Published: 15 September 2016
Author: Ryan Carlisle Thomas Ryan Carlisle Thomas

Ombudsman's Report highlights unfair WorkCover rejections

In the Victorian Ombudsman’s report 'Investigation into the management of complex workers compensation claims and WorkSafe oversight' tabled on 12 September 2016, the Ombudsman is highly critical of the country's major insurance companies and their management of complex WorkCover compensation claims.

We have told the story of one of our clients, a farmer from Western Victoria, whose battle with respect to the termination of his weekly payments of compensation post the 130 week WorkCover review period is featured in the Ombudsman's report. Another of our clients is also featured in the Ombudsman's report. In this case our client had his claim rejected at the outset on the basis that his injury was not caused by his work, despite overwhelming evidence to the contrary.

Our client is a nurse who sustained a back injury while lifting and moving a patient. He did consult a physiotherapist on the day of the incident, but then attempted to work on for a couple of days and did not visit his GP until a few days later. Despite his treating doctors' opinion that his injury was caused by the incident at work, and despite an Independent Medical Examiner’s opinion agreeing that the incident and our client's employment was the direct cause of his injury, the Insurer rejected his claim on the basis that he did not report the incident immediately and did not seek medical attention immediately.

On our client's behalf, we referred the rejection of his claim to the Accident Compensation Conciliation Service. The Insurer's file notes, discovered by the Ombudsman, confirmed that the representative who attended Conciliation on behalf of the Insurer was instructed to maintain the decision to reject our client's claim and push our client to the doors of the Court - despite a clear acknowledgement that if he was to proceed to Court he would succeed. Fortunately, the Insurer accepted the claim before our client got to Court.

The Ombudsman’s report highlights many examples of tactics being used by Insurers to delay legitimate compensation claims. We repeat. It is a disgrace and urgent action by the WorkCover Authority is required”.

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