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.
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.
When you’ve been injured on the job, you will -sadly- encounter a whole new world of workcover insurance related hurdles in obtaining your prescribed medical treatment. The fact of the matter is that the workcover insurance company will try to -and often does- totally control your medical treatment at all stages.
Obtaining medical treatment under workcover can be a full time job
When you’suffered a workplace injury, you will -sadly- encounter a whole new world of workcover insurance related hurdles in obtaining (appropriate) medical treatment. This includes all of your work injury related treatments such as medical care, surgery, radiology (MRI, CT scan), home help, home modification, hydrotherapy, physiotherapy, psychological treatment etc etc.
Unfortunately it is not always as easy as heading to your (nominated) doctor for a referral.
The reality is that the insurance company, through its non-medically trained case managers [and nurse case managers in some states], can and will contact and even coerce your doctor(s) – and they’ll do it often.
They do this for various reasons, such as to see if you really need to be off work for the next couple of weeks, or whether you need that MRI now as opposed to, for example, three months from now; and whether you really, really need that prescribed physiotherapy etc. If they can’t coerce your doctor(s) into “adapting” your certificates, agreeing that, hey, you really do not need physio (as you can hop on your home bike), you do not need a particular treatment, even surgery; then they will sent you to an “independent medical examination”; preferably a well known biased and pro-insurer one (oh yes, they have lists of such IMEs) for “objective assessments” in the hope of hopes the IME complies with the insurer and amends fitness status, treatment requirements etc. If that still doesn’t work, doctor shopping will start, until such a time as they do obtain what they’re after.
The best advice we can give is that your doctor can be your biggest ally in a workcover claim. Unfortunately not all injured workers’ doctors are standing up for their patients and many do buckle under the relentless pressure, intimidation and harassment from case managers.
Whilst the insurance company has the right to pick your IME doctor, it cannot disagree with the recommendations of it’s own authorized doctors (IMEs) just to cut costs or end treatment.
You will not earn respect if you do now show respect.
Here are a few tips with dealing with your own doctor(s), such as your nominated doctor and/or insurance doctors (IMEs):
Try to be assertive with your doctor, IME etc. but not aggressive
When dealing with your [allocated/nominated/local/ specialist etc] doctor and his or her office staff, It’s important to try to be assertive, but not aggressive.
There is a difference in not taking no for an answer, and yelling at the Doctor or the receptionist. Make a polite but assertive effort to explain your problems to the doctor, don’t allow your concerns to be glossed over, but remain patient and remain cool. If you’re concerned about the doctor sending you back to work too soon, explain why you cannot perform your job – don’t tell the doctor that he or she isn’t in the one in pain.
Remember that this is a kind of “process”, and that it may take several visits with a doctor to obtain the results you’re looking for.
It is important to be assertive when dealing with the doctor. This means making certain that you tell the doctor all of your complaints even if you don’t feel you need treatment for a specific body part. Part of the process of visiting a doctor is to document the nature of your injuries, which leads to proper diagnosis and better treatment. Often an injured worker will focus on the part that’s hurting him or her the most and gloss over or shrug off lesser problems. The problem is that if the doctor doesn’t know about a particular problem, it is very difficult to come back and treat it later. Telling the doctor all of the problems as a result of your injury will protect you down the road, if the insurance or employer tries to deny part of your claim. These problems can include things like depression, anxiety, PTSD or other injured body parts.
We believe it is a good idea to do some research about your injury or condition before and during treatment. A little knowledge will help you understand the doctor. For example, you should ask if there are options other than surgery, whether it might be time for a CT or an MRI, or a referral to a specialist.
It’s really not helpful to question your doctor’s credentials, judgment or ability to make a decision – this aggravated many doctors/IMEs. Ask questions designed to explore all treatment options and scenarios. You may be right about a treatment option for example you researched, but if you alienate your doctor, you could be or get in trouble.Never ever go alone, bring some support
It is always extremely helpful to bring your significant other, a an advocate (i.e your psychologist), friend or loved one to the doctor’s office.This is particularly important so that your support person can be a witness of what is done and said at the visit.
They can also help make sure the doctor understands your problems, but they need also to make sure it does not lead to a confrontation. It is hard for someone who cares about you to remain patient when they do not feel the doctor is giving you appropriate attention, but again they need to remain objective, calm, patient but assertive. All kinds of bad things can happen when the doctor is ganged up on and backed into a wall.
Be direct with your doctors, but not confrontational – nobody wins if that happens. If you are still having issues obtaining your entitled medical treatment, seek legal advice and/or remember that you can always appeal a denial of medical and like service/treatment. For example in Victoria you can lodge a conciliation dispute within 60 days of receiving a rejection/denial letter.
If you are injured at work, you have the right to medical treatment provided by your employer or their insurance company. They must pay for whatever treatment is required to cure or relieve the effects of the injury.
However, they do have the right to direct you to an independent doctor (IME) of their choice and you must go to their doctor. If you do not go to their doctor, you risk paying for medical treatment out of your own pocket as well as losing compensation for any lost time from work.Make sure the doctor know what you are doing for a living
Strange as it may seem, what you do for a living has an impact on the nature and quality of your medical treatment. If you work in a physically demanding job, or a job that requires others to depend on you for their health and safety, it is important that the doctor know. It makes a difference to the doctor what has to be done to return someone to work in a sitting job versus someone who needs to return to work in a physically demanding or a job that involves a safety risk. It may also impact how long you are kept out of work and also determine the nature of the treatment you may need to restore function.Be very specific about light or suitable duties
Often while providing medical treatment for a work related injury, a doctor will consider the possibility of releasing an injured worker back to work on “light duty” (suitable duty). This can be a good idea because studies have shown that the longer someone stays out of the work environment the more difficult it is to return.
But, before a doctor releases you to light duty, make sure he is specific about the restriction. A doctor who merely writes on a slip of paper “light duty” will find that the employer generally does not honor the restriction because, frankly, the employer does not understand the restriction. Therefore, make sure the doctor’s restriction is as specific as possible. If the doctor says no prolonged standing at a job, he needs to spell out how long you can stand. If the doctor puts a restriction on how much weight you can lift, then he needs to spell it out specifically in terms of how many pounds you can lift. Once he does that, make sure you keep a copy of the restriction and carry it with you in the event that your employer does not wish to honor it.Don’t treat your own
Treating through your personal doctor(s) and billing your private health insurance may seem like a good solution – this is a bad idea. You can wind up personally responsible for hundreds or even thousands of dollars in medical bills. Over the years, private health insurance carriers have included language in the policies excluding payment for work related injuries. Insurance carriers have also become far more aggressive in recovering monies they have paid directly from injured workers. If you go out on your own, you can end up responsible for the medical bill.
The Workers’ Compensation Courts [Conciliation and Medical Panels and court] do allow remedies if medical treatment is not provided. A request for medical treatment can be filed with the Workers’ Compensation conciliation in the first instance as long a it is supported by a doctor describing that the treatment is needed. If an insurance IME makes a treatment of recommendation that the insurance company refuses to follow, the Court [conciliation -> medical panel -> court] may also grant an Order compelling the insurance company to provide this treatment even without conducting a hearing.