Published: 26 November 2015
Author: Ryan Carlisle Thomas
WorkCover insurers again hauled before Victorian Ombudsman
The announcement that the Victorian Ombudsman, Deborah Glass, will conduct an investigation into the management of WorkCover claims by WorkSafe agents QBE, Gallagher Basset Services, Allianz, CGU and Xchanging is very much a welcome one.
The investigation will focus on whether workers’ claims are being unreasonably rejected or terminated. It will also look at the role of cash incentives provided to Insurers and whether these incentives result in unfair rejections of claims.
The investigation comes only four years after a 2011 investigation into record keeping failures of WorkSafe agents conducted by the then Victorian Ombudsman, George Brouwer.
My experience suggests manipulation is rife
As a practising WorkCover lawyer, it comes as absolutely no surprise to me that there were more than 370 complaints made to the Victorian Ombudsman regarding WorkSafe Insurers in the 2014/15 financial year. In fact, the surprise is that there were not more.
The WorkCover scheme in Victoria entitles injured workers to claim a percentage of their wage by way of weekly payments and have their medical expenses covered. Despite this, workers are often treated with contempt when they put in a claim and judged suspiciously by Insurers for no reason at all.
All too often insurers are making decisions to reject or terminate a worker’s entitlements on evidence which is severely deficient. I have encountered numerous cases where a worker’s entitlement to weekly payments or medical expenses have been terminated despite clear medical evidence from their treating practitioners that they are unable to work as a result of an injury sustained in the workplace.
Rejections and terminations of claims are not the only problem.
Delays in WorkSafe surgery approvals
Delays in decision making also cause great stress to injured workers and hinder their recovery. For example, I have encountered workers who have had to wait many months for WorkSafe to approve a surgery which their doctors have advised is “urgent.” Many workers feel that they are stuck in a system where they have to fight for every little entitlement.
There is no doubt that poor decision making by the WorkSafe insurers can result in financial and emotional stress to the worker, longer recovery times and compromise effective return to work. Having to involve yourself in a protracted legal battle for what should be a simple entitlement is not conducive to good health and recovery from injury.
Insurer incentives compromising scheme
The May 2011 Ombudsman’s report concluded that poor record keeping at WorkSafe agents led to manipulation of the WorkSafe incentive scheme for agents, delays in payments, poor and delayed decision making and the reduced effectiveness of the scheme. The report led to CGU being fined $2.8 million by WorkSafe.
Despite the 2011 findings, matters do not seem to have improved and complaints continue to rise.
It is no wonder that workers are losing confidence in the scheme.
Victorian Ombudsman: https://www.ombudsman.vic.gov.au