Published: 12 September 2016
Author: Stringer Clark WorkCover Law team

"Catastrophically injured" farmer kicked off WorkCover benefit for 12 months

Victorian Ombudsman releases damning report on WorkCover scheme

A catastrophically injured farmer who had his benefits cut off by Allianz Insurance and WorkCover is one of a number of case studies featured in a damning report into WorkCover released today by the Victorian Ombudsman.

Up to 20% of injury compensation claims in Victoria are being mishandled by WorkCover, leaving thousands of injured workers stranded and without income support payments, according to the report which is an investigation into the management of complex workers compensation claims and WorkSafe oversight.

The report slams the incentive scheme established by the Victorian WorkCover Authority that encourages private insurers, who directly manage and process entitlement payments, to kick injured workers off the scheme. Sometimes this is done by “cherry picking evidence to support a decision to reject or terminate a claim” according to their media statement.

The report is damning of WorkCover and some of the country’s major insurance companies including Allianz, CGU, Gallagher Bassett and QBE.

The Ombudsman is particularly critical of the management of complex compensation cases where terminations of payments are rewarded by the Authority. “The process of resolving disputes also demands careful consideration“ the report says.

Injured Western Victorian farmer left stranded

Our client and his wife were one of the Ombudsman’s featured cases. The details are distressing and caused misery for the rural couple who were forced to eventually sell their farm because of Allianz’s obstruction and the severe and disabling nature of our client’s injuries.

The man was seriously injured on his farm back in 2012. Because his company had been paying WorkCover injury premiums, he was covered for replacement income. But once the 130 week period of payments was reached, both WorkCover and Allianz refused to accept medical evidence that he was no longer fit to return to meaningful full time work.

As a result, he was kicked off weekly payments and struggled to continue to hire in labour as he had done so, since his injury. This escalated the financial strain and proved too costly.

The farmer came to us for help. On our client’s behalf, we appealed the decision to the Accident Compensation Conciliation Service (ACCS). The ACCS recommended to WorkCover and Allianz that the farmer was unable to resume meaningful work and that his case should be reviewed.

Despite medical evidence from an independent doctor, Allianz continued to argue against reinstatement of benefits.

We took the matter to the Magistrate’s Court on our client’s behalf and in 2015 WorkCover and Allianz were eventually ordered to resume payment of regular ongoing benefits. Although by that time, the couple had sold their farm.

Delaying tactics causing misery

These kinds of delaying tactics are common among insurance firms and to which WorkCover turns a blind eye.

The Ombudsman says that the WorkCover Authority has been gradually reforming its complex case procedures, including its use of incentives with insurance firms. But clearly, it is dragging its feet.

There is no reason that so much more hardship should be caused to people who are seriously injured and can no longer work. That in this one case a man and his wife had to fight in the courts to have a legitimate compensation payment reinstated is reprehensible.

That the system has similarly treated so many other injured workers like this is a disgrace and requires urgent action by the Authority.

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