Published: 14 January 2020
Author: Stringer Clark

Ombudsman Publishes Damaging WorkCover Scheme Findings

In December 2019, Victorian Ombudsman Deborah Glass released a scathing report on the state of our WorkSafe scheme. Her 18-month investigation found evidence of “downright immoral and unethical” practices being used by Victoria’s worker’s compensation agents.

In Victoria, WorkSafe outsources management of WorkCover claims to five insurance agents: Allianz, CGU, EML, Gallagher Bassett and Xchanging. These agents are responsible for the day-to-day administration of injured workers’ claims, making decisions about physiotherapy, surgery, income payments and small lump sum claims.

Those of us practising in the worker’s compensation field know that the bulk of the stress experienced by our clients relates to the way they are treated by these insurance agents and the decisions they make about our client’s claims. Unfortunately, many of my clients tell me that the WorkSafe agent has cut off their entitlement to weekly payments even though their doctor has certified them as unfit to work.

Similarly, I often hear of clients being pressured to return to work well before they are physically and mentally able to, often with verbal threats that their payments will be terminated if they don’t comply. Whilst any decision made by an agent can be appealed to the Accident Compensation Conciliation Service, the process really is a toothless tiger and, in most cases, legal representatives are barred from attending to assist their clients.

Disturbingly, the Ombudsman found that all five agents had engaged in “cherry picking” and “doctor shopping” in order to reject and terminate claims. Even worse, Ms Glass found evidence that the agents were given financial incentives for the speedy termination of workers’ claims.

The Ombudsman’s report highlighted one particularly troubling email exchange between an EML case manager and a return to work specialist, describing the termination of an injured worker’s claim as “another win” followed by a sick joke by the return to work specialist about depositing the money saved, or as they phrased it, the “75K made today” into an “offshore Cayman Island account”.

Whilst Ms Glass made a number of recommendations to the State government and WorkSafe, many relate to the establishment of a new dispute resolution process and will, therefore, take some time for their presence to be felt. Without any sanctions being imposed on the agents, it is fair to say nothing will happen to change their behaviour any time soon.

If you think you have been unfairly treated by a WorkSafe agent or want advice on your rights, we encourage you to contact Ryan Carlisle Thomas without delay. In most cases we can not only help provide advice about agent’s decisions but also give advice about your entitlements to lump sum compensation as well.

If you want advice on any aspect of your WorkCover claim you should:

  • gather copies of important documents like your initial claim form, certificates of capacity and payslips;
  • make sure you know the date of your injury or have your Worksafe claim number;
  • have copies of any decision letters you wish to dispute; and
  • make an appointment with us without delay.
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