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Workers' compensation scheme failing employees, says report

Victoria's workers' compensation system is failing vulnerable and injured people and needs to be fixed, a Victorian Ombudsman's investigation has found.

Ombudsman Deborah Glass said complex cases, which make up 20 per cent of all WorkCover insurance cases, were being mishandled, deliberately delayed, or cancelled with minimal medical reasoning.

The report was also critical of the way WorkSafe, Victoria’s workplace health and safety and compensation agency, used financial incentives that rewarded agents for terminating compensation, saying it distorted the system.

The investigation, sparked by 500 complaints about WorkSafe and its agents in 2014–2015, looked into the management of 65 complex compensation claims by WorkSafe's agents, including major insurance firms Gallagher Bassett Services, QBE and Allianz.

It found that agents had been using a number of strategies to frustrate and deny workers’ claims:

  • Regularly changing case managers, resulting in multiple requests for same documents
  • Delays in making decisions on claims and approvals
  • Sending clients to multiple medical examiners one disagrees with claim ie “doctor shopping”
  • Withdrawing entitlements regularly, forcing clients to seek legal representation to get reinstated
  • Suggesting that something in the client's background is responsible for their condition.

Unfortunately these strategies are not confined to WorkSafe’s agents. Insurers and self-insurers (such as Telstra and Australian Post) will always be tempted to resort to such approaches in order to reduce the cost of claims.

CWU members seeking to have recognition of and compensation for a workplace injury should always contact the union before proceeding with a claim so as to protect themselves against these abuses of the compensation system.

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