Tag Archives: Ramblings

Who is investigating the multi-layered administration driving the costs of workers comp?

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

Physio

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 

…and then they blame “injured workers” for massive workers comp blowout costs? Think again!

Home help

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.

As evidenced just by those two examples alone, workcover insurance companies are part of the “problem” and definitely not the “solution”. They are nothing but major players in the multi-layers of bureaucracy and administration which costs the public purse (the government) a fortune within the workcover system.

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.
I/we really challenge the media and/or any supportive politician to investigate all the above – millions of dollars could be saved from the “growing workcover schemes’ deficits” simply from addressing the insane bureaucracy, administration, red tape and immature, under-trained, hostile (and possibly overworked) insurance stakeholders.

 

[Post predicated and entered on behalf of WCV]

http://wp.me/p1MA9G-3iG

Evidence that money breeds greed and kills empathy

I can’t help it, the social scientist in me won out. I just came across a very interesting article in the New Scientist.   I think it offers an interesting insight into why the workers compensation is the way it is.  It doesn’t address this system directly, but it does highlight why the concerns of injured workers are so often overlooked.   The ‘greed is good mantra still prevails’ in the minds of many employers, insurers and politicians.   Interestingly, most injured workers are forced into poverty or near poverty – which, as this research suggests increases empathy ( as this blog readily confirms).

Poor little rich minds: The price of wealth

Dishearteningly, Keltner’s research might also suggest that the money and prestige of high office could degrade the altruistic tendencies of even the most well-meaning politicians. “A government run by wealthy, educated people is going to be interested in maintaining the current social order,” says Kraus. “[Its members]  will not be interested in the welfare of everybody, but in the welfare of themselves and their own goals.

[popup url=’ http://www.newscientist.com/article/mg21428611.100-poor-little-rich-minds-the-price-of-wealth.html’]http://www.newscientist.com/article/mg21428611.100-poor-little-rich-minds-the-price-of-wealth.html[/popup]

Psychologists now have evidence that money breeds greed and kills empathy. Knowing how could help solve social ills

THE idea that money changes people for the worse is deeply ingrained in western culture. From A Christmas Carol, with its archetypal miser Scrooge, to Wall Street with its ruthless anti-hero Gordon Gekko, countless stories have featured individuals who forsake compassion as they amass their fortunes. More recently, the press has taken to vilifying bankers for awarding themselves huge bonuses while taking excessive risks with investments.

But what is the truth behind the clichés? Do riches really breed selfishness and greed at the expense of empathy and compassion? If so, why? Although researchers have explored many of the ramifications of class and wealth since the birth of social science in the late 19th century, only recently have they started to look in detail at the way money shapes our ability to relate to other people. The results are surprising, offering a picture of the impact of wealth on our psychology that goes far beyond the usual stereotypes. Understand these effects, and you get a better handle on the other inequalities marking the vast gulf in health and well-being that separates the rich and poor. It might even help explain our diverse reactions to the current economic crisis.

Dacher Keltner at the University of California, Berkeley, has pioneered much of the recent work. He first started to contemplate the link between wealth and empathy after being struck by what he calls “the profound self-interest and social disconnect” shown by Wall Street bankers, while at the same time recalling the generosity of his neighbours growing up in a poor area. Someone going through tough times, he reasoned, needs the help of others to see them through and so becomes more sensitive to the feelings of those around them. For example, if you have less income you may have to rely on friends and neighbours for childcare or travel, and as a result will develop more effective social skills. “If you don’t have resources and education, you adapt to the environment – which is more threatening – by turning to other people,” says Keltner. “You just have to lean on people.” Those with more money, in contrast, can afford to pay less attention to others, which could explain why your well-paid boss is so unsympathetic.

From these musings, Keltner and Michael Kraus at the University of California, San Francisco, designed a series of experiments to test whether people from different social backgrounds really do interact differently. In one of their earliest studies, they divided about 100 volunteers into pairs, and then filmed each pair meeting and getting acquainted for 5 minutes. To make sure that their own expectations couldn’t sway their interpretation of the behaviour, Keltner and Kraus asked two independent observers to view the resulting videos and rate each participant’s actions during the exchange, by counting how often they showed signs of interest such as nodding, laughter and eye contact, compared with more detached
behaviours such as doodling.

In line with Keltner’s theory, the poorer subjects were more likely to use warmer and more expressive body language and gestures that signal engagement, while the richer participants were more stand-offish (Psychological Science, vol 20, p 99). “Those from the wealthiest families would go directly to their cellphones to check the time, or they would fiddle with their backpack to make sure it was in order,” says Kraus.

The team suspected that these different styles of interaction might have reflected the participants’ ability to judge another person’s feelings. To find out if wealth can influence empathy, the researchers first asked 200 university employees, with jobs ranging from administrative support to managerial positions, to rate the emotions expressed in 20 photographs of human faces – a standard test of emotional intelligence. As predicted, those with the more prestigious jobs were consistently worse at the task.
In another experiment, the team divided a group of students into pairs and asked them to act out mock interviews – one student as the potential employer, one as the would-be employee. Afterwards, they were asked to rate their feelings, such as excitement, hope or worry, using a 10-point scale. They also had to estimate the scores of their partners. Once again, the students from poorer backgrounds were better at guessing their partner’s feelings than those from wealthier backgrounds (Psychological Science, vol 21, p 1716).

Importantly, Keltner and Kraus have found that these difference were fluid, changing with the participant’s perception of their position within a group. When asked to imagine a conversation with someone they deemed to be higher up the social ladder, the wealthier participants became immediately better at reading emotions. The team concluded that the observed effects are probably automatic reactions that lead us to become more vigilant and mindful of others when we feel subordinate.

Keen to investigate the way in which wealth might influence other behaviours, the team turned to an experiment designed to test altruism, in which each participant has to decide how to divide a reward with an anonymous partner who is supposedly sitting in another room. Despite being poorer, people from less-privileged backgrounds tended to give more than those higher on the social ladder. Similar results emerged from an online survey and game
(Journal of Personality and Social Psychology, vol 99, p 771).

This selfish tendency on the part of the better-off seems to translate to all kinds of situations, with laboratory and real-world experiments revealing many instances in which wealthier people are more likely to behave unethically than those from poorer backgrounds. For instance, Keltner’s latest study has found that richer people are more likely to commit an offence while driving, eat sweets that are intended for children, or cheat to increase their chances of winning a prize (Proceedings of the National Academy of Sciences, vol 109, p 4086).

Taken together, the results provide some preliminary support for Keltner’s theory. However, it may be best to reserve judgement until someone tests the apparent behavioural differences in more true-to-life settings, says Linda Gallo at San Diego State University, California. She points out that many of the experiments have been conducted in university labs – and people might not be as empathic as Keltner’s studies suggest if tested “in situ” in tougher, deprived areas. It is also possible that the choice of participants, who were mostly students, doesn’t reflect the rest of the population. If so, they wouldn’t be the first experiments to have been skewed by a relatively narrow sample; psychologists are becoming increasingly concerned about studies that rely on educated subjects in western, industrialised countries to draw conclusions about humanity (New Scientist, 13 November 2010, p 42) Movie Camera

Yet Hazel Rose Markus at Stanford University in California, who studies the effects of culture on behaviour, has also found that social and financial success can make people less caring. She suggests that the differences may arise from the sheer range of opportunities afforded by wealth – the rich spend more time considering how to spend their fortune than worrying about the needs of others, she thinks (Social Psychological and Personality Science, vol 2, p 33). “The conditions of life of those in the professional middle class focus their attention on themselves and their own needs, interests and choices, which makes them less caring,” she says.

Markus suspects that psychological differences may help to explain some of the other inequalities between the rich and poor. Consider a few districts in London; the average male life expectancy is 88 years in one particularly well-heeled district in the borough of Kensington and Chelsea, as compared with 71 in one of the poorest areas, Tottenham Green in the north of the city.
Part of the explanation for this is straightforward: money can buy a better diet, a gym membership and better healthcare. Furthermore, wealthier people are more likely to have a better education, which leads to less physically stressful and more rewarding jobs.

Poorer people have less of all of this, and they also have the stress of knowing they are low down in the pecking order. There is now much evidence that this tension compounds the impact of a less comfortable lifestyle. For instance, the extensive Whitehall studies, which examined the health of British civil servants over decades, found a very clear link between illness and job grade. Those lower down the hierarchy were more likely to have cardiovascular and respiratory disease and to die younger than those in more senior positions, even after other social and economic factors had been taken into account.

Richard Wilkinson, who studies the social determinants of health at the University of Nottingham, UK, has described the distress caused by social inequality as equivalent “to more rapid ageing”, because it “compromises the immune and cardiovascular systems and increases our vulnerability to so many diseases”.
Emotional double hit

Where do the recent findings come into this? Social interaction is meant to be vital to mental and physical well-being, so you might expect the closer social ties in poorer communities to mitigate these stresses. Yet the increased empathy may in fact amplify the burden, by making people more acutely aware of their lowly position on the economic ladder. “My hunch is that the increased empathy of the working class does not buffer them from stress but rather adds
to the stress,” says Markus.

Her intuition finds some support in one of Kraus’s most recent series of experiments. He placed pairs of participants in slightly tense social situations, in which they were encouraged to create amusing nicknames for one another. Rating their emotions before and after the exchange, those from poorer backgrounds tended to show a greater dip in their mood – suggesting they are more sensitive to perceived social slights (Personality and Social Psychology Bulletin, vol 37, p 1376). “This is one of the negative consequences of being empathic in a context that is profoundly unfair,” says Kraus.

It adds up to a double whammy of disadvantage: not only do the worse off face poorer resources and opportunities; they are also more attuned to the injustice of their situation, which may contribute to higher levels of anxiety, hopelessness and depression – and, as a result, ill health. Gallo agrees that “a low sense of control and self-esteem and high levels of negative emotions such as depression and hostility help to explain why individuals with low socio-economic status have worse physical health”.

The more self-centred mindset that comes with riches might also have a profound effect on someone’s political opinions. When the team asked university students to explain increasing economic inequality in American society, those from poorer backgrounds thought it due to political influence or disparities in educational opportunities. Those from wealthier backgrounds put it down to hard work or talent (Journal of Personality and Social Psychology, vol 97, p 992). In other words, poorer people, who must rely much more on others to get by, are more aware of contextual or social factors that might contribute to someone’s circumstances, while those with the social and financial resources to go it alone consider that life is what you make it.

On one level, this seems predictable: wealthy people want to feel they deserve their high income, and no one who is hard up wants to hold themselves responsible. But such perceptions may have important consequences when it comes to politics. Although the links between wealth, personality and political opinion are difficult to disentangle, it’s plausible that the reduced empathy that comes with wealth and success may contribute to a more conservative, right-wing position aimed at preserving the interests of the rich.

Dishearteningly, Keltner’s research might also suggest that the money and prestige of high office could degrade the altruistic tendencies of even the most well-meaning politicians. “A government run by wealthy, educated people is going to be interested in maintaining the current social order,” says Kraus. “[Its members]  will not be interested in the welfare of everybody, but in the welfare of themselves and their own goals.”

More generally, the work could be seen to undermine “trickle-down economics”: the notion that money made or inherited by rich people will end up benefiting poorer individuals, through the creation of new businesses that provide jobs for middle or low-income earners, for example. This argument is often made in support of tax cuts for the wealthy. Yet if the rich do create more jobs as a result, Keltner’s findings suggest they will be more concerned with preserving their own interests, by awarding themselves hefty bonuses, for instance, rather than creating a constructive working environment with fair wages for all. “Our results say you cannot rely on the wealthy to give back, to fix all the problems in society,” Keltner says. “It is improbable, psychologically”.

Fortunately, not everyone seems to be corrupted by the trappings of success – as many instances of generous philanthropy attest (New Scientist, 24 September 2011, p 36). And although Kraus and Keltner’s experiments may seem to offer a pessimistic view for those hoping to achieve greater social equality, they do at least suggest that the tendencies aren’t set in stone, and that under the right circumstances, the well-off can be encouraged to become more empathic.

“If you can make them aware of those things, you can shift their self-interest,” says Kraus. Future research will no doubt offer some suggestions for the best approach – although it will probably take more than psychological trickery to open the eyes of many dyed-in-the-wool politicians.

Michael Bond is a New Scientist consultant in London

Injured workers are treated like cars in an accident, written off or patched up by dodgy insurance companies

I have so many examples of injustice in these systems, says B, an injured worker. ” As I sit here and wait for the next stabbing pain, I thank you so much for this site and for the courage of all the victims. One day maybe we can get better treatment but that only comes if more people know about how bad it is….”

Injured workers are treated like cars in an accident, written off or patched up by dodgy insurance companies

There are so many things wrong with this system and I feel  quite humble when I read about the injuries you guys have, at least I can still use my hands.

I think the media needs to know some of the background of why we have this system.

Originally workers could only sue under common law for their injuries. Even though it was more difficult to succeed, workers were being given huge payouts by the courts, so employers opted for a no fault system where they would accept liability in exchange for lower payouts.

And guess what has happened, yes they are now trying to reduce compensation for workers even more by restricting access to common law and tampering with benefits.

This is the basis for the injustice we are receiving.

We are treated like cars in an accident, written off or patched up by sometimes dodgy insurance companies, doctors, rehab providers and case managers, all of which are motivated by money.

What has been forgotten in all of this is the undeniable FACT, employers have accepted liability for our injuries and should be held accountable for how they fix us up and that includes their agents (the insurance companies).

Instead we are treated like dirt. I saw very little empathy or humanity from anyone involved in this industry except for my own doctors.

There definitely also needs to be a clarification of the roles and responsibility of doctors employed by the insurance companies.

Injured workers true example

The insurance doctor who examined me (I called him Dr Freeze) wrote that even though my [leg] was untreatable unless I had a [joint] replacement which I refused as my specialist said I was too young and the gym could help me stave it off until I was older (they can’t force you to have an operation).

He stated that I could be employed doing simple tasks. There was no mention of how I would get to the employment and no acknowledgment that the legislation states that they are not to give us jobs that are way below our abilities.

But the main problem was the fact that I had no legal recourse against this doctor. As I tried to explain to the case manager, this doctor was not my specialist (who had already performed several operations on me), if I followed his advice and got injured again, I had no legal recourse against him.

Of course the insurance company does not pay for me to go to the gym, I pay that and it is the only thing that has helped me. So what are the responsibilities of these doctors?????

“I have so many examples of injustice in these systems. As I sit here and wait for the next stabbing pain, I thank you so much for this site and for the courage of all the victims. One day maybe we can get better treatment but that only comes if more people know about how bad it is”.

 

Thank you B for sharing your story and your thoughts and for allowing us to publish them! 🙂

 

Shortlink: http://workcovervictimsdiary.com/?p=7501

 

Beg and pray you’ll never get a workplace injury

We received an anonymous email overnight from a seriously injured worker, wishing to publicly share her opinion. ” After reading those horrid comments from that workcover employee on your blog, I felt physically sick.  Do you know why I have not talked much about my own workplace injury and subsequent dealings with the WorkCover system? The simple reason for my avoidance of this very touchy subject is that the topic upsets me terribly. I’m talking fast heart-rate, sweaty palms and truly vomit- kind of upset….”

I’m not the only one either. A simple Google search will bring up thousands of sites and forums portraying the exact same experience with these so called, ‘worker’s compensation’. I use the word compensation sarcastically as compensating they most certainly DO NOT. Torture, relentless abuse and emotionally beat down, yes, but compensate definitely not.

Beg and pray you’ll never get a workplace injury

Back early in the 1900’s these Worker’s compensation systems were developed to assist injured workers but today they are nothing more than workcover insurance companies hell bent on denying all claims and saving as much money as possible, or better yet: making as big a profit as possible.

Workcover insurance companies do everything in their power to search for even the slightest of “inaccuracy” that they can use against the injured worker… and use it they do.

Until I had to deal with them, I had no idea just how cruel, unethical and cold-heated they could really be. My initial conversation with my case manager was great. She informed me that she was there to help me and do everything within her power to assist in my recovery and return to work. Hell yes, she was nice, awesomely caring in fact. She would ensure that I was offered every resource available, I was not to worry my pretty little head, she would have everything taken care of and I was to simply focus on my recovery. Sounds wonderful doesn’t it? Well, it was wonderful, for the first couple of weeks. Even my employer was lovely for the first few weeks. Then everyone did an about-face and turned on me like they do every injured worker.

They assume everyone is a fraud, malingerer or ‘milker’. There is no innocent until proven guilty here…You are just guilty and playing up and exaggerating your injury s you can have a “paid holiday”. But who in their right mind would set themselves up for such torture if they didn’t have to? Trust me, if I were able, I would be back a work, yesterday! I have my degrees and post-grad diplomas. I am good at what I did . I have worked for about 20 years and loved every minute of it. If I could I would be there in a heartbeat! Without it, I really feel empty and lost.

Take care and PLEASE don’t get injured on the job!

 

Shortlink: http://workcovervictimsdiary.com/?p=5214

 

The workers’ compensation system leaves us feeling weak, futile, helpless, hopeless

As I have often stated, the workers’ comp system is ill-equipped to deal with ALL  injured workers, point.  But it is even more ill-equipped to deal with those injured workers who are of above average intelligence, greater than high school educated, highly motivated, in great physical pain and understandably depressed. For such people, the workers’ compensation system not just a nightmare but it is a quagmire.

The workers compensation system leaves us feeling weak, futile, helpless, hopeless…and, ultimately, depressed

To those injured workers, everyone seems bent and determined to label them as manipulative, exaggerating , malingering and attention seeking.

The very nature of workers’ compensation case management is, in my seriously injured opinion – fully maladaptive. It is based upon a common bond of distrust. If an injured worker does not have a lawyer, they are [even more] fair game for manipulation by the system. If they do have a lawyer, they are then seen as unscrupulous and conniving, pains in the a*se!

However, I believe that especially “white collar” workers, who are involved in work-related injuries, are placed in an environment that is REALLY not designed for them.

These are intelligent, honest, respectful individuals who are used to private care, selecting their own doctors, and who are considered good patients and most of all are treated with respect.

Now that they are injured, they sit in crowded waiting rooms, ordered to see doctors who, to them, feel largely cold and indifferent, appear uninformed, and seldom-if-ever does anyone attempt to explain to them where treatment is going…or why.

Such patients (injured workers) have referred to this process as “I don’t belong in this system” or “this system was not meant for me” or “why do I feel like everything thinks I am after something?”

“A few bad apples” is the best explanation to give them. A few bad apples have made us all suspicious and distrusting. A few bad apples use this system to solve problems that they have been unable to otherwise solve. A few bad apples use this system as a source of income and financial advantage. A few bad apples have created something in which you are now trapped.

My experience has been that the honest and motivated patient [injured worker] is in a disadvantageous position.

I therefore suggest that if the injured worker is a well-educated one, that the unfairness and unsuitability of the workers’ compensation system is most likely to leave them feeling weak, futile, helpless, hopeless…and, ultimately, depressed.

 

 

case-manager-workcover-insurer

WorkSafe does not achieve satisfactory outcomes for injured workers

A Victorian Auditor General’s report on claims management by the Victorian WorkCover Authority (VWA) aka WorkSafe finds that WorkSafe does not achieve satisfactory outcomes for injured workers.

WorkSafe administers the scheme through six authorised private agents (workcover insurance companies). The agents manage claims and serve employers and workers according to guidelines set by WorkSafe.

WorkSafe’s claims management model, revised in 2002, aimed at ‘improving return to work outcomes’ and ‘achieving cost effective claims management’. The Auditor General’s report finds that a significant reduction in projected liabilities of the scheme has been achieved. The model has been effective in the management of high risk claims, maximising the financial sustainability of the scheme.

However, it also states that ‘There is scope for WorkSafe to improve agents’ case management practices in order to better maximise outcomes for injured workers.’

‘Scope for improvement’ doesn’t sound like the end of the world, but commenting on the report a senior officer of  WorkSafe  privately suggests that the consensus view within WorkSafe of the agents’ performance regarding return to work is that it is simply “bad.” “They don’t get it.”

Apparently, while succeeding with a model that has cut costs and improved management of high risk claims, the agents stumble badly when it comes to dealing with the people side of managing claims. But, is it sensible to expect that a management model that is firmly focused on the bottom line should also be good at interpersonal relationships that satisfy the needs of claimants, who have diverse and different agendas that arise out of personally traumatic experience? Is it the agents who are the problem, or the system they are stuck with?

The common criticism we hear of the Victorian claims management model is that it is ‘process driven’. A box-ticking exercise rather than a supportive experience. Claimants say that the system reduces them to a number.

The lack of positive feeling in the system is perhaps one reason why there is such a high turnover among claims staff.

A full 32% of case managers employed by Agents do not have the required minimum two years claims management experience. The Auditor’s report recommends identifying industry roles, specialisations and career paths to improve staff retention and the introduction of a mandatory standard training framework for case management. Improved training and an established career path with identifiable job satisfaction is long overdue.

The report also recommends an ‘Annual Performance Adjustment’ (APA) that directly rewards or penalises agents on their claims management performance as a means to improve outcomes for claimants. The APA approach to claims management seeks to apply a bottom line KPI to a bottom line management model in order to improve performance in the context of relationships.

Sounds screwed to me

The key elements to successful return to work are regular communication, positive relationships and solid partnerships. Being ‘a paid friend’ just doesn’t ring true in this mix.

There are a number of good recommendations in the Auditor General’s report that have already been accepted by  WorkSafe. Stuff that deals with improving the engagement of medical practitioners, reviewing stakeholder communication, identifying risk, strengthening case management planning and other matters in this report. Find the full report here.

Will churn in case manager jobs in Australian insurers and agents lessen while the role continues to be ‘bad cop’? If the high staff turnover is to be stopped, claims managers need to be given a good reason to stay. Creating a well trained professional group who enjoy appropriate work conditions and the daily satisfaction of helping people is the way to go.

Until case managers are able to develop positive relationships with claimants rather than tick boxes in what is essentially a regulatory role, not much is likely to change.

It’s pretty simple really. There is a high turnover in the claims manager role because the job sucks. People come into it wanting to help others but very quickly learn that the system has set them up to be the squishy bit in between what people feel they need and what the system really offers.

It’s the difference between creating opportunities for claimants whom we trust to contribute the unknowable and therefore priceless work they have not yet done to society, or making sure they don’t get away with anything because the system is biased towards protecting the bottom line and hence starts from a position of distrust.

 

Shortlink for this post: http://workcovervictimsdiary.com/?p=3377

 

Injured workers, stand up for your rights, start a united voice NOW!

Or sign the petition to Mr Tweedly, CEO WorkSafe (Vic)

Get involved!

The suffering inside the workcover claim

According to many articles and insiders’ stories, workcover case managers are all stressed out (and yes most are real sourpusses) because of large caseloads.  They can’t put out enough fires in a day let alone make real progress towards resolving cases.  The phone rings constantly, emails pop up endlessly, big decisions need to be made in a second, paperwork grows exponentially.  The meetings, seminars, conferences, deadlines and just sheer craziness of their work day are exhausting.

Believe it or not, the workcover case managers are the lucky ones!

Imagine living the life of an injured worker for a day.  Pretend for a moment you have a back injury.  All back injuries are serious.  A simple sprain/strain, in the moment, is extremely painful.  Your first challenge is getting enough rest.  A peaceful night’s sleep no longer exists in your life.  Each change of position increases your pain level and finding a comfortable position for sleep is as good as impossible.  Your sleep is continually interrupted and you have to adapt to sleeping positions you would never have considered prior to your back injury.  Sleeping for three to four hours at a time is a dream!

Then, the alarm clock blares, and it is time to begin your day.   Everything you do seems to make your back pain worse but you keep moving, you have to.  The world doesn’t stop just because you injured your back.  You manage to get yourself ready for the day.  Your family has to fend for themselves because the most you can do is take care of yourself at the moment.  Your top priority is taking medication in hopes that the edge will be taken off the pain.  Then your day can really begin.

Maybe today you will find out whether your MRI has been approved.  It is nerve wracking wondering whether you have a herniated disc instead of a back strain.  Maybe tomorrow your surgery will finally be approved. All the material you have on hand and read indicates the sciatic pain that is causing numbness in your leg all the way to your toes is a more serious condition.  But there is nothing you can do to hasten the approval process.  The frustration and emotions, and the sleep deprivation you are experiencing seem to make the pain worse.  You don’t understand why you keep on having to go to independent medical doctors who are not even trained nor qualified in the field of back injuries or back surgery.  The on-going paperwork from the workers’ compensation insurance company is very confusing and endless.  Every time you call for clarification you receive a voicemai or get put through to music-on-hold.  You have called ever changing case manager for three weeks and still have not spoken to a real person yet.  You wonder about retaining a lawyer but everyone you share your story with tells you it’s too soon.  And, it seems, everyone has a workers’ compensation horror story to tell.  Your head is spinning from information overload and all you really know is that you hurt and want it fixed.

Along with the pain, you worry.  Worrying becomes your job.  What will you do if you can’t return to work?  You don’t have any other skills.  Why oh why didn’t you continue your education when you had the opportunity to do so?  What will you tell your three children if you have to move because you can no longer afford your home on temporary total disability income?  What will you do if benefits end and your condition has not resolved?  Will your husband/wife stay with you if you can’t return to work and s/he has to take on all the household and family responsibilities?  This just can’t possibly be how your life ends up after all the years of hard work you have contributed.  Who can you turn to that can actually help you through this process, help you get proper medical care, figure out return to work options and help you get your life back?

Can you turn to the case manager?

You, the so called “claims professional”, the experience case manager, must put yourself in the shoes of your injured claimant every day.  Sometimes that is hard. After years in the industry, there are a percentage of injured workers that are not honest or ethical about the details of their injury or their condition.  Everyone who is a veteran in this industry knows that. However, those fraudulent or exaggerated claims account for less than 1% of all claims and the majority of the injured are in genuine pain and are very much afraid about the potential consequences of the injury to their lives.  Perhaps it is time that all case managers think about what injured people are going through and how frightening it must be.  Provide them the resources they need.  Return their phone calls promptly, practice patience in explaining the process, do your best to authorize services quickly and move treatment along for the injured worker.  Speak to the doctors if necessary, many of them will welcome your calls.  Work with the employer to return the injured worker to suitable (read SUITABLE) work as soon as possible.  And, please, do everything possible to give the injured worker back their life.

You are being paid for doing your job, so do it well please. Before my injury I used to be a specialist nurse, think about it, would you like to be treated like a criminal in a hospital bed because you are taking up space, or because you injury or illness is not as important as your neighbour’s injury/illness? Would you like me to have denied you medication, clean linen or a wound dressing because I needed to save money for the hospital? Think about it…

It takes one second for an accident to occur that changes your life forever.  Realise that you – dear case manager – could easily be one of the statistics and try to walk in your injured worker’s shoes every day.  Play it forward, you never know when you might need a helping hand in the future.

Can we fix the sick workcover system?

Dealing with the Australian workers compensation system is a very strenuous psychological challenge. There are many legal and -yes- illegal acts and actions in the name of profit. This article explores options on how we could possibly remedy our sick workover system…

A workcovervictimsdiary.com calls the workers compensation system and the workcover insurance companies Crimes or Criminals; as the actions of these national-wide compo “systems”, violate the United Nation’s Declaration of Human Rights, in Australia our Civil Rights are very much violated as well; not to mention the criminal actions of fraud, threats, blackmail, medical malpractice, social discrimination, cover-ups, rip-offs and countless accusations of untruths and what-not.

It is bad enough with the lies, manipulation and being spied on by these workcover insurance companies, that they also send their paid psychopathic workers to infiltrate internet sites, blogs and injured workers support forums, and groups of person’s that have been disabled on the job, causing disruptions and shambles to the point of total paranoia amongst these emotionally fragile people, that some no longer trust each other and begin to question their own thoughts and actions, due to the ongoing, sheer, demoralising  frustrations of their attempts to gain a little self esteem and self worth!

In many cases, our very own employers –  in some cases viewed like family, where everyone seemingly stands up for  each other through thick or thin on the job- treat us nothing more then a disposable slave, once we have suffered a work injury. On many occasions our very own employers will also attempt to prevent us, injured workers, not to lodge a workers compensation claim. In some cases they even claim that the employee did not even have an accident at work, or they will claim that it’s not their responsibility. And then there are those employers who will gladly manipulate injured workers’ financial, medical and even personal information, just to save them workcover premiums.

Needless to say that many injured workers in those sorts of situations find it very hard to trust anyone, even their own families. Friends are lost due to petty arguments, as they never experience anything like it, which makes them unable to realize how much control this sick “system” has on our lives.

And those that abuse us, employers, workcover case managers and the like have no one to control them as our Governments have allowed for free reign w/judicial protection that prevents them from being held accountable for all atrocities and fraud they commit.

Yet billions of dollars in the accounts of these workcover insurance companies  and the millions of dollar’s being handed over to different “committees” and “organisations”, yes even political parties and unions– from a fund that was originally set in place for the injured, by the employers (premiums), which includes our respective Governments, federally and state– while those for which this was originally created for, live in total poverty, medically untreated,  financially ripped-off,  and physically and psychologically abused.

And all this when the workcover insurers and worksafe for that matter decides to deny us our legally entitles benefits; which includes medical treatment, surgery, home help and anything else that is related to our injuries.

How many of us injured workers are unable to get decent medical care, because they are not allowed to seek treatment for that “injury” as it is the compensations system that is 100% responsible for that injury and proper medical treatment, it is no wonder that many injured workers have been left to street drugs just for pain control.

Some injured workcover victims have been driven to suicide, some to criminal acts, others left to rot in the confines of their minds, while contemplating their next move towards the life, they once had , knowing they need proper medical/vocational/financial assistance which they’ll never get….

Is this not Money Laundering? Taking from the employers that what is meant for injured employees and using it as if it their right to control and distribute as they see fit?

With incomes of hundreds of thousands, the people in charge of those insurance companies make their living from literally robbing the vulnerable and being praised for their actions amongst their peers with whom they share the profits with.

Should we keep our mouths shut, get treatment through the Public Health Care system (Medicare), visit Centrelink for loss of income?  While the employer pays the often large premiums for “safety organizations” [WorkSafe] that do f*ck all other then promote “Safety at work”?

I am so utterly sick of this rotten, corrupt system and more so since I have finished reading Ray Bourhis’ book called “Insult to injury, the business of bad faith insurance“. A great book which I highly recommend to all who are interested in finding out why those insurance companies get away with virtually anything….

The question is how can we fix such a sick workcover system?

Our great Australian landscape is littered from ocean to desert with the bones of injured workers who have been dissected, inspected, bisected and rejected! They are victims of what Allan Greenspan called “an infectious greed”, served up by share (or stock)-option-crazed workcover insurance CEO’s with shiny dollar signs in their eyes. Is there no answer? No solution? How can we possibly bring about change in this industry is the question. Especially with wildly pro-insurance, pro-corruption majority in Government, among our insurance regulators, and even in the Supreme Court… Is there anything we can do? Maybe so, according to Ray Bourhis.

click for more info about this book and its author, R Bourhis

According to Ray Bourhis there are several things we, the people, could do:

  • Time to take to our windows: Bourhis refers to a movie called “Network”. People started throwing open their windows and shouting “I’m mad as hell and I’m not going to take it anymore”. Bourhis tells us that maybe it is time for us to do just that: time we took to the windows. From Melbourne to Perth, Darwin to Tasmania. We should really be asking ourselves what in the world is going on here? After all it is our country and it certainly doesn’t belong to the [workcover] insurance industry. What workover insurances sell is basically “peace of mind” and a promise. What they sell (to our employers) is their word that if your life falls apart, they will be there to for you.
  • Rules with teeth in them: Bourhis tells us that we really need some special rules for this [workcover] insurance industry. Rules that protect people no matter where they live, no matter whether they bought their insurance policies (car, house, life etc) at work (via employers), at home or over a cuppa. As you may have read in the bad faith article, bad faith does not apply to workcover insurances!!!! So Bourhis tells us that one step we could/can take is to simply push for the adoption of workcover insurance bad-faith practice acts at the state legislative levels.
  • Bad-faith acts: Bourhis tells us that we ought to be able to raise enough hell that states will be forced to initiate reforms. After all, he says, the one thing most politicians care about more than anything else is the opportunity to become national politicians. They don’t want to get hooted out of their own fund-raisers for opposing something that has their constituents screaming out their windows, Bourhis claims. Such a legislation would basically simply state that any insurance company that unfairly or unreasonably denies a valid claim is responsible for paying all of the damages caused as a result, including the insurance policy benefits, consequential damages, costs, fees, and –when the insurer has acted with malice, fraud or oppression — punitive damages.
  • Contact individual members of parliament: Bourhis claims that whilst there are pretty bad characters amongst our members, it also has decent public officials, individuals who care about people (A. Bressington comes to mind). Tell them to get their colleagues to join them in dumping the Supreme Court decision that workcover insurances cannot be sued for bad faith! They can then rewrite the laws so that it protects employees rather than skewering them. Tell them to talk about this problem in the media, i.e. Four Corners, 7:30 Report etc, and suggest that they join their constituents screaming out of the window!


Another possible option would be, in my seriously injured opinion, to ensure that “safety training” is a mandatory part of every school curriculum, let the employers’ premiums go into a publicly controlled fund that covers all that is needed, with 80% year end profits paid into Public Health Care.

Bourhis states righly that

the bottom line is this: our corporate ship of state has sprung a big leak. Hell, it hasn’t really sprung anything. A handful of greedy, silk-suited pirates have been busy chopping holes in the hull searching for hidden bullion. We’ve got to get them off the damn boat. We need to take a sword to their britches and force them to walk the plank, so they can get soaked like the people they’re spending their careers cheating….”

 

More information and further reading

 

 

Compensation payments for injuries by insurance companies reduced yet again

Don’t move to Queensland! On 1 July 2011, a compensation regime which imposes Civil Liability Laws on Queensland workers came into effect. At the same time, the Civil Liability Law itself was also tightened. These changes caused yet again compensation payments by insurance companies, including WorkCover, to be reduced again.

Civil Liability Laws were enforced by state governments following the controversial Ipp review in 2002, initiated by our former Prime Minister Howard; and these laws are alleged to have  eliminated 70-80% of personal injury claims payments and, of course, boosted insurance company profits by more than $20 billion.

Chief Justice of Queensland stated correctly, in 2006,  that the laws have “brought about marked erosion of a fundamental right to adequate compensation” for injury and that there is a “need for active reconsideration of whether the so-called reforms have proven justified, or should be wound back”.

The state Attorney General stated, in 2008, that he was considering a review of Civil Liability Laws because they had “gone too far”.

Lawyer organisations and even Unions , which previously had vowed that these laws should never be applied to workers injured on the job,  have all, for-God-what-obscure-reason- supported the application of Civil Liability Laws to workers rather than fight government!!!

A few sad facts about Civil Liability Laws

  • businesses who refuse to invest in safety and injury prevention are in fact “untouchable” from the true cost of their reckless and negligent behaviour and actions
  • businesses that do invest in safety are actually penalised through increased cost of production ( relative to that of the unsafe competitor)
  • people who are injured and although through no fault of their own actually carry and bear the lifelong cost of the injury;
  • and a large part of medical treatment costs are transferred to the taxpayer through Medicare and public hospital treatment of victims (previously these expenses were paid by insurance companies)…..

Compensation payments for injuries

The Government however feels that reducing compensation payments for injuries to injured/maimed workers was/is necessary to make up or reverse a deficiency in WorkCover’s financial reserves!

But, the fundamental question is thus why has WorkCover reduced its employer premiums in the first place (almost every year since 1999)? Are they [WorkCover] themselves not to blame? Why reduce premiums (up to 30%) and not ensure there’s enough money in the reserves for difficult times? They reduce premiums so low just to have the lowest premiums in the nation, or what? What for? I mean, surely you get what you pay for?

And then comes “an economic crisis” and bang, the Government starts slashing our rights, just like that – nice one!

So, who’s responsible for implementing the laws that take away the compensation rights of the Australian people (or at least the Queenslanders)? Well, the answer is simple: both major political parties of course. I can only assume or interpret this action as an intention or a start to eventually scrap and take away all such rights. It is a shame that citizens are oblivious to the mounting erosion and elimination of their individual rights, for which previous generations have fought so hard!

And so it is that big businesses and greedy insurance companies profit even more from the government’s disregard for individual human rights.

Note: This post is dedicated to “Ben” 😉