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case-manager-workcover-jailed-for-fraud

QBE workcover Case Manager jailed for processing K165 fraudulent claims

We don’t hear or see it often, but it surely happens more than you think – here is another , well hidden case of a recent workcover case manager, who worked for QBE in NSW, who was jailed for processing fraudulent claims in the sum of $164,466.07. Shame on you!

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privacy-breach

WorkCover Victoria in massive privacy breach

Victorian WorkCover (aka WorkSafe Vic) CEO Ms Denise “Fish-Face” Cosgrove does it again!

Not even a year into her tenure at the VWA Ms Cosgrove has manage to pull off yet another massive privacy breach of personal data – this time it’s the personal details of 100’s of Victorian injured workers.

If presiding over the biggest privacy breach in New Zealand’s history wasn’t enough for her, Ms Cosgrove has bought her stellar skills across the Tasman to Victoria’s injured workers.

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workcover-insurer-cover-up

QBE insurer & employer dirty attempt to cover up work place injury

In this most disturbing NSW legal case, QBE workcover insurance together with the employer (Wattyl) attempted to cover up a case of bullying by blaming the injured worker – who was the victim of an assault by another employee- for serious willful misconduct instead! Are we surprised? Nope! This case, again, highlights to what despicable lengths both workcover insurance companies and employers will go to deny liability for a work injury. As we said over and over again, HUMANITY is something that is not understood by the “system”.

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QBE-jobs-go-overseas worksafe-week

Workover Week 2012, QBE’s "Hour of Power"

As I’ve transcribed the document below, I have listened to this recording over, and over, and over for hours and hours in the past week. I have QBEitis I’m sure. Please read and let me know what you think is going on. They’ve been more careful, less blatant this year than the last time I heard them present. Nonetheless, there seems plenty to be read between the lines.
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vulture-insurance

Dear Insurer, I don’t like doing business with vultures…

Insurance companies have fingers in many pies, and the same pack of vultures who are making a killing off the plight of injured workers will stop at nothing to win your business.  They have cover for all occasions such as house, house contents, CTP Green slips, comprehensive vehicle insurance, income protection etc.

We have listed the BIG 7 insurers in NSW below and would suggest that if approached by any of the Big 7 to take out other forms of insurance, you may consider sending them a polite letter declining their offers.  You also may consider cancelling any existing policies (ancillary products) you might already have with a scheme agent and get a better price with a non-scheme agent.

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WorkSafe awards – injured workers should nominate themselves: a priceless story

“Love your site, so wish it had been here when I was pushed into this journey ten years ago. A workplace bullying victim me, bullied even more by Workcover, the legislation and all those trough slurpers who suck at the Workcover purse”, says P, who is sharing a rather nauseating verbatim transcription of a question and answer session that was conducted at Worksafe Week 2009 by QBE, and a most enlightening letter she wrote to the then workcover Minister Tim Holding.

“I was found to have incurred a 30% psychiatric injury in 2006, and was “compensated’ out of the system with barely two years income to support me and blocked at all attempts to get retraining.

Now homeless and deeply impoverished living on the disability pension.”

WorkSafe awards – injured workers should nominate themselves!

Worksafe Week (Victoria) is coming up, think it would be great if all injured workers nominated themselves to receive Worksafe Awards.

Just get on their site and do it. Anyone who enters and or survives that system definitely deserves one. Nominations close in just one week, Fri 27th July.

I went to Worksafe Week in 2009 just to see what happens there. I blundered into one session run by QBE insurers and found myself taping the rather astounding proceedings. To me it looked like direct evidence of the ways in which the insurers encourage employers to be totally adversarial about doctor’s diagnoses of an injured worker’s health condition.

I’ve attached the transcript and a copy of the letter I wrote to the Minister. He whitewashed the situation, of course, but I think the transcript speaks for itself.

Transcript of the Worksafe week 2009 run by QBE

QBE answering questions on Risk Management

The following document is a verbatim transcription of a question and answer session that was conducted at Worksafe Week 2009 during session No. MEL 34, “Risk management essentials for integrating workplace OHS, Return to Work and premium.” The session was presented by QBE, a Worksafe Insurance Agent.  The information exchange that is featured in this transcription is conducted between unknown members of the audience, and various Panel Members representing QBE.

 Audience Member 1 (Male):

“I’ve just got a couple of questions. Uuh, you mentioned a couple of times about uuh, getting in contact with the treating doctor early in the process.  Uuhm, the first thing I want to ask you about, is what if the employee, doesn’t give you authorisation at this stage. The next thing I want to ask you about is with regard to, performance management and stress, uh my experience is very often that uuhm, people who have been performance managed, then put in stress claims, aahm and it becomes a fairly difficult exercise in terms of, making contact with that employee. In fact what quite often happens is if you, endeavour to maintain lines of communication, you get accused of exacerbating their stress and stress and perhaps moving towards bullying. So I’m interested in your comments on both of those issues.”

Panel Member 1(Female):

“Yeah for sure.  I guess from that perspective, when uuhm, you know workers give you permission to talk to their treating practitioner, well that’s part of the claim form.  And they need to sign to make sure. Because otherwise uuhm you can’t  manage the return to work if you can’t talk to their doctor. So that’s something where, uuhm you know QBE would need to get involved and talk to the injured worker and say, you know  “As part of your claim on the claim form there’s a release, to authorise, you know both QBE and your employer to talk to your treating practitioner. You need to sign that so that we can appropriately manage, your worker’s compensation claim.

Stress? Oooh.. It’s uuh… I wish I had you know I had a black or white answer for you. Stress claims, are extremely difficult to manage because they are somebody’s perception and as I said before, perception is reality. And like it’s depending on the circumstances uuhm, you know, working together with your agent to look at you know, so if you have been performance managing somebody,  and you’ve been, you know documenting all your procedures and things like that going through the process and they have lodged a stress claim on you, throughout the investigation process that QBE would go through, uuhm you know and if you’re trying to make contact with the injured worker and they’re saying  that you know that it’s bullying and harassment uuhm I guess that’s when we need to come back and have a look at it, on a case by case basis. So you know, uuhm, in consultation with QBE, we’ve got, you know,um health management specialists within our organisation that can assist in that circumstance. So if the worker is thinking that you’re harassing them [giggle] because they’ve put in their stress claim, um there’s other avenues out there, for you to get assistance, because they are really trained to manage.

Yes?”

Audience Member 2 (Male):

(14 seconds speaking but inaudible)

Panel Member 1 (Female):

“I don’t have that data on me at the moment[Aside] Do we have that? How much is psychological and how much is physical? (Inaudible cross talk) I don’t know. I could find out. I could find out. [Word or two inaudible] I could give you my details afterwards and I can come back to you. Sorry, sorry I don’t have that data on me at the moment. Sorry.”

Panel Member 2 (Male):

“I would probably think that, It’s my experience when claims get over 26 weeks, I mean, taking a degree of black and white, you soon work out whether a claim is legit or it’s not legit, and I think, in relation to what this gentleman said about performance managing, it’s quite often not that you’re performance managing, it’s the way in which you performance manage. So if you don’t have clear policies and procedures, just going back to your question, so, if you’re dragging them in for a performance management meeting and you haven’t followed protocol and you haven’t given them written documentation about what the meeting’s about, what the allegations are and that they can bring a support person well you’re just shooting yourself in the foot so it’s very, going back to what you were saying yes stress claims are the most difficult claims to manage. But if your documentation and your procedure is accurate, you should be you should be ok with it. That’s my experience. Going back to your question in relation to the “after 26 weeks” I would probably think, more often than not, when claims get to that, and this is just my experience, you have depression or something as a secondary factor. So yes, I think that you are dealing with potentially psychological or other factors that are impacting on getting the worker back to work. Which then becomes right back to the early intervention stuff, and so crucial too if you’re concerned about the worker. If we write, as soon as we get a medical certificate, our philosophy is we write to the doctor. In relation to stress claims, we write to the doctor and actually tell the doctor, in an appropriate way, what has actually been going on in that we’re trying to performance manage. So, because we take the view is the doctor doesn’t know what the doctor doesn’t know so you’ve got to be on the front foot and you provide that information and you’re basically painting the picture. But I think that’s a very good question going back to in relation to after the 26 weeks, I’d say more often than not that there are psychological factors and even if there are or there aren’t, I guess when a claim gets to 26 weeks, you really have to think, very openly about, well what is the likelihood that the person is going to return back to this organisation, and this work. And that’s where it’s it’s sometimes it’s better to look at, the whole rehabilitation process and um get a rehab provider involved and look at retraining. “

Audience Member 3 (Male):

Simple question, if you had an organisation that has, a preferred doctor, if you had an organisation that has a preferred doctor that it refers its employees to, after an injury has been recorded, but that worker then goes to, their own doctor and you have the company preferred doctor saying “Yes they’re fit for, certain duties”, but their own doctor then turns around and says “No, they’re not fit for any duties, where do you go?”

Panel Member 1(Female):

“Again..”

Audience Member 3 (Male):

“You’ve got a conflict of medical evidence..

Panel Member 1(Female):

I guess from that perspective, one potential option uuhm and from a cost perspective, instead of just jumping for an independent medical examination opinion first, uum the first option that we could try would be to actually sit down with the treating doctor, have a case conference and say “You know what, you said this person can’t do anything. We have sent them to another doctor  who’s actually saying, ‘well you know what they can do something’ and sitting down with them and saying to them ‘Explain to me. Explain to me, why this person in your opinion doesn’t have a capacity … We obviously can’t force them, to change their medical opinion within, I guess, that conference, uuhm but generally’ I guess we can fit it in with saying ‘well Somebody else is saying something different”. That can be a first option. Another option, would be to utilise, as I’ve said before, a health management specialist to give the doctor a call and say ‘You know what, we’ve got a differing opinion to you’, so can you, and sometimes you know, doctor-to-doctor uum you know can be quite a successful tool to use. If you’re not successful in, you know, using both those techniques as a starting point, well then you can look at sending the person for an independent medical examination should it be, appropriate.”

 Panel Member 3 (Male):

“And Lara [speaker clears his throat] sometimes, and I know it’s not always easy, but we’ve we’ve been successful in the past. If we’re having a doctor that is strongly uuh, has a strong opinion in relation to return to work and getting them back to work well then we get that doctor to come out, to our workplace and we pay for the visit and it might cost us a thousand dollars or fifteen hundred dollars for the doctor’s time, but I look at it this way, it’s money well spent because if we get the worker’s doctor let’s just say on side, or, are able to give them insight as to how our organisation actually operates, as opposed to what an injured worker’s perception may be which can be two totally different things. So the other alternative is sometimes by throwing a few, a few dollars out of your organisation and not putting it through the costs of the claim uuhm you, you advance, further. And once again it comes back to ensuring that you pass the information that you have onto the appropriate people.”

Panel Member 1(Female):

Any more questions ?  No.

END OF QUESTION & ANSWER SESSION.

 

Letter Minister WorkCover

click to enlarge a little

 

Thank you so so much for sharing this gem with us! It’s priceless!

Worksafe Awards 2012

View the “spiel” about the upcoming [popup url=’ http://www.worksafe.vic.gov.au/wps/wcm/connect/wsinternet/WorkSafe/SiteTools/Events/WorkSafe+Awards/’]worksafe award on the worksafe website[/popup]

Or, even you feel up to it, view the blah blah about the [popup url=’http://www.worksafe.vic.gov.au/wps/wcm/connect/wsinternet/WorkSafe/SiteTools/Events/Work+Safe+Week/ ‘]WorkSafe week coming up in October[/popup] on the worksafe website. Perhaps it’s time for some new transcribing!

 

http://wp.me/p1MA9G-2Xu