from the [original injury limb] to that finger OR it a case of advanced RSD/CRPS (which I have in that arm following original work-injury) which causes in its end stages inflammation in distal joints which lead to deformities). If none of those 2 things are responsible for the “reddened and tender” finger, of course I will happily accept liability for the cheap x-ray which I had done last week already! And my case manager fully knows that I had the x-ray done already before she sent me that stupid email on Friday evening.

How fu***ng stupid must you be to even think that:

  • a simple, cheap x-ray of a hand would take two (2) DAYS!?
  • that anyone would prescribe a nuclear radioactive Gallium body scan scan/or a complex white blood-cell labelled scan for a stupid “reddened and tender” finger? Come-on!

Can this absurd, dump case manager NOT read or what: what does it say on the referral form? Two tests. An xray and a Gallium scan, and two (2) reasons of which the reason for the Gallium body scan (or WCC scan) is “multiple R shoulder surgeries, with known infection 6 years ago ,ongoing pain (in shoulder etc), ? chronic infection

Perhaps my surgeon should have put each test on a separate form because obviously these non-educated mere clerks cannot differentiate between an x-ray and a nuclear medicine test for two different reasons.

So, this idiot (case manager) left me FURIOUS over the weekend and stranded. I went to see my GP over the weekend who told me NOT to DELAY the Gallium scan at any cost. So I had the displeasure to catch public transport (which is really not advised on doctors orders because of the way things are -very fragile), as I did not get my taxi.

So off I went this early morning, bus, tram, train and had the Gallium injection. In 48 hours time (Wednesday)I have to go back to the hospital for the scan itself because it takes 48 hours for the radioactive gallium to get to your (infected) bones.

I have written several emails to this stupid woman and cc’d to my surgeon and hope to be able rectify the issue asap. Otherwise I’m in for a case at the ACCS again…and I am tired and exhausted and just sick of having to fight all the time for what I am legally entitled to!

Interestingly the stupid, vindictive case manager from hell has been hiding all morning – I have not heard from her – whilst she tends to overwhelm me with harassing emails on a daily basis.

 

I really believe that Case Managers should be mandatory trained healthcare professionals in the first instance, i.e. hold a nursing degree or something similar. They make decisions everyday about OUR health care and treatments, on their OWN and don’t even understand what a doctor writes. This is so so scary, especially when you suffer from something severe and potentially life-threatening, like an infection or an unstable spine. Yet those donkeys have no fu***ng clue and play GOD. “I, who is uneducated, illiterate, non-medically trained, and I,who have never even seen you, decide what treatment I will approve and what not”.

Grr… I am ENRAGED!

Another recent example of my donkey’s behaviour was that “after she had spoken with my specialist orthopedic surgeon” she needed an “objective” assessment by an IME. Well donkey sent me to an 86 year old general orthopedic surgeon – I kid you not. One of donkey’s questions to the IME was what type of surgery (number eight) I should have. Well, first of all donkey must have “forgotten” that I had been sent to the Medical Panel by her colleague donkey 2 weeks earlier. You can only send someone for a permanent impairment assessment/rating when the injury is considered “stable”, which means, yes, that I signed a very legal document with my solicitor stating that it is my wish not to have further surgery for the foreseeable future given that I had undergone 7 failed massive procedures with many many complications. So, for an injury to be considered stable you are not allowed to have further surgery in the “foreseeable future”. At that time, we did not know yet that I may have chronic osteomyelitis (we only realised this at the last stage of the Panel 3 weeks later and the Panel rightly suspended the impairment assessment because of “injury not stable”).

The 86 year old IME, who never ever operated on this sort of injuries in his whole life by the way, was of the very old-fashioned opinion that I should have procedure X done (massive surgery). This procedure X has been abandoned about 20 years ago because it causes a hell of complications and is irreversible. They may in very very rare occasions perform this procedure on very old people (75+) to help alleviate pain. Isn’t that shocking? In addition the procedure involves bone-union (growing of bones together). Now consider that I have most likely osteomyelitis (if not, severe osteoarthritis) and consider, most importantly, that I have very severe Vitamin D deficiency, which includes lack of calcium and phosphate. This means that my body is totally unable to grow bone or heal a fracture… do you know what I mean? Jeezus. ..oh boy, oh boy!

The worst part undoubtedly is that I am medically trained with 20+ years experience and I know too much for my own good and so I see all these things and “opinions” and lie awake at night worried sick about my fellow workcover victims, who may not even be aware that they are misinformed, mislead or given the wrong treatment(s).

Sigh, sigh…

Navigating the work accident war zone: tactics used by workcover agents

Did you know that the day you were injured you entered a war zone with the workcover insurance industry!

Workcover insurance claims managers, including case managers will use any means necessary to pay out as little as possible, even on legitimate claims that involve serious injuries.

Workcover insurance claims managers receive extensive training on how to save the insurance company money, and not necessarily on how to examine a claim and pay a fair settlement.

Many workcover insurance companies reward their case managers and claims managers with bonuses or promotions based on how much money that person saves the company rather than how many claims are resolved.

The claims manager/case manager accomplishes this in many ways:

  • Using Delay tactics: The case manager is a master of using delay tactics to wear people down. He knows that many people will at some point throw up their hands and say “enough!” and finally accept the workcover insurance company’s last offer just to be over and done with the whole stressful process.
  • Requesting Unnecessary Information: Another method is when the case manager makes repeated requests for “documentation” even if the information will have little or no bearing on benefit to be approved or the amount that will be offered in “settlement”. Repeated requests for unnecessary documentation can easily frustrate people and wear them down so they’re more likely to accept a lower benefit or settlement offer.
  • Disputing the Medical Treatment: Another way the case manager will try to minimise your claim is to dispute or question your need for medical treatment, despite having no medical training! (and even if the treatment is prescribed by their own doctor!). Often it does not matter to the case manager that your treatment has been recommended by a reputable  physician or specialist. A “triple play” is very common with doctors’ requests for medical tests such as MRIs. The insurance case manager delays response to the doctors office’s request for approval, then requests “documentation from the doctor” and then the case manager says the MRI is not necessary. Six months later, you finally get the MRI and the correct treatment. What has the delay cost you? A slow medical recovery, lots of pain, financial stress and possibly the loss of your job!
  • Failing to Advise an Injured Worker of All His Benefits or Any of his Obligations. The case manager doesn’t have to tell you that certain types of benefits even exist! I have never known in my 7 years on workcover  a case manager to freely give this information. What is worse than not getting “fully made whole” is to lose your benefits altogether, i.e. because of time limits!
  • Acting as Your Friend. There are times when the case manager from hell will try to “befriend” you and make it appear that she is watching out for your interests when in fact she is not. Sometime the case manager will give you advice about the type or frequency of your medical treatment, and then decide later on not to pay for the treatment because it is “excessive.” The worst is directing you to change physicians to a “company doctor.” (i.e. a doctor who is more easily persuaded to state nothing is wrong with you and certify you fit for work.)
  • Making False Promises. There are times when the case manager will make promises to you that he or she knows can’t be met. For example, I know of a fellow workcover victim who was promised that the workcover  insurance company would pay for her to go to TAFE course. This went on for months until the injured worker was resigning her light duty position and retiring to attend the full time TAFE courses. The problem was that the injured worker didn’t find out about the insurance company’s decision  not to pay for the classes until she had resigned!

Real examples of dirty workcover tactics

My specialist orthopedic surgeon recently requested a high reslution MRI. Whilst no prior-approval is required for an MRI if it is requested by a specialist, I needed to have a letter addressed to the radiology clinic detailing that the MRI would be paid for by workcover (they refuse – rightly- to undertake any MRIs without prior approval). A week alter I still did not have that 2 word letter.My treating GP sent a fax to my case manager stating that PROMPT approval was needed as I was in terrible pain and the MRI was deemed urgent. Well, it took my case manager 28 days (almost 1 month!) to write me that 2 word letter for the radiology clinic.

My treating specialist orthopedic surgeon recently requested I undergo extensive blood tests as part of an investigation for an infection in my injured limb. The request was filled out by the specilialist surgeon and the slip detailed that the reason for the test was to look for an infection because a (limb) scan had showed some suspicious spots. The case manager from hell refused to pay for the blood tests (amounting to $432) because it was her opinion that the blood test had nothing to do with my injury. It eventually took over 2 months and several “debt collector”letters to have that bill paid. For Christ’s sake!

A very reputable pain specialist/anesthetist had prescribed me an anti-epileptic drug which is also used to treat nerve pain. The case manager again refused to pay for the drug stating that it had nothing to do with my injury. She was well aware that I had suffered a serious nerve injury during the previous [limb] surgery, and for which liability was accepted! In the end it took several visits to my pain specialist and GP to get additional unnecessary documentation (at workcover’s cost) and after 65 days the drug was paid for. Meantime I was struggling to pay for the expensive drug, being poor as hell!

 

These are just a few of the tactics that the workcover insurance industry uses to badger and wear down injured victims so that less money is paid out.

And to a large extent, the industry has been successful!

The workcover insurance industry will do everything possible to withhold fair settlements and deny valid claims until you convince them that you are ready, willing and able to go the limit. But do not be discouraged. You CAN achieve fair compensation for your injuries and beat the insurance industry at their own game. But it may take time and lots of effort.

Hang in!

 

 

 

WorkCover has morphed into “Mother May I” medical care

Workers’ Compensation has really morphed into “Mother May I” medical care system.

Mother, may I have some physical therapy for my injuries?

No you’ve had enough already…

 

Mother, may I have some psychological treatment to help me deal with my  injuries, PTSD and depression?

No, you can talk to me [case manager]

Mother may I have the surgery that will make me a whole person once again?

No it costs too much…but maybe in 2 years’ time….

Mother may I have a power chair so that I can get around my house?

No our expert clinical review doctors who have never met nor examined you don’t feel that it will help you!

Mother, may I now  have much needed home help which I requested 4 years ago?

No, I [case manager] who have never seen you believe that you can still crawl and hence lick the floor clean

Are You Sick & Tired of rampant workcover insurer fraud that goes unchecked?

 

  • Judges who will ignore it!
  • Legislators who will condone it!
  • A worksafe Comissioner who closes his eyes to it!
  • Lawyers who look the other way while their clients are being victimised by it!
This is the type of fraud that destroys and ruins the lives of injured workers and their families!

It is truly unbelievable, the extent that workcover insurers will go to to deny you the benefits to which you are legally entitled to. Their lawyers are “Master Manipulators” of the law and they will spend obscene amounts of money to make sure that a dangerous precedent is not set; that of an injured worker actually getting the proper treatment that he or she is entitled to under the law!

The most serious defect of the workers compensation system is that there is no real deterrent such as real audits, enforcement, or statutory penalties.

Did you know: The goal of the workcover insurance  has nothing to do with the cost of an individual claim. A single claim is nothing more than a small part of the total “statistical” outcome that the workcover insurance company monitors. There is also no consideration to the medical aspect of a claim, it is only about how little money it will take to resolve the claim.

For example, if 100 claims are filed and denied, this will result in only a small number (less than 10 percent) of “claimants” who fight back.

Most injured workers will just accept the denial as a painful reality and succumb to the abuses of the system because they don’t know better.

Of the few that do file a grievance,complaint or an appeal, only a small number of those will result in benefits being awarded and most will be denied or unfairly settled due to the “discretionary clauses” designed by, and exclusively for, the workcover insurance industry.

Remember, insurance is a business and a claim is a debt that has to be resolved.

Unfortunately, the more a case manager/claims manager/whatever demonstrates an ability to resolve claims, by whatever means, the more claims/cases they will be responsible for, which will save the company even more money. Eventually, greed becomes the motivation; the greed of the workcover insurance industry’s desire to make a profit, coupled with the individual greed of a case manager/claims manager (or, yes, examiner) to be paid more for their work; morals, ethics, and adhering to the law become secondary considerations.

There is a psychology used in the claim process that makes this all easier to live with, except for the injured person. You will note that there are no personal references; almost always terms like the Worker, injured worker, Claimant, Patient, and/or Applicant are used in place of more human terms, this step alone removes the need or desire to be compassionate or caring when evaluating a claim. If you are nothing more that a statistic, you will never be respected as an individual or even seen as an injured person.

“Nothing personal it’s just business”.

We’re not afraid to “Get In Their Faces!” If you aren’t either, then join us! And do your part to stop the fraud and corruption that simply goes unchecked. It’s up to you. Put your best foot forward and be counted….. and together we can try to fix this mess. The choice is yours….
If you don’t get involved you have no one to blame but yourself!

Please share your stories!

 

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…

My workcover case manager is making me sick

A few days ago, I posted “can I put a restraining order on my case manager“, and while the answer is YES, it doesn’t mean that your horrible workcover case manager will refrain from harassing and bullying you in a different way. In my case, we successfully put a “restraining order” on my case manager about 12 months ago – she was not allowed to contact me directly and all correspondence was to go through my solicitor and/or medical practitioner and direct contact with me was prohibited unless prior approval was granted.

Well, what can I say… Whilst this nutter of a workcover case manager ceased to phone me (up to 10 times per day), she soon found another way to make me sick by emailing me  constantly and several times per day on my personal email address. This in-spite of having emailed her personally that she was not to contact me via email (all contact was to be via letter) and that all her emails would be deleted unread.

In a way it’s good she persisted on emailing, because the contents of her emails can now be used as evidence of her disrespectful, uncooperative, dishonest, incompetent, harassing, demeaning and obstructive behaviour. On the other hand she is making me sick and I start feeling nauseated just opening my personal email inbox.

Some specific examples of my case manager’s emails

  • attempting to cease my psychology entitlements whilst I just had been referred to a psychiatrist (by my psychologist) for severe depression after I had been illegally sacked by my employer
  • stating that “I did not need to see a psychologist or psychiatrist because I could talk to her (WTF!)
  • ignoring the ACCS ruling entitling me to have as many psychology sessions as required (as per the Act) and in fact refusing to pay a psychology bill of over $700 (when confronted by the ACCS she stated that it ‘had been an oversight’
  • sending me to a vocational assessment whilst certified unfit for all work by my GP, psychologist, orthopedic Surgeon, Psychiatrist and independent psychiatrist
  • not providing me with a list of three choice service providers for occupational rehabilitation and making a direct appointment with her provider of choice
  • overriding a previously approved special orthopedic brace – i.e. we received approval for a brace requested by my treating orthopedic surgeon, purchased it (very expensive) and then one month later received a letter that the brace was not approved – again when confronted my case manager simply said that ‘it was an oversight’
  • ceasing my physiotherapy entitlements ‘because I am not improving” and failing to realise that when you cease physio on a severely damaged joint, the remaining muscles and tendons will also start deteriorating – which happened to me (for which I now have to undergo major surgery number 7).
  • making me wait 28 days to write a 2 line approval letter to the radiology facility where I was to undergo an MRI (the radiology facility insisted on having an approval letter),whilst 1) the request for the MRI came from my treating specialist (no prior approval is needed for an MRI in that case) and 2) my GP had sent an urgent fax as a follow-up requesting PROMPT approval for the MRI as I was in a very bad shape
  • when she was told that my injury had significantly deteriorated (MRI,report from surgeon and request for major surgery-approved by her!) she stated that “she was not interested in my physical condition, but only my psychiatric condition”
  • my case manager – whilst aware of the severe deterioration of my injury (request for major surgery etc) sent me to a shrink for an independent assessment because she needed to assess ‘my ability to engage in rehab and return to work…’ (WTF?)
  • my GP requested taxi transport as well as  my orthopedic surgeon but whilst my case manager allowed 1 taxi travel (to an IME) she stated that I should not assume that this (taxi transport) would be ongoing…. as she first had to have me assessed psychiatrically and physically before making the decision whether or not I would be allowed to travel by taxi. WTF – given that she had spoken to my orthopedic surgeon and has all the clinical evidence on file, including recent MRIs, emergency x-rays, requests for major surgery and the explanation from my surgeon on what was going on with my injury
  • why did I not tell her on the day that I had to go to the emergency department with a dislocated joint that I was going to the emergency department – WTF
  • sending me to a physical IME because she needs an “objective assessment of my injury” (of course by an IME who has no expertise in the field of this type of injury) after ‘having spoken to my orthopedic super specialist”… Can you make sense of that?
  • stating that there ‘is no reason why I could not drive my car’, whilst she had just received the emergency department x-rays (showing dislocated joint), MRI results and requests for major surgery… WTF?

Anyway, there are lots more examples… but just recalling them makes me fully sick. Is your workcover case manager also treating you like a criminal or a piece of s**t?

I have now instructed my solicitor to ‘deal with her’ and have her immediately replaced, for I will not tolerate this kind of treatment any longer. Life is hard enough as it is at the moment and I don’t see why I should be constantly insulted on top of it all.

[dictated post – apologies for spelling mistakes ]
resraining-your-work-cover-case-manager

Can I put a “restraining order” on my work cover case manager?

Is your work cover Case Manager driving you nuts? Is he/she calling you multiple times a day? Do you feel harassed? Are you becoming scared of picking up the phone? Do you feel that she/he is aggravating your emotional/psychological state and/or recovery? Sounds familiar? Well, here is some good news for you:

Yes, you can stop your case manager from contacting you directly!

 

I personally was inappropriately harassed by a Case Manager for a number of weeks. I was receiving up to 10 phone calls per day and the nature of those calls were really making me sick.

One one occasion, shortly after having been (illegally) sacked by my employer based on “impairment”, I was extremely upset and depressed, to the point where I felt that I would be better of dead… Well, this Case Manager kept phoning me to tell me that “I should work” and that “she knew I could work” and that “she would be sending me to occupational rehabilitation/retraining” and “make sure I would return to work”.

Given that I had been sacked a few days before – and that my horrible employer terminated my long standing employment (we’re talking 6-7 years after the injury/accident) based on “impairment” (read: refusing to make some ergonomic changes to my work place before and after my latest surgery), I strongly felt that it was most outrageous that my case manager could behave like that. I mean he/she (work cover) was certainly also responsible for my sacking as they failed (for many years) to ensure that I would be accommodated in the work place with the medically requested and reasonable tools. Moreover, I had just been certified unfit for all work by my GP and treating psychiatrist.

So, I get sacked because my employer basically says that I can’t work (I am too disabled – mind you I was not too disabled up to 3 days before the last surgery and did the same job in a much worse physical state!), and I was doing office work for God’s sake! I plunged into a very severe depression and had been certified unfit for all work by my treating GP and Psychiatrist . So, here I was, devastated and receiving all these inappropriate calls from my case manager. I was starting to feel really sick when he/she called and at one point had a nervous breakdown on the phone.

Anyway, to cut a long story short, I consulted my lawyer and asked if it was possible to put some sort of restraining order on that case manager. Well, the answer is yes! I am not sure exactly on the legislation involved but it is about your civil rights.

Here is an extract of some correspondence with my lawyer at the time (and I am pleased to say that I have never received a phone call from my case manager since ;))

 

resraining-your-work-cover-case-manager

click to enlarge

So, don’t put up with any s**t from your ‘case manager’!

Request for MRI under workers compensation

What is a Magnetic Resonance Imaging (MRI)?

Magnetic Resonance Imaging (MRI) is a radiological investigation to create cross- sectional images of the body.  These detailed clear images are used by medical practitioners to diagnose and investigate a range of conditions.

An MRI service requires a referral and consists of imaging, reading and providing a written report by a radiologist.

 

Referral for an MRI from a surgeon, registered consultant physician or specialist

If your surgeon, consultant or specialists refers you for an MRI, you do not need prior approval from work cover (your case manager) for the MRI.

However, some Radiology facilities (i.e. Olympic Park Imaging) will require an approval letter from workcover for any MRI, even if it has been prescribed by your surgeon or specialist.

In this case, simply ask your work cover case manager to write you a letter addressed to the Radiology facility, stating that the MRI has been approved and will be paid for by work cover. Your case manager should be able to do this immediately. However, make sure you tell (or write/email) your case manager in “child language” what it is you are after (because they don’t understand plain English!)

Example (true story):

My surgeon referred me for an MRI. I sent the MRI request form (from my surgeon) through to my case manager and asked her for a letter of approval stating that the radiology department had requested one and will not undertake any MRIs without a letter from work cover, detailing that the MRI has been approved and will be paid for. After a few days I did not hear back from my case manager. My GP, whom I happened to visit a few days later, wrote a letter to my case manager, stating that my surgeon had requested an MRI and could she please ensure prompt approval as I was in great pain. This letter was faxed to my case manager, again with the request to provide me with a simple letter for the radiology department. Well, about 3 weeks (!!!) later I contacted my case manager and her Team Leader and told them that I was still waiting for that letter for the radiology department. They told me that the request for the MRI needed to be reviewed by their in-house doctor before making a decision whether or not they would approve the MRI  (- which was requested by my surgeon, and made urgent by my GP-). A few days later (we’re now waiting 25 days) my GP tells me he had been contacted by the work cover insurance ‘house doctor’ to discuss the need for the MRI!

28 Days after having sent the urgent referral from my treating surgeon to my case manager, I finally obtained that 2 line letter for the radiology clinic, stating that the MRI had been approved and would be paid for by work cover.

My case manager insisted she had 28 days time… in-spite of me writing to her that I would hold her personally liable for any additional damage I would sustain and that I would rely on our correspondence in a court of law.

NO- she did not!!! An MRI requested by a surgeon does NOT need prior approval ! Needless to say how frustrated we (me and my surgeon) were. Imagine, you are in f***** agony, have done some serious damage to a body part, your treating surgeon and your GP feel that you need an urgent MRI, and they make you wait (inappropriately) for nearly 1 month before writing a 2-line letter! WTF!

What is wrong with these people? Are they illiterate? Are they just trying to wear you down until you give up? Or are they plain stupid?

Extract of WorkSafe’s policy regarding MRI’s

Is prior approval required for an MRI service? An injured worker may be referred for an MRI service by a consultant physician or specialist recognised for this purpose by the Commonwealth Health Insurance Act (1973). In these cases prior approval from a WorkSafe Agent is not required. It is recommended that the referring consultant physician or specialist contact the WorkSafe Agent to confirm that their patient has an accepted claim and that the region to be scanned correlates with the region of the accepted injury.

Read WorkSafe’s Policy here

Request for an MRI by your treating GP

WorkSafe will consider a request for an MRI service by a treating medical practitioner other than a consultant physician or specialist, where access to consultant physicians or specialists is limited and provision of the service would be expedited by a referral from the treating medical practitioner.  In these cases prior approval by the WorkSafe Agent is required.  The treating medical practitioner should provide a written request that includes a working diagnosis, an outline of examination findings and a clinical rationale for the MRI service.  A medical practitioner at the WorkSafe Agent will review these requests on a case by case basis.

I would love to hear about your stories!