It’s now 2015, we’re back, I’m back. Case Managers are back. Legislators are back. Judges are back. Workers are back, and Business is back. And Boy, was 2014 a tumultuous year for a couple of workcover schemes…
Again, following a series of rather rude and inappropriate comments posted by injured workers to fellow injured workers, it is more than clear that many injured workers harbour a great deal of anger and resentment.
“I was once told that I was stupid and useless. It took me years to overcome that one sentence because, tragically, I believed it. However, I have since learned that it had more to do with the person who spoke those words than it had to do with me….”
Dear Mr Lawyer -Thank you for your letter. If you were up to date with workcovervictimsdiary.com you would have had no need to threaten us with a “defamation” lawsuit as we already published our reply to your client misguided attempt to advise us, the administrators of workcovervictimsdiary.com of our rights at law.
This and what follows is the official reply we – the site’s administrators – sent to Mr Lawyer of the very retaliatory and well known victorian based bia*ed IME shrink…
You may have heard, through the grapevine (comment section), that workcovervictimsdiary.com was, again, threatened with a most unfounded and utterly pathetic lawsuit for “defamation” by an “independent doctor“, a psychiatrist no less! The most unfounded and intimidating “defamation” allegation referred to two anonymously posted comments by two injured workers-dating back almost one year ago!!! – who had been, unfortunately, “assessed” by this IME psychiatrist and who did not even refer to this “doctor’s” full name, location nor identifiable features! The IME and his/her lawyer were not even capable of giving us an exact date of when the alleged “offensive” comments were published, and not even a link to these”offenses”.
You won’t believe it, but during the sheer stress and grief of having my site under DoS attack, I also faced ongoing “denial of service” – basic medical care – from Xchanging and my perceived adversarial case manager. On this occasion they denied me physiotherapy treatment, notwithstanding I suffer from an end stage shoulder which requires a joint replacement. As usual- and despite hundreds of medical reports- “additional information” was requested by my case manager to justify why physio would be “reasonable”. I obviously asked my treating GP to respond to this [outrageous] demand and, to my delight, he formulated an interesting response to my case manager. Injured workers doctors ought to follow his example and speak and stand up against the ill treatment of their injured patients by workcover agents!
Injured workers medical practitioners ought to stand & speak up against ill treatment of their injured patients by workcover agents
The workcover insurance companies are a for-profit business and all and any”benefits” are routinely denied, even to those severely injured workers who are in desperate need. They are trained in the art of bullying, intimidation and denial and will make all injured workers fight for their meager “entitlements”.
The most frightening part is that case manager’s medical knowledge is very limited to non-existent but they can make sweeping decisions that have major impact on the injured worker!
The stance of today’s Case Manager (hell- why I am even bothering to use capital letters here!) has been termed “adversarial help“, with priorities of simple cost containment set by department heads and supervisors. Not to mention the carrot on the stick – $$$ bonuses for achieving certain KPIs of course!
Letter to my Xchanging case manager written by my treating general practitioner
[Click on the image to enlarge]
Treatment of injured workers by workcover agents
And, what’s worse, our workcover system, supposedly to protect injured workers, continues to erode away injured workers rights and benefits, without anyone noticing – except of course the employers and the workcover insurers that have brought about these changes and who profit from it insanely. Look at what’s happening in NSW!“Starving them (injured workers) out” is the key motto and modus operandi used by workcover insurers.
Not only is workcover [the workers compensation system] not there to help, except to help stuff the deep and overflowing pockets of their workcover insurance agents, but it also routinely adds to the enormous burden to be faced by injured workers. It forces a BATTLE for medical (and like) treatment and for general weekly pay, of the very SURVIVAL of the injured worker – and at the same time that it accuses us (injured workers) of faking, exaggerating and malingering it, even the deceased worker of causing it (his/her own death).
What on earth has happened to our good ol’ Australia? A country that now allows workcover, corporation and insurers to literally throw away the lives, and the health of so many injured workers, without caring, and without fear of being exposed or being held accountable? Well, it’s called workers compensation – but I prefer the term workcover terrorism – the very system we thought was there to protect us if we were injured at work.
Workcover case managers and dirty tricks
The (medically untrained) WorkCover case manager
- Never have to answer the phone – voice mail only
- Do not return calls – no expiry date either
- Assume no continuity of care – it appears some insurers change their case managers like underwear
- Deny petty things like physio a neck pillow, 30 min massage, home help- for what? Don’t they realize how fu**ing demoralizing that is?
- Can be late with payments without reason. Then don’t answer calls…
- Order potentially painful Functional Capacity and other repeated”Assessments” without good reason
- Order “vocation assessments” when you haven’t slept for a week, can’t see straight from the pain and are actually thinking that you may be best off dead
- Always infer that you can be cut off at any time
- Make promises – sometimes in writing- then change their minds
- Cut people off to see what happens
Workcover insurance case 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.
- 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 service 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!
All this can have a devastating effect on someone who is severely injured and lives with chronic pain.
I refer to an earlier article stating that the Australian Medical Association (AMA) has told the NSW state parliamentary inquiry that poor administration and red tape are to blame for blowouts in the NSW workers’ compensation scheme. The AMA NSW vice president told the inquiry that benefits to the genuinely injured and disabled wouldn’t have to be cut if administration could be streamlined. And I ask myself the question who is actually investigating the mega-layered administration which is clearly driving workers compensation costs?
Who is investigating the multi-layered administration driving the costs of workers comp?
Fact is that when you have suffered a workplace injury, and even though your liability for your injury may have been accepted by the insurer, the injured worker becomes not only the suspect but also the enemy – and hundreds of thousands of dollars are spent by insurance companies just in order to mitigate their losses, by endless bureaucracy, administration and red tape. That is: insurance companies will put the suspect and the enemy under increased scrutiny, by delaying and denying legitimate benefits (i.e. medical and like services) and by sending the injured workers to endless so called independent medical examinations (in the hope to have their injuries or capacity for work changed); utterly useless rehab service providers and repeatedly demanding the same information over and over again in order to approve or – more likely- to deny a service (i.e physio, home help, counseling etc.). The bureaucracy [administration and red tape] and attached costs involved is actually mind-boggling.
Multi-layered administration examples
Just to give you a recent example, I was not long ago asked by my treating upper limb surgeon and GP ” to have a crack at physiotherapy” in order to help me re-enlocate repeated shoulder joint dislocations or subluxations and to help unlock my shoulder blade which has recently started turning 90 degrees, with the tip of the shoulder blade literally moving into my armpit. A medical referral to a my (former) physiotherapist was subsequently made and sent to my case manager for approval.
I attended 2 physio sessions and submitted the account (I had paid for myself) to my case manager along with the medical referal (prescription) for physio and a copy of an email from my upper limb surgeon requesting I have a go at physio with a focus on scapulo-thoracic exercises.
My submitted accounts for physio were rejected and sent back to me along with a letter stating that physio is “unreasonable” for me, however, provided I could submit them a detailed letter/report from my treaters – within 28 days- explaining the need for physio, the relationship between my injury and phsyio; why physio is reasonable, explain the gap in treatment and provide them with a detailed physio treatment plan; my case manager may review the information supplied and review her decision to deny me prescribed physiotherapy.
I emailed my case manager again and explained to her that I did not understand the need for the “additional information” (a lengthy report), given that I had undergone 7 massive but failed shoulder reconstructions; had been diagnosed barely 6 months ago with an irreparable shoulder, end stage traumatic osteo-arthritis and end stage rotator cuff failure, which requires the insertion of a reverse joint prosthetic, as detailed in my upper limb surgeon’s surgical and follow up reports, including a medico-legal report dated April describing the rapidly deteriorating shoulder status and prognosis as “dreadful”. In addition I pointed out to her that the barely 12 month old “independent medical assessment” also clearly stated that I would need “indefinite supportive and palliative care”. I attached all reports and again ensured she understood that she was denying me physiotherapy on a joint that needs an urgent prosthetic. I also pointed out to her that my former case manager had taken it upon her uneducated self to cease my physiotherapy treatments 2 years ago (even though I underwent another 2 surgeries after that and was prescribed physio!) and this explained the “gap” in treatment, as she should be aware of.
Well, it wasn’t good enough for my thick case manager stated she needed a new report/letter from my treaters explaining the mechanics of my initial worklplace injury (8 years ago); my injury status; the relationship between my injury and physio, why physio would be reasonable etc.
So even though I sent her recent pictures of my shoulder, the reports and the referral letter for physio and that she has – indeed- more than enough hard evidence [I am talking about more than 50 medical reports] to make the decision that hey, physio is reasonable on such a severe injury, physio is still denied to me!
It is a false economy! Considering that the workcover insurer now has to pay for additional visits to my GP and surgeon (to request the report and give them a copy of all the questions that need answering); they have to pay for my transport (taxis) and for the reports that will be prepared (probably $250 each). So in order to try to deny me an entirely appropriate, reasonable and legit treatment, and not to pay for a $136 physio account, they will happily pay around $1000 all together (medical appointments, taxis, reports). So in the end my benefit will have cost them $136 but they will have spend 10 times the amount ($1000) plus hospital emergency department visits so I can have the severely painful dislocations rest …
Another insane example is that I was denied home help. Part of the process required an “OT assessment” (which costs money). Subsequently I requested a “senior review” after my heart had failed as well during the last surgery. Another OT assessment was undertaken and still I was denied hone help. The matter went to conciliation. This cost the insurer about $750 just on medical reports (ortho surgeon, GP, pain specialist). The conciliator eventually had to refer the matter of “home help” to a full medical panel as I wanted to have a most reasonable 2 hrs of cleaning per week rather than the 1.5 hours per fortnight offered by the smug insurance representative. Now, brace yourself, because I also had to be assessed by a psychiatrist at the medical panel (WTF!) for “home help” on this shoulder, as well as by a panel of another “3 experts”. The medical panel charges a flat fee of $5000 and this does not even include additional medical reports I submitted (and insurer paid for). The psychiatric assessment for “home help” also re-traumaitzed me half to death, having to regurgitate all the traumas that happened to me (incl. 2 near deaths). The consequence was that I suffered from a severe PTSD crisis, which needed intensive medical treatment. So the insurer now also had to pay for psychiatric and psychology services (treatment) as well as new additional medication. Again, what did I as the injured worker “benefit” out of this insane bureaucracy? And how much did the insurer pay in order to attempt to avoid having to pay for increased home help? The money they spent on this could have bought me home help for 2 or 3 years! And because of the insane delays (red tape) I found myself without much needed, medically prescribed help for an extra year, which only aggravated my physical (and emotional) condition.This is the reality. This is how workcover “works”.
Bureaucrats fear their superiors and try desperately to impress them.
Bureaucrats suppress their humanity and sense of decency.
Bureaucrats praise their own accomplishments in order to obscure their cruelties.
Bureaucracies protect and hide the incompetent.
I have been asking myself over and over again
- I ask myself who on earth is investigating the multi-layered administration which is driving the workers compensation and cause “massive budget blowouts”, for which people like Barry O’ Farrell believes injured workers are responsible – given that in his uneducated opinion injured workers’ meagre benefits need to be cut even further?
- I also ask if there are any additional team or personal bonuses being paid to insurance companies or case managers when benefits (i.e. physio, home help, counselling, surgery, MRI etc) are successfully denied to injured workers?
- I ask whether any team or individual bonuses are being paid when injured workers are sent back to work (and as such cut off weekly pay) – regardless of their injury status (i.e. certified unfit for all work by own specialists, even IMEs)?
- The lower echelons of workcover insurances (i.e. case managers) repeatedly and consistently call, threaten and even bully our own treating doctors and specialists ‘fishing’ for a way to have their injured patients returned to work regardless of the medical status of the injured patients – does this mean that insurance companies (and staff) receive bonuses for shunting injured workers back to work regardless of their medical condition? To me, it certainly appears that insurance companies work on a “sales man” model, where monetary incentives are given for achievements
- Why are no questions being asked? We challenge the media to investigate and to uncover the truth
- Like any other type of bureaucracy, it feeds of the “system” – and I ask myself why has this not been audited (and re-audited) and why is the public not informed?
- In my experience workcover insurances recruit front line people (those working in the trenches such as case managers) who are extremely young, inexperienced, totally under-trained, who have not even basic anatomy knowledge and who lack the experience, maturity and knowledge to handle such responsibilities (such as denying vital medical care, forcing badly injured workers to work and in doing so seriously aggravating their injuries etc.) These case managers are not only unable to read our medical or case file notes; they do not acquaint themselves with our cases (i.e. the need to demand the same medical information over and over again); they have no medical training whatsoever and yet are very much involved in our medical care and are in “constant” communication (coercion) with our doctors.
- They (case managers) also “come and go” faster than you can change socks; and I wonder whether they are burnt out, did they leave, are they overworked, simply insufficiently trained, immature, dumb, glorified clerks or are they simply too inexperienced for this level of responsibility?
- Insurance companies and their case managers are simply injured workers’ greatest adversaries; and should also be viewed – in my opinion – as the workers comp schemes worst enemy. How else can one explain their illogical behaviour and their reckless wasting of hundreds of thousands of precious dollars per injured worker? They are not “working” for injured workers! They do not care about our well-being. Fact is case managers rarely answer our phone calls; they only call in a harassing and intimidating manner if they are after something; they never show respect and always assume an attitude of hostility and POWER. Most are definitely very young and inexperienced, save for a few old hags whose job it is to “deal with difficult clients” (meaning finding ways to cut off benefits, services from even the most seriously injured workers).
- Every single case manager that I have had over my 8 year ordeal demonstrated that they had not even brought themselves up to date with my case, injury and needs – again well demonstrated by repeatedly demanding (not asking) for 9costly) medical (or other) information they already had.
[Post predicated and entered on behalf of WCV]
There is plenty going on at the moment – between desperately finding a witchcraft potion for my debilitating pain, coping with and “accepting” my dreadful condition and prognosis, trying to sleep, navigating the endless trials of being on workcover, fighting for my entitled basic home help, deciding whether or not I am prepared to literally risk my life for a reverse shoulder prosthesis, encouraging my partner to care for me and the house…and my blog!
workcover victims diary – update
A few days ago I received a wake-up call in the form of a medical report from my treating upper limb specialist surgeon. Not that I needed a wake-up call as such, hell, I know I am deteriorating rapidly and every day, but I did perhaps not realise that, even if I had the guts to undergo and would survive the needed reverse shoulder joint prosthesis, I would not ever regain anything resembling normal function again in my arm…[I suffered two massive heart failures and very nearly died during two of the eight shoulder surgeries and although my heart failure is directly related to the shoulder specific surgical procedures, they remain uncertain of what exactly it is that caused the hart to fail so badly].
The pain I am in, and have been in over the past weeks/months is inhuman and is literally pushing me at the very end of my limits, both physically and mentally, as well captured by my surgeon’s report.
I hardly sleep from it and have, since months, resorted to camping in the living room at night, so that I can watch TV, read the blog, whatever and cry myself into a slumber without disturbing my parrots and my partner.
Extracts of the surgical report
The mechanical or functional status of my right (dominant) shoulder (and arm) is now at such an extent that I am no longer able to physically write [at all], hold a cuppa, hold a book, a fork, or – most importantly – hold the microphone or the keyboard keys on my laptop (i.e. CRTL-SHIFT) to blog!
Whilst I have been using voice recognition software for posting the bulk of the articles of the blog in the past with some success (and with receiving manual help with insertion of pictures etc. from other people), fact is that I am now no longer able to even “blog” this way. The only thing I can do is to record – with dictation or dicataphone- articles and have someone else insert (post/blog) them on my behalf . This is, obviously, a major issue given that I am running a very popular blog!
Many people have – kindly- sent me (the blog) emails stating that they have noticed that “I was not blogging much” and wondering “if I was OK”.
Yes, I am “OK” – well, I am alive. But I am struggling myself stupid. I am having a damn hard time and bracing myself for even worse. And, ouch, I just found out, the hard way, that [arthritic] pain is so much worse in winter and that it is not an old wife’s tale 🙁
I just want to take the opportunity to warmly welcome and thank “Trinny” who has, as of today, “officially” joined workcover victims diary as a co-author! Trinny is also an injured worker and has been contributing to the blog for months (behind the scenes, via email and Twitter initially), for which I/we are extremely grateful and already forever indebted.
I also want to take the opportunity to warmly welcome and thank injured worker “Jamie” who has kindly volunteered to co-author our (neglected!) Facebook page as of 6 or 7 June 2012. “Jamie” [nickname for ID protection] has been commenting regularly on the blog and has been an insightful contributor and an absolutely delightful forum “buddy”.
And let’s not forget to applaud the wonderful and hard work from John McPhilbin who joined us about a month ago. John has been a great “asset” to workcovervictimsdiary.com, and this is well reflected in the ongoing growing popularity of our blog (Google stats are just mind-boggling!).
Thank you to all our readers, supporters and contributors for your wonderful support, a workcover victims diary would be nothing without you!
Today, marks a significant milestone for this blog. workcovervictimsdiary.com has had just over 150,000 page views since it’s launch in August 2011 (8-9 months ago only!). Given its increasing popularity and growing impact, some of us have been wondering whether it’s time to rethink our blog’s design and layout? Make it more official-looking?
aworkcovervictimsdiary milestones and blog design
Today, marks a significant milestone for this blog. It has had over 150,000 page views. When I launched it about 9 months ago, I wasn’t really sure how much interest readers would have in the developments and trends of a system that is -frankly- almost a century old!
As some of you may recall, this blog was started as part of my psychological therapy, prescribed by my treating clinical psychologist and psychiatrist. Given that I (workcovervictim) – due to my workplace accident- am unable to physically write, let alone type, I was not able to commence a paper diary (journal) and had to find a digital “diary”where I could use dictation software… so it became a blog!
The very initial goal of this “diary” (hence the URL chosen: aworkcovervictimsdiary.com) was, believe it or not, to help me vent and turn my rage (oh yes) against my workcover insurer and the Victorian workers compensation system into semi-coherent sentences, in order to prevent it [my rage] from making make me -further- ill!
Born to “help people” (I was an intensive care nurse before my horrible accident), I soon realised that I could still do what I was born to do and that is help fellow injured people, by sharing my experience(s), learned tips and tricks; and by raising awareness. …The rest is history!
Community involvement has been very instrumental in making workcovervictimsdiary.com efforts so successful. I am extremely grateful to our loyal (and growing) readers and the large number of outstanding “guest bloggers” and contributors who have contributed to reaching this milestone. I would also particularly like to take this opportunity to personally thank Actavista, Workcovervictim3, Trinny and John McPhilbin for their invaluable support and for co-authoring some of our best articles.
A very special thanks goes to my treating psychologist and psychiatrist – you know who you are ! I still can’t believe you made me do this 😉 and – of course- to my hero, Erin Brockovich!
Our current analytics reflects that there is a strong interest in the wrong-doings of the workcover insurance companies (i.e. shared stories); health and safety (i.e. OHS, bullying) and the “benefit system” known as workers’ compensation in general. The spectrum of story interest is as widely diverse as the multitude of workcover insurances, schemes (and it’s tactics) in existence.
It is very encouraging to know that the expanding readership base has a growing concern about the manner in which injured workers are being treated by their insurance agents and about worker’s health and safety. Hopefully, as workers’ compensation schemes “mature and develop”, there will also remain a strong desire to create a healthier work environment. My hope is that this blog can continue to provide a voice for injured workers and a forum for creative ideas.
Given this milestone and the “status” of workcovervictimsdiary.com, some of us have been wondering whether it would be worth re-designing our existing blog, in particular to make things “more official” looking and created -perhaps – a stronger presence…?
Any and all feedback would be greatly appreciated – feel free to add a yes/no question and/or leave us your comments, tips, feedback, ideas and suggestions!
Friday the 23rd of March was a very special day for Lisa. She woke up thinking it was just going to be an ordinary day, which unfortunately, due to her circumstances, isn’t very pleasant. The last thing she was expecting was to have the famous Erin Brockovich turn up on her doorstep….