WorkCover insurers wrong-doing
This is what some injured workcover victims have reported
- injured workers being told by their workcover insurance to ‘just work through the pain’
- discrimination against certain types of injuries such as chronic stress
- cruel and abusive psychological treatment of injured workers by workcover insurance case managers and employer
- false and under-rated diagnoses
- manipulation of facts, evidence, dates, medical words and expressions
- concealment of facts and evidence
- recurrent use of avoidance or distraction techniques
- multiple medical reports for the same visit/intervention
- excessive use of independent medical examinations (i.e. 5 per year)
- coverup of wrongdoing that caused physical harm
- putting intentional and inappropriate emphasis on the injured worker’s psychological status rather than addressing physical origins or causes of injuries
- inappropriate psychological profiling
- denigrating/vilifying the injured worker’s character
- workcoer insurance (though IME) falsely accusing the injured worker of having a family history of alcoholism, even when this is refuted by an independent psychiatrist’s report
- violations of trust leaving the injured worker feeling “emotionally raped”
- workcover case managers who disregard doctors and specialists who say the injured worker is unable to work – compensation, weekly payments and/or benefits are cut off anyway
- injured workers unable to eat properly and relying on food hampers, charity
- injured workers reporting that they feel they are “fighting for their life”
- workcover insuance refuses diagnostic tests such as MRI despite request of multiple specialists
According to a report by the Victorian Omubsman released in May, 2011 injured Victorian workers are facing a system in crisis, with privacy breaches, lost documents and delayed payments stemming from poor record keeping by insurance firms, according to the findings in a report by Ombudsman George Brouwer tabled in Parliament in May last year. The report slammed the performance of Worksafe and the six big insurers it authorises to manage workplace claims.
The Ombudsman’s investigation was sparked by a nearly 30 per cent increase in complaints it had received over the past three years about WorkSafe and its insurers.
The report reveals many failures in the management of Victoria’s 56,000 active workplace injury claims because of poor record keeping. Bad file maintenance, inadequate understanding of the law by managers and outdated computer systems have all contributed, the report found.
“Many of the complainants who approached my office raised concerns about having to repeatedly submit the same documentation to the agents and delays in service this was creating,” Mr Brouwer said.
In one case, an injured worker had to wait months to receive more than $20,000 in back pay, because Xchanging lost her documents and maintained only minimal records of her claim.
In another case, a worker who required a kidney transplant because of a work-related illness, and was unable to walk to the bathroom, had to wait more than a year for Gallagher Bassett to act on a claim for the costs of home modifications.
Mr Brouwer’s investigation found the agencies had manipulated incentive schemes, delayed payments to workers and mismanaged files. Insurer CGU was found to have hidden about 10,000 invoices in a locked cupboard in order to obtain lucrative WorkSafe incentive payments. CGU has since been fined $2.8 million and ordered to repay the $2.5 million for the manipulation known as ‘gaming’, which Mr Brouwer said was “clearly improper”. Mr Brouwer’s investigation uncovered evidence that CGU staff, including managers, were manipulating the scheme, benefiting by $2.5 million before the practice was detected.
During interviews with the Ombudsman, workers from CGU admitted some files were binned if they lapsed the due date for payment, because there was no system in place for recording when the account was lodged. This meant the agent would wait for a duplicate account to arrive to process that within the allocated time period, avoiding a fine by WorkSafe and claiming a bonus payment for processing the payments on time.
“If I was a person punching accounts and I have to hit a certain level, that’s checkin in that day, and the timeliness is really thoroughly checked and it’s a tight measure…I could throw a whole batch of those in the bin, walk over to the security bin…and they’re gone,” a manager at CGU told the ombudsman.
WorkSafe has six authorised claims agents – CGU, Allianz, Gallagher Bassett, GIO (no longer an approved agent), QBE and Xchanging. WorkSafe has committed to modernising its IT systems and holding its insurance agents to account
Allianz, CGU, Gallagher Bassett, GIO, QBE and Xchanging are the insurers WorkSafe uses to deliver services such as weekly payments and medical treatment, with the authority paying the six about $212.5 million in fees last financial year.
The report found that each insurer’s files, apart from GIO and QBE, were in inferior order, lacked contemporary notes of conversations and meetings and were secured poorly. All insurers use a computer system more than 25 years old, while managers showed ”limited or no knowledge” of the Public Records Act.
The report revealed one woman did not receive weekly payments worth more than $20,000 for 18 months until this year because Xchanging repeatedly bungled her case. It also showed 222 reported privacy breaches – including medical records emailed to the wrong address.
Former facilities manager Alex Nicholls, who dealt extensively with Allianz after suffering nervous breakdowns due to workplace bullying, said he was not surprised by the findings.
Mr Nicholls, whose son was suffering cancer at the time, said after his first breakdown forced him to leave his job in December 2009, Allianz did not return phone calls and tried to make the process as difficult as possible.
After his claim was approved, they failed to ensure he was receiving weekly compensation, leaving him without adequate payment for three months. When he suffered another breakdown last year, they again did not ensure he was receiving the right payments.
”They were atrocious,” he said. ”You are dealing with someone’s livelihood.”
Allianz did not respond to questions on these matter.
WorkCover Minister Gordon Rich-Phillips said the government was concerned by the developments but would not say if it showed the WorkSafe board was incompetent.
The Ombudsman has made sweeping recommendations to fix the problems, including annual audits of insurers’ record keeping and the introduction of a modern computer system.
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