We recently received the following question from an injured worker: “why is it so hard to get help from doctors when you are on work cover?” Many doctors are just fed up with the extremely time consuming ,“ridiculous” amount of paperwork required by WorkCover, for which they are most often not paid, and with the constant harassment, interference and pressure from case managers.
Quite often the lack of a bonding and lasting doctor-patient or doctor-injured worker relationship is a central part…and —often— a central problem…of the workcover system. Quite often the injured worker did not choose to see their doctor or specialist, and the reverse is also true, quite often the doctor did not choose nor want to see this injured worker…
Most injured workers know that it can be very difficult to find a doctor, specialist or surgeon who is willing to treat your work related injury (or illness). It can be even more difficult to obtain a 2nd (and 3d) opinion, and if you are not happy with your treating doctor (i.e. s/he does not believe your symptoms), for many, it is almost impossible to find a new doctor/surgeon/specialist who is willing to take over your care. So what do you do?
Injured or ill workers deserve good medical care, rehabilitation, as well as compensation for permanent injury. Unfortunately more and more doctors are shying away from treating patients in the workers’ compensation system, They should not but they should be aware of how the work-over system works.
We very often receive emails from injured workers asking us how long it will take for workcover to approve their surgeon’s request for (elective) surgery. The answer is however long it will take for your dimwit case manager/ workcover insurer to decide whether your surgery is “reasonable” or not, and this -unfortunately- includes the all too often the “need for additional information” request, be it endless communication with your surgeon, or an “independent” medical opinion (IME).
Omigod, our co-author “Trinny” stumbled upon and kindly shared the Medical Practitioners Guide to Workcover NSW, “sloganeered” by “ABILITY NOT DISABILITY – A BACK TO WORK APPROACH”. Read between the lines, guys and imagine you are a GP and in receipt of this “guide”… would you not feel, uhhh, pressured to return even the most seriously injured of your patients to work?
Doctors are refusing to take WorkCover SA patients, forcing people to travel from as far as Murray Bridge to the city for treatment. The Australian Medical Association president Peter Sharley said it was an ongoing and significant issue.
There is no doubting the complex and demanding nature of medicine, however, poor communication only adds to the distress of patients. Research shows that poor communication is one of the most common reasons why patients file malparactice suits. For example, two doctors with the same level of expertise make the same error, however, only one is served with a malpractice suit, why? It’s easier to forgive someone you like and trust, however, it it not so easy to fogive someone who is rude and dismissive.
On 1 October there were some important changes to workers compensation in NSW that will affect medical practitioners and their patients as a result of recent reforms to the Workers Compensation Scheme.The new certificate of capacity focuses on what your patient can do rather than what they can’t do…. that’s right, folks, read between the lines and brace yourselves!
New certificate of capacity in NSW
New certificate of capacity – Doctors call 1800 661 111 to find out more
The reforms, passed by the NSW Parliament in June, focus on helping injured workers return to work and maximising work capacity.
As with the medical certificate, the nominated treating doctor or treating specialist medical practitioner is responsible for completing the certificate of capacity.
The new certificate of capacity will be the main way for nominated treating doctors to communicate with all parties involved in the return to work process.
…that’s right, read between the lines folks!!!!
Medical practitioners are required to use the new certificate of capacity instead of the WorkCover medical certificate for all patients with a workers compensation claim. The old medical certificate is no longer available from WorkCover.
There will be a grace period of six months to allow you to make the adjustment, during which time the insurers will continue to accept the old medical certificate.
You can download the new interactive version of the certificate from WorkCover’s website by simply typing WC01300 into the onsite search. WorkCover is working with the main providers of medical practice management systems to incorporate the certificate into their software.
By November 2012 you will also be able to order printed pads of the certificates from WorkCover.
For more information email firstname.lastname@example.org or call the Doctor’s helpline on 1800 661 111.
The new certificate of capacity
View (or download) the certificate of capacity in a separate window>>
Sourced and kindly shared by At A Loss : http://www.workcover.nsw.gov.au/aboutus/newsroom/Pages/New-doctors-helpline.aspx
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.