Here is an article by Benjamin Preiss from The Age of 11 September 2016. The Ombudsman has investigated the WorkCover Insurers’ practices and she was less than impressed.
WorkSafe system failing ‘particularly vulnerable people’: Ombudsman
Insurance agents working for WorkSafe have reaped rewards for unfairly denying payments to injured workers, Victoria’s chief complaints investigator has found.
Ombudsman Deborah Glass has released a report revealing the workers’ compensation system has failed some “particularly vulnerable people”.
Ms Glass found that the overall system was not broken but identified problems in complex claims, which made up 20 per cent of claims.
“They cannot simply be explained away as a few bad apples spoiling the barrel,” she said.
The report’s release comes one day after Fairfax Media revealed insurance companies were using dirty tricks to avoid paying out entitlements.
The Ombudsman’s investigation found agents had “unreasonably denied liability or terminated entitlements” for compensation claims.
Ms Glass conducted a detailed review of 65 cases, in addition to a random sample of email records and interviews with injured workers and executives from the five agents.
In one case a mother took her life after losing her medical entitlements for a stress disorder that originated from workplace sexual assault and harassment.
The Ombudsman made recommendations including improving workplace injury and compensation laws and preventing agents from using “preferred independent medical examiners”.
One component of the remuneration deal included financial rewards and penalties for agent performance, including the termination of claims before they reached milestones of 13, 52 and 134 weeks.
The investigation examined five WorkSafe agents that covered public and private sector workers, from police to farmers.
Ms Glass said the great majority of claims were not complex and did not attract complaints. But complex claims had failed some vulnerable people.
“We found agents cherry-picking evidence to support a decision to reject or terminate a claim,” she wrote.
Complex claims accounted for 20 per cent of those received each year but made up 90 per cent of the scheme’s liabilities.
Ms Glass found that WorkSafe needed to examine its use of incentives and independent medical examiners.
The investigation uncovered a range of “unreasonable decision making” across the five agents.
In some cases agents allowed employers to “improperly” influence their decisions, provided inadequate review processes, unreasonably used evidence and made decisions that contradicted medical panel opinions.
“My investigation found numerous examples of agents selectively using evidence to reject or terminate a claim, while disregarding other available evidence,” she wrote.
There were also cases where examiners engaged in “doctor shopping” to support a rejection or termination of entitlements.
In some instances agents persisted with their decisions to reject or terminate claims despite knowing their decision would be overturned by a court.
The government has accepted all of the Ombudsman’s recommendations, Finance Minister Robin Scott said.
“It’s unacceptable that injured workers did not get the support or respect they deserved,” he said.
The Police Association secretary Ron Iddles said the report vindicated its push for government to introduce legislation that creates a presumption that post-traumatic stress disorder diagnosed in frontline workers was caused by their jobs.
“This is now evidence of what we have been saying,” Mr Iddles said.
“And the report highlights the process is more brutal than the psychological injury at times.”
In a statement, WorkSafe chief executive Clare Amies said the Ombudsman’s recommendations were being implemented.
She said WorkSafe and its insurance agents managed more than 90,000 injured worker claims a year and made more than 2 million decisions annually about compensation and treatment.
The insurance agents in the Ombudsman’s investigation were Allianz, CGU, Gallagher Basset, QBE and Xchanging.
Fairfax Media has contacted all the insurance agents for comment.
Xchanging said it co-operated with the Ombudsman’s investigation and was reviewing the final report. Gallagher Basset referred to WorkSafe for its response.
IAG, whose brands include CGU, said it would work closely with WorkSafe to implement the report’s recommendations.
An Allianz statement said the company had reviewed its seven cases involved in the report and it was confident its decisions to continue or cease benefits were made in accordance with the law.
Here is the link to the original article in The Age:
Do not accept at face value whatever your WorkCover Insurer tells you about your claim. It might not be in your best interests. Always seek advice from an accredited specialist in personal injury law.