Injured at work means loss of control
There is definitely a loss of personal control over your health care when you have suffered a work injury or illness. For many injured workers it is the WorkCover insurance company that dictates your health care – they approve, and – more often – deny medical treatment recommended by your own specialist. This can be a denied MRI or even surgery.
Injured workers have little control about their health care
Your treating doctor
Although you are allowed to choose your own treating doctor (for example, in NSW this is called a Nominated Treating Doctor), injured workers may never have a satisfying relationship with their chosen doctor. This is because you may have little control over who is actually willing to treat you under WorkCover. More and more GPs and Specialists refuse to treat injured workers because of the frustrating and time-consuming bureaucracy, red tape and underpayment by the WorkCover insurer (the fees are capped to Medicare
Denied or delayed treatment
You may, for example, suffer from certain work-related injuries or illness for which you see your treating doctor. He or a chosen specialist may diagnose your problem and write you a prescription, physio or even surgery. And here it starts… The prescription may not be filled by the pharmacist if they have a direct billing arrangement with your WorkCover insurer. It is not uncommon for WorkCover to deny you certain medications for no reason at all. As an example, I once suffered from septic shock from my infected total reverse shoulder prosthetic and was admitted to hospital for weeks, and treated with IV antibiotics. Upon discharge, the hospital’s director of infectious diseases prescribe me long term therapeutic antibiotics as well as life-long suppressive antibiotics. The therapeutic antibiotics were very costly (from memory about $200 a week). Out of the blue, my case manager sent me a rather rude email stating they would not pay for the antibiotics as they were, allegedly not related to my work injury. Ha! Given that the Director of infectious diseases was working in a public hospital, I had great trouble obtaining a letter/report to explain the need for the antibiotic treatment and the (obvious) relation to my work injury (assault->10 surgeries->total reverse shoulder prosthetic->infected). In short, the senseless bureaucracy required from the WorkCover insurer (as in report etc.) caused me to cease the antibiotic treatment as I could not afford it myself. This then caused the infection to simmer and 5 years later I am facing a total arm amputation or a high-risk 2-stage attempt at replacing the prosthetic shoulder. This surgery is extremely costly and so I ask why would they cease/deny antibiotic treatment in a quest to save money, but pay a hundred times the amount “saved” down the track for major surgery? Go figure!
If tests such as a costly MRI have been ordered by your treating doctor or specialist, again the WorkCover insurr may or may not be approve the test without a confirming second opinion, an independent medical examination, or endless addition reports from your treater. The same conceept applies to surgery, many injured workers face insane denails or delays to have their rcommended surgery approved.
It is no wonder injured workers feel like they have no control over their health care; and, worse, it is no wonder that many injured workers become seriously injured and permanently impaired because of unnecessary delays and denials from their WorkCover insurer.
For most of us, this is of course deeply unsatisfying and very fustrating!
Loss of control for WorkCover victims
A work-related injury (or illness) generally occurs as the result of an uncontrolled event. Whether this is a slip and fall, a man/machine interaction, or a phsyical or mental assault, the injury is, for the victim, already a period of loss of control.
For normal patients, it isn’t the same as for WorkCover victims. Normal patients simply choose whom they wish to see, they choose their pharmacy and they simply comply with their treater’s orders, rest and recover. They don’t have to face insane denials, delays. They don’t have to be examined by independent medical assessors.
Within our cost-containment-focussed WorkCover system, the health care of the injured worker is tackled and managed as a business model. A greedy business model in which the injured worker loosed control over their own medical treatment. Rules, regulations and laws mandate how WorkCover insurers run our injured lives.
Individual choices vanish, and those delivering health care to injured workers decrease because of the required bureaucracy, red tape and capped payments.
It certainly appears that our WorkCover insurers are quite accustomed to directing injured/ill workers to “do what’s not best for them no matter how vigorously they protest.”
Since the relationship of injured workers is primarily with WorkCover insurance companies, rather than individuals, the patient is no longer a respected individual human! The injured worker becomes merely someone with a WorkCover claim number who must and will, wait long periods to be properly treated (if at all).
Being injured is a frightening, painful experience for which treatment may span weeks, months, or even years. During that time, the most pressing experience for the injured worker is the sense of the pervasive lack of control over this unexpected event.