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What to do when workcover medical treatment & surgery is denied

If you have a WorkCover claim, and the WorkCover insurer has made a decision that you don’t agree with, it is important that you know that you are allowed to challenge this decision. This can include denial of medical and like treatment, even denial of requested surgery. In this article you will find some useful resources to help speed up the decision-making process, as well as dispute and complaints avenues.

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Workcover and the term Psychological Overlay

In the quest to curb costs, the WorkCover system often engages in counterproductive actions or inactions such as delaying care, inadequate care, denial of responsibility and minimization/ downgrading of the injury. Way too often, the depressed injured worker learns that delayed or inappropriate medical care has resulted in a chronic condition, and they are told that this could have all been prevented had you seen a doctor/surgeon earlier, but the (Eg. nerve damage, whatever) is now permanent. The injured worker already felt a sense of frustration, fear, and helplessness, but with that information, they now feel angry and hopeless. In addition to that many WorkCover case managers will take the liberty to fabricate intricate mumbo-jumbo cover letters that are sent to a cherry-picked independent medical examiner, together with some irrelevant medical information. One of the more common cover letters we have seen states that “… it has been alleged that there may be a psychological overlay…“.

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injured worker prosecutes EML case manager

EML WorkCover NSW Case Manager sued by injured worker

Further to the recent article by ABC Investigative Journalist, Pat McGrath about an injured worker who has taken the unusual step of prosecuting her case manager (EML) for its failure to determine her claim for compensation as and when required under the WIMA,  it has come to our attention that the New South Wales Workers Compensation Independent Review Office (WIRO) has published on their website that they “bring to your attention that on 29 November 2018, the Supreme Court of NSW (per McCallum J) declined to grant prohibition to Employers Mutual Limited (EML) in respect of a Court Attendance Notice (CAN) that was issued by the Local Court of NSW upon an application by an injured worker : Employers Mutual Limited v Julie Ann Heise and the Local Court of New South Wales – 2018/356687. Her Honour’s judgment has not yet been published, but her decision provides authority for the proposition that SIRA does not hold a monopoly regarding the prosecution of offences under the WIMA.

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Who is your workcover case manager

The only reason workcover case managers are employed is to help the Agent (aka the insurance company) to make money, or save money – as that is what all insurance companies do. They wouldn’t be in the business of providing “workcover insurance” to employers, if they weren’t a business. The whole idea is to make profits. Period. Below are a couple of their most common “dirty” tactics.

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Screenshot_2019-06-28 case manager

Workcover Case Managers: from Pizza Hut Team Leader to Claims Manager

You may remember that we have – over the years- posted quite a few articles about the Workcover Case Managers (aka Claims Assessors). They often have the right to withhold treatment recommended by our own medical specialists or to over-rule evidence-based treatment based on thorough medical knowledge. Workcover Case Managers also change often, without notice. The problem becomes even more absurd in that the Workcover Case Managers do NOT have appropriate education nor qualifications, certainly not in the medical or allied medical field, yet they are given the power to deny your claim and to deny your medical and like services! Continue Reading…

Screenshot_2019-06-17 Current Investigations - Victorian Ombudsman

Workcover insurers celebrate delay and denial of claims

In the 2016 Ombudsman Investigation into WorkCover VIC practices, emails from for example, workcover agent (insurers) made public by the Victorian Ombudsman show management congratulating staff who had “achieved their termination target” and were “top terminator” or top deny/rejector” of insurance claims! Fully sick, considering they celebrate injured workers’ pain, suffering and misery!

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workcover case manager cartoon

Workcover insurers reward case managers

I have recently been involved with a couple of injured workers FB groups and to my disbelief, I noticed that many injured workers are unaware that their medical and like services are routinely delayed or denied, not bcause of bureaucracy but because the insurer actually rewards those case managers who achieve the most denials! Why? Simple: their job is to save money for the workcover insurance company!

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Your Workcover Case Manager will NOT take care of you

We’ve heard it a lot : “my workcover case manager calls me and appears to want to look after me”, “my case manager is super friendly..”… ” my workcover insurance case manager will take good care of me”. WRONG! Workcover insurance case managers are not your “good neighbour”, you are NOT in good hands, and they are certainly not your friend (even if they pretend to be)!

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case-managers-are-not-your-friend controversial-workcover

The answer to changing workcover insurance companies: debate

We recently received a rather highly controversial email from an injured worker. The aggrieved injured worker believes that ‘killing’ ‘defective’ workcover employees (such as case managers) is the answer to fixing our horribly broken workcover system. We believe that the fundamental problem is that of bad faith…

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