We recently received a rather highly controversial email from an injured worker. The aggrieved injured worker believes that ‘killing’ ‘defective’ workcover employees (such as case managers) is the answer to fixing our horribly broken workcover system. We believe that the fundamental problem is that of bad faith…
Many people may not realise that workcover insurance firms are actually in the business to earn money. As such, they learned long ago how to leverage situations so that they are able to delay and deny rightful workcover claims and benefits. Many insurers attempt to use stall tactics in an attempt to frustrate the injured worker enough to get away with not paying claims.
Let’s just imagine that we are a doctor or specialist and that we’ve accepted to treat an injured worker.Who is really making the medical/surgical decisions about our injured workers? Shouldn’t the workcover insurers at least share the liability or at least bear the responsibility of their own actions or lack thereof?
Five (5) Australian insurers have been announced as the scheme agents for the workers compensation scheme run by WorkCover in New South Wales, with two previous contractors missing out on renewal. It’s a pleasure to announce that – especially- Xchanging but also Gallagher Bassett have been left out.
Does the workcover insurance company care about injured workers? Does your workcover case manager care about you? Most are just big mean ogres that wants to do everything they can to screw you over, and, as you’ll see, some times (read: often) their actions are so ridiculous, you have to wonder if they are really run by humans!
You may not realise it, but at the time of your workplace accident(or illness) you actually enter a war zone. And that war is between you and the workcover insurance company.
Workcover insurers and their case managers can be master manipulators. They often use various delay tactics to wear you down, knowing that you need the money. They will also often delay or discourage or even out-rightly deny medical treatment that is needed.
Did you know that many workcover insurance companies have programmes in place that give case managers a direct monetary interest in the claims they handle? Some workcover insurance companies pay cash bonuses in return for achieving goals set by the company.
Any workcover issue can lead to disputes and/or litigation, and many do. If you have a particularly aggressive workcover insurer that loves nothing else but deny cases, benefits and settlements, it will often lead to legal hearings over adversarial decisions the workcover case manager made on the claim. Some workcover claims/cases which are in litigation are more complex than others, but all have one thing in common: they (generally) drag on forever. Let’s look at some of the factors involved that (may) lead to protracted litigation/settlement.
It is important to remember that our employers, and often all too many politicians, workcover insurers and especially the media portray our workcover system as some sort of undeserved benefit (or even a free “holiday”) that all deceptive injured workers abuse.
Workcover is portrayed by the media as an undeserved benefit
Let’s refer back to some excellent comments made by injured workers, regarding workcover and the media. As injured worker “EFFEDUPNOW” asked , [has] anyone really tried to get this [workcover abuse, stories] in the media?
The answer is simple: yes… but the media is not interested!
The media bias
A typical national prime time television show airs shows on workcover fraud, usually opening very dramatically with footage of for example an old man working on a farm and a lawyer interviewing that same old man. And it goes something along the following lines:
Announcer: This is [programme] Wednesday, March 20th, 2014. Tonight. It’s a crime that takes money out of your pocket, it starts with a lie.
(Unidentified Lawyer) : Are you able to lift anything?
Injured old man: A cup.
Lawyer: A cup?
Injured old man: This is how I am.
Announcer: Think he’s a broken old man? Here’s what hidden cameras showed he was really doing while collecting money from you.
Maybe an IME: The man can grip. I see the legs working, I see the arms working.
Unidentified Lawyer: When you first saw that videotape of him throwing that bale of hay, what was your reaction?
Insurer maybe: I was mad.
Announcer: injured old man, with lies, ripoffs and videotape
One of the many incendiary messages in such sensationalised TV show is in the announcer’s very first line when the viewer is informed that (in this example) “money is taken right out of their pocket.” Seconds later, the announcer again informs viewers that the supposedly injured man was throwing hay bales “while collecting money from you.”
Interestingly money does not mysteriously float out of viewer’s pockets as portrayed by the sensationalized lead into such frequent TV segments!
First, money paid to workcover claims, including alleged fraudulent ones, comes directly from insurance industry profits. Only after dipping into insurer profits does the cost get passed onto employers purchasing workcover insurance (premiums). Then, the costs are spread over the entire group of mandatory policyholders; costs are not charged back to each employer dollar for dollar with their workers’ injuries. If employer premiums do increase, the employer pays for it by one or more of the following ways: taking it out of the company profits; reducing wages; and passing it on to consumers. For the smaller number of companies that choose to self-insure, they pay the claims directly rather than pay premiums for workcover insurance. Then, and only then, does it come out of the general public’s pocket IF the public chooses to purchase the specific products made by companies with high workcover rates. In neither case does money flow out of unsuspecting people’s pockets as portrayed by the insurance industry. …
Such over-sensationalised shows typically fail to mention that for example (at the time), the workcover costs were only 1.something % of payroll down from a peak of 2.something% 5 years or the year before. It also routinely fails to explain that in the past 5 years or so, workers’ compensation costs to employers decreased x% as a percentage of payroll while benefits to workers declined x%.
Instead, the announcer of such sick and twister shows will state something along the lines of… “After all, workcover fraud is very common. The industry estimates it adds up to $X billion a year.” How many of you have heard this $X billion claim before, which Unions, and even Lawyers will explain and defend.
Such allegations have absolutely no relationship to fact but are based on ‘attitudes’ and ‘perceptions’ about fraud (when for example respondents say they ‘know’ of someone supposedly on workcover even though s/he might be capable of working). Similar fabricated claims put workcover fraud at for example 20% of the total of all claims in (a state); the truth is however that suspected fraud that year, is for example three-tenths of one percent!
Anyway whether the true fraud rate is less than one-percent or as high as two-percent, it is hardly “quite common”, duh! (Off to my Soap Box).
The myth of workcover fraud
In recent years, the insurance industry’s focus on cheaters and malingerers helped push through state workers’ compensation reform, a profitable cost-cutting campaign supported by outrage over alleged abuse of the system. The problem, however, is that the fraud image is false for the vast majority of workcover cases.
Studies show that only 1 to 2 percent of workcover claims are fraudulent.
Certainly, the tens of thousands of workers killed every year were hardly aiming for a free ride on their employer’s tab!
The presumption is constantly that fraud in our workcover schemes lies with the injured workers. This is fuelled by media portrayal of ‘cheats’ in the system and the presentation of material in the public domain by employer groups, politicians (at election time) and insurers. The evidence, however, is to the contrary. The incidence and cost of fraud in the workers’ compensation schemes lie predominantly with employers and to some extent service providers.
The detection of fraud in Australian workers’ compensation schemes is focused on the more easily identifiable fraud, that of the injured worker. Employer and service provider fraud is much harder to detect and there is less incentive to eliminate such conduct as a result of the structure of the various schemes.
The pressures of injured workers being suspected as a fraud really do not assist recovery.
“Despite the claims of the insurance industry, employer groups and workers’ compensation authorities that rorts and fraud by injured workers are widespread, all official inquiries into the various workers’ compensation schemes in Australia in the last 20 years have found no cogent evidence to support claims of widespread fraud, malingering or malpractice.” (1)
How can injured workers address the media bias
We believe that the only way to address the media with regards to workcover is to write a commentary on for example each single sensationalised TV show/programme of newspaper article!
Sample letter to Media
Dear [Media Stinger],
Approximately [2 weeks ago], you broadcasted a report on fraud by an injured worker in [State]. I frankly don’t know whether or not this injured worker in fact committed fraud. I have no sympathy for injured workers who defraud the workcover [insurance] system. But what is astonishing to me is that your report/show focused on what is acknowledged by the vast majority of academic experts to be, by far, the source of the lowest amount of fraud in the workcover system. In every study that has been done on fraud in workcover, employer, insurer, and service provider fraud are found to be a dramatically greater problem than injured workers’ fraud. At a time when injured workers throughout this nation are suffering enormously from “deform” of the system driven primarily by insurance providers, your report/show/article gave a seriously skewed presentation on the problems with the system.
I certainly don’t believe you have a serious interest in what is happening to injured workers [like me], but if by chance you do, I urge you to take a look at for example [the recommendations that were made by the xxxx (an administration not particularly sympathetic to workers), then have your staff compare those recommendations to today’s reality for injured workers. We should really be deeply ashamed of what we are doing to injured workers throughout this nation.[Or take for example my situation… explain your story…]
I wish I did not feel cynical about sending you this letter/e-mail. I am sorry that you have bitten the insurance industry bait, hook, line and sinker![Sincerely,]
More workcover sample letters can be found under our Useful Stuff.
Workers’ compensation is hardly the gold mine insurers, politicians and the media portray it as. Fat lawsuits and big settlements are usually completely out of the question.
When a workcovervictimsdiary tells distraught families who just lost someone in a workplace fatality that they cannot sue the employer, they are shocked.When we tell incapacitated workers that they can not obtain compensation by means of a pathetic lumpsum or common law, they are shocked.
Sometimes it takes lawyer(s) to tell these families and injured workers the same thing until they believe it! We’ve had families and severely injured workers go to 3 or 4 lawyers until they would accept it…. depending on how angry they are.The bottom line is that in all but the most willfully negligent circumstances, injured/ill workers and their families cannot sue their employer for killing them/making them injured or ill.
[Post dictated by workcovervictim and manually transcribed on behalf of WCV]