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A horrid equation: Medical + Legal = Medical Panels

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From where I’m standing, you could never believe our Government has set up a system to support injured workers.

This very system that was established (apparently) for the injured worker is very well calculated and excruciating to navigate and whilst navigating it, the injured worker usually remains unfed and untreated.

My complete process from application to outcome and reimbursement of weekly payments (if I ‘win’) could go on almost a year. And there was a year before that when the system threw me into a disillusioned hole when it pulled the rug from under me after I declared a part time work capacity.

If you’re an injured worker reading this – don’t ever declare a part time capacity until you’re sure you have a solid one.

Whichever way you look at the situation for injured workers, the equation always adds up to unnecessary, unfair and insensitive treatment.

While I wait for the Medical Panels to send me their decision, their faces, movements, questions and gestures swirl around my head and I try desperately to guess the outcome.

Even at 2am, I fail to guess. It should be simple to go to an appointment and explain your personal health status shouldn’t it? It’s simple for my pain team.

However it isn’t simple for the Medical Panel because it’s not an appointment, it’s an assessment – they’re not the same. From my experience, this assessment is a full blown investigation and that so severely changes the experience… and my heart rate. I doubt I need to state that this scenario changes my pain levels but if I do, head back to

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The need for toughened glass

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med-panels-revised-letter

Crap happens in life but it’s how you’re treated when the crap happens that makes a difference and helps you manage as best you can.

I’m not talking about chronic pain in this post but rather my treatment by the worker’s compensation system (system) as an injured worker. That’s the major, most frustrating, tragic event to have happened in my life.

I’m sick of the injured worker stigma dished out from the very system itself. It’s true that the fish stinks from the head and in the case of worker’s compensation, that saying is 100% applicable.

I had two appointments to get through on Tuesday at the Accident Compensation Conciliation Service (ACCS) in order for the Insurer’s questions to be answered about my work capacity (I realise how absurd it sounds to have physical and psychiatric assessments to work out capacity but I have no choice in the matter). I know the answers to the questions but that makes no difference to anyone in this dreaded system.

I didn’t need to be assessed, I have a great pain management team, my husband understands my health issue, my family and friends understand and I even have a magical employer who understands and has pulled out all stops to make up a position and whole business for me to be a part of!

None of that matters. None of that counts. The system knows better… apparently. Or at least the system thinks it does.

Who are the system?

It’s this kind of scenario, can you imagine a monstrous haunted house? Now imagine that inside it reside: WorkSafe, their Insurers, the ACCS, WorkCover Assist, many medical ‘professionals’, various other related ‘professionals’ and let’s not forget the lawyers, barristers etc.

As an injured worker, it feels like I’m in the dungeon of this house.

On Tuesday, Theo and I attended two appointments planned for me at the ACCS. Three physicians and two psychiatrists were assigned to assess me. In order for them to assess me, it is a requirement that these medical practitioners have not seen me and vice versa. I hadn’t. I checked. I checked thoroughly.

A few minutes before my physical assessment, the receptionist had news for me. One of the psychiatrists had ‘seen me’ before. I was mortified at the thought that I had made such a mistake. Injured workers can’t make mistakes – it’s unforgivable. I was mortified also at the thought of the consequences – the insurer might have to make me pay for it! The ACCS, their professionals and the insurer would be furious for the time I wasted.

But worse than this was the treatment that followed. I tried really hard not to take a photo when I was in the waiting area at the ACCS talking myself out of feeling like I was a criminal as I faced the toughened double glazed office enclosure the staff were sitting in. There’s a walk way too that’s behind glass that leads the professionals to the assessment rooms (yes, their path is different – an escape with a view) – I struggled to find a reason for this and didn’t succeed. I felt offended.

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My dog’s breakfast is proving to be quite a serve of offal

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A never-ending feast in fact (if such food takes your fancy)!

It is the eve of my appointment at the Medical Panels. Tomorrow I will see the 12th lot of medical practitioners and the 8th lot of psychiatrists that I’ve had to see to obtain no less than four medical panel opinions.

If you haven’t come across my history, here, entertain yourself – it’s quite a few mouthfuls, even for a large dog!

To summarise the situation, my three medical panel opinions all ‘confirm’ that I have a Chronic Pain Disorder (no mention of neuropathic pain), that I have a total 0% whole person impairment, and that I have a limited capacity to work – and that will be the case for the rest of my life. They do not appear to have considered the diagnosis of pudendal neuralgia (which at least does attract an impairment rating).

This poor excuse for a diagnosis (Chronic Pain Disorder) not only awards me the whopping sum of $0 for my impairment lump sum, but also makes my two stimulation implants irrelevant to my supposed ‘psychological condition’. It allows the WorkSafe insurer to offer me a 10 month settlement on my first 93cd application and avoid paying me partial weekly wages for the rest of my life for reasons I’m yet to fully comprehend. Apparently it has something to do with payslips.

Theo called Worksafe again today seeking to find out the reason why the insurer didn’t accept my medical slips as recommended by the Conciliator (it had been three weeks since he heard the reassuring news – ‘I haven’t opened the email yet’). There was no answer forthcoming, other than the vague protocol response.

In a recent letter in response to our Worksafe complaint about the matter, I received this explanation:

‘In accordance with the Act, the matter was referred to the Medical Panel who provided an opinion on her medical condition and incapacity. (Insurer) accepted the opinion of the Medical Panel on the issues of the nature of her medical condition and her incapacity, however rejected the application on the basis of the value of Ms Mantalvanos’ earnings.’

Theo raised a fair question today:

Are we going back to the Medical Panel for adjudication of a financial matter?

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Worksafe, who are you really helping?

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Worksafe’s Mission is: ‘Actively working with the community to deliver outstanding workplace safety and return to work, together with insurance protection.’ When speaking with a WorkSafe employee today it was made quite clear to me that Soula’s insurer is doing everything possible to delay potential reimbursements. Yes, the WorkSafe employee agreed with me that the…

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My life as it is within Workers’ Compensation – it’s a dog’s breakfast

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med-panel-03

In my current state of bewilderment, this may be the best way I can describe my life as it is today.

I shouldn’t bag a dog’s breakfast, as unlike that which the workers’ compensation system has dished out to me – a dog’s breakfast is nutritious, and dogs love eating it.

But the vision of pieces of food strewn apart, sliding about and sloppy, and pretty much dumped in a bowl destined to last a few seconds before it’s consumed without much thought or agenda, reminds me of what the system dishes out to me as an injured worker.

The system’s employees I’ve come into contact with lack any compassion, and all too often even some basic thought processes (i.e. common sense) appear to be absent. Their awareness of my predicament is shallow and their span of attention shorter than the time it takes a hungry dog to finish its breakfast.

I can imagine the bowl … I can see it all very clearly what it contains – a damn mess.

In technical terms I have outlined my current position within the system:

  • My 93cd second application has been submitted, rejected and referred to the Medical Panels (it was late, but who cares?)
  • This is the second 93cd application as the first time the insurer managed to reject the Medical Panel opinion – I know that is unheard of but somehow they were allowed to get away with it
  • I have been given no reason as to how or why the insurer was able to:
    1. contest the Medical Panel’s decision;
    2. ignore the conciliator’s instructions (well, point 385 of the recent Ombudsman’s investigation does me some idea of these machinations);
    3. get passed Workcover Assist’s instructions;
    4. offer 10 months part payments for the duration of the application process and suggest I re submit another 93cd application (what I’ve now done after selling my home!);
  • I have complained to Worksafe employees, who have notified us over the phone that the Medical Panel referral still stands and the letter of confirmation and explanation is coming to me by mail.
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My workers compensation battle is turning into a WorkSafe carnivale

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Medical questions

It’s been a huge few weeks for WorkSafe and injured workers in Victoria.

I’ve always encouraged anyone who contacted me with their frustrations and horrid experiences of being an injured worker in Victoria to call their Ombudsman.

The Ombudsman’s role, as it was explained to me, was to gather complaints and if/when the complaints amounted in one specific matter, the Ombudsman would have reason to report the complaints to our Government and possibly investigate.

Clearly there have been many complaints and the Ombudsman just recently released this report about Worksafe’s ‘oversight’.

After finally gathering myself from the last blow that left Theo and I having to sell our home and start all over again, I resubmitted a 93CD application (that’s an application for part payments). Actually Theo is managing the application as I was unable to navigate the trauma of it all again but I also couldn’t bring myself to accept the insurer and our Government had gobbled up my compensation. Both very difficult when you have a chronic health issue and when you feel you’re being responsible for it but the other parties are trying to bury you instead of help.

I’ve seen the ad, ‘getting back, we’ll get you back, it’s good to be back, get you back, nothing like getting back.’ Hogwash! No one tried to help me get back to work! Nor did they advise us as self employers either!

Worksafe promises alot when they take our insurance premiums.

So, we’ve sent, what’s called a 93CD application to the insurer accompanied with:

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Act 3 – explained

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reward-penalty-workers-comp

Big day for me today. Thank you to the Victorian Ombudsman and to all the injured workers who spoke up. …Sadly too late – won’t bring our beautiful home and life back. Act 3: Home lost to these vile insurer (and WorkSafe Victoria supported), unjust actions: ‘At interview, one former agent employee said that management…

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Worksafe’s Dirty tactics – finally realised

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I woke up crying last night. I hardly ever cry. My boiling point hits when I’m feeling that I’m in a situation where I see no hope in sight and that I’m being treated unfairly and disrespectfully.

My boiling points have been few during the minute-to-minute demands of chronic pain management (over the last 9+ years) because it makes sense to me that you can have an accident and things can go wrong in life – that’s understandable although very upsetting and very difficult to deal with.

However, in respect to managing as a self employed injured worker with a workers compensation claim, I am unable to accept and understand the unfair and unjust treatment our Victorian system delivers.

I’ve felt the treatment from the insurer managing my claim (I don’t need to name them because they’re all the same!), Worksafe, the Independent Medical Examiners (IME’s), the Accident Compensation Conciliation Service (ACCS) and the Medical Panel IME’s has been unfair, unjust and throughout the 9+ year ordeal, I have sensed a corruptness about it.

Why? Because the system has no way of assessing chronic pain. No one asks the neuropathic pain related questions and given chronic pain is invisible, it makes it almost impossible for me to explain the injury.

That means it makes it really easy for the insurer to make me look like there’s nothing wrong with me and that I have more ability than I state.

Why was I in tears of frustration last night?

Because the insurer monster handling my claim has rejected the previous  Medical Panel Opinion from 2014 (yes the document that is meant to be binding in Federal court) for a reason I still don’t understand and no one can explain. In the next couple of months, I have to return to the ACCS for yet another horrific examination by yet another 5 IME’s who know they have no means of assessing neuropathic pain but who still require me to undress and who measure my scars (having no place to put the evidence) in order to somewhat respond to the insurer’s pathetic cluster of misconstrued information that they use to dispute my right to compensation.

The insurer has the right to do this. Worksafe loves them for it – in fact I believe they encourage it with incentives.

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Own motion workers compensation investigation with the Victorian Ombudsman

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Workers compensation frustration again

The horrid treatment toward injured workers has to stop. Two neurostimulation devices in my body are not there for the fun of it. My treatment is not ‘irrelevant for my psychological condition‘.

And the fact this system provides no appropriate measures for me to be assessed fairly for neuropathic pain is appalling.

But I’m glad to hear there is an Own Motion investigation with the Victorian Ombudsman (twitter:@VicOmbudsman).

For those fortunate enough not to encounter this monstrous system, imagine you have a health issue and you are forced to visit a specialist who was unqualified to assess you properly. You wouldn’t go right?

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This injured worker is about to burst

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Art & Chronic Pain - A Self Portrait

(Image from my book, Art & Chronic pain – A Self Portrait)

I’m going to erupt!

I feel I’ve been left without any avenue to vent the poor treatment I’ve experienced as an injured worker. I can’t make it any simpler :

I had a work accident and after declaring I had a p/t work capacity, I’m now left with $0.

That’s $0.

  • $0 financial help for any future treatment (currently undergoing thousands worth)
  • $0 wage top up
  • $0 superannuation
  • 0% return to work training or assistance
  • 0% guidance, and
  • 0° (except for this blog) to reasonably seek the promised help that I personally paid a 100% premium for in Victoria.

Wait, I have more to vent and please stay with me because you’re my only avenue remember?

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What is Pudendal Neuralgia (PN)?

Most simply put PN is Carpal Tunnel in the pelvis/buttocks. Compression of the Pudendal Nerve occurs after trauma to the pelvis and is aggrevated with pressure. The pain is often described as a toothache like pain, with spasms, sensations of tingling, numbness, or burning. It can be very debilitating.

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