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Insult and Injury

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How’s this for an opening line to my post:

Perspectives on workers compensation issues from Dr Peter Sharman – Occupational Physician.

Hopeful and hopeful is it not? Finally a practitioner putting it out there and standing up for a better Australian Worker’s compensation system.

It’ll be no surprise that Dr Sharman and I connected over a few tweets of frustration and WorkSafe/WorkCover hashtags. He’s been a fabulous support since, providing honest and open conversation about the primitive ways of the system, whilst expressing his frustration with not being able to help injured workers more. Well, now he is really helping injured workers and I believe it’s time for other practitioners to support him too. Peter has thrown open the topic and put it up for discussion on a fabulous blog platform. He’s also putting his views out there on how we can have a better quality system. I can’t wait to read his posts, they will be a huge support for me particularly now as I am heading back, once again, to conciliation to battle for my rightful compensation after a rejected part payment application (93cd) from my WorkSafe Agent (which now leaves me at 14 months with $0/0% support during my return to work process).

The literature is clear that people whose injuries are managed within a compensation system have worse outcomes, but why? Insurers would have you believe it is all because of fraud, secondary gain or that injured workers don’t want to get better. In reality it is more complex. Certainly there are issues about ’taking responsibility’  for one’s own recovery that can be lacking within a compensation system, but there are many other factors that affect the outcome. Important issues include stigmatisation of workers who put in claims and lack of access to appropriate treatment. The system often unreasonably questions a person’s genuineness, creating a response to prove there has been injury. The system of claims management remains adversarial. Responses include the development of secondary psychological illness which can be more disabling than the original injury. These issues can have dramatic effects on injured workers, i.e. Adding Insult to Injury….

…As a practitioner in private medical practice, I wanted to contribute to debate from my experience of the problems with the workers compensation system. Not only to raise issues, but to put forward solutions. That is difficult as a solo practitioner.

Here’s your chance practitioners, stand up, contribute and speak out. Demand a better Worker’s Compensation system.

Follow Dr Sharman:

Off to the Convenor of Medical Panels with my invisible pain

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You know that feeling before something great is going to happen, like just arriving at the airport and knowing you’re off on a great holiday? It’s a great feeling isn’t it? Makes your insides really happy, the body and mind get a lift, and troubles seem to slide away, everything feels like it’s going to be alright. Well, I couldn’t feel more the opposite right now. I have an appointment with the Convenor of Medical Panels on Tuesday and I’m feeling more like I’m facing a funeral.

Who are the Convenor of Medical Panels for those lucky enough not to have had any experience with them? I’ll just pop in their website information as they explain it best:

Medical Panels are constituted pursuant to the Accident Compensation Act 1985 and the Wrongs Act 1958.
A Medical Panel may be asked to provide an Opinion where there is disagreement or uncertainty about aspects of a WorkCover related injury or medical condition.
A Medical Panel may be asked to provide a Determination where there is disagreement or uncertainty about the degree of impairment resulting from an alleged Wrongs Act injury.
A Medical Panel Opinion or Determination on a medical question must be accepted as final and conclusive.

If you’re an injured worker, you won’t need to read on as you’ve either experienced the Panels yourself, or after reading the above lines you’ll know exactly what I’m about to say. For those who are not injured workers and want to understand your injured worker friend, read on. And if you are a Panels assessor*, please, consider the following and what injured workers have to endure when they face you.

Following, are my thoughts and the questions that will swivel around my brain, down my spine and burn my pelvis until this appointment is over and the final decision is mailed to me. Continue Reading

Theo and I, live on The Scheme Project’s broadcast

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Theo Soula Live In The Studio

Live In The Studio Scheme ProjectDoing my bit again for injured workers and hoping that sharing my story will bring positive change to the primitive Workers Compensation system in Australia.

Both Theo and I attended today’s live broadcast with Kris Vanston, Simon Toppin and their team to discuss the aims of The Scheme Project.

My specific rants are;

  • the inadequate methods of assessment for pain impairment within the system,
  • the out of date Accident Compensation Act 1985 and limiting AMA Guidelines also used for assessment,
  • the ‘Independent’ Medical Examinations (which are certainly not independent), and
  • the putrid investigation methods, (actually I could go on)…

Basically the whole system needs an update, this is not quality insurance or appropriate and respectful treatment for any person living in Australia, or anywhere else for that matter.

It’s time to speak up wherever and however you are involved with this system and contact The Scheme Project to contribute your experience.

Listen to the live broadcast here. Sign the petition or pledge funds so The Scheme Project can produce their documentary.

Happy to be stars of The Scheme Project

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Soula Theo On Scheme Project

Soula Theo On Scheme ProjectMy rants are plenty in regard to the WorkCover system and my efforts to express the limitations and lack of support I’ve experienced as an injured worker for almost 7 years have been endless. All efforts have led to the usual dead-end letter from a WorkSafe Agent, Government body, WorkSafe themselves, if not the dead silence and ignorance that’s on offer for most workers’ concerns.

I was ecstatic when I heard about Kris Vanston and The Scheme Project. and I offered to jump on board and help in any way I could. Theo and I have signed the petition and have both made our pledges. Recently we took our support one step further and spoke up in front of the cameras for The Scheme Project’s Pozible campaign promo. Continue Reading

Pain sucks for injured workers

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Quintner-Dr-John Apr12

Surfing the many ‘pain’ forums you eventually get to ‘cyber’ know the regular contributors. One of my favorites to bump into is the highly accredited and regarded, John Quintner. I give full attention too John, he is a great support for me (and to the world of pain). Regular readers of my blog might remember his previously posted paper ‘John Qunitner’s point of view‘ and may have also seen some of John’s great comments, in particular where I vent my frustrations with WorkCover.

But this post isn’t about me, it certainly interests me as it refers to assessments within the WorkCover system. Although John speaks for WA this does also apply for Victorian injured workers. I’m happy to be able to post this on my blog, although flattened and left without acknowledgement with my personal WorkCover impairment. I still hold hope our out-of-date system will be updated someday and it will be opinions such as these that will instigate that change. Future injured workers should be grateful for them.

If you haven’t come across John Quintner then my advice would be to google his name, he has some great opinions to share about chronic pain.

Written by Dr John Quintner
Monday, 01 July 2013

Dr John Quintner. Consultant Physician in Rheumatology and Pain Medicine

Mr Chris White, CEO, WorkCover WA (WA compo compares favourably, June 2013) rightly calls for factual information to support any suggestions as to how the scheme he administers could be improved.

In so doing, he has sidestepped the call for reform of the system made by pain specialists Drs John Salmon and Stephanie Davies (Management of WA’s work injured needs reform, May 2013).

Does WorkCover have a case to answer or are these experienced pain specialists making a big fuss about nothing? Well, let’s look at some facts.

In the WorkCover WA Guides for the Evaluation of Permanent Impairment (3rd edition, 2010), we read that because there is currently no validated measurement tool for the assessment of pain, WA has followed the NSW WorkCover Guides by excluding Chapter 18 (The Assessment of Pain) of the AMA(US) Guides V.

Without providing any factual evidence to bolster its position, WorkCover WA claims that pain has already been factored into the impairment ratings for demonstrable work-related conditions.

If that were indeed the case, extrapolating from this administrative decision, one might reasonably expect to find that the Guides being used in WA (and NSW) rely upon the use of validated measuring tools to determine the extent of bodily impairment.

But that is not the case: there are hardly any studies that would validate the assessment of physical impairment currently being used by WorkCover. [Davies, 2008]

This is doubly detrimental to the injured worker with ongoing pain and apparently little or no assessable impairment. Contrast this to the attempt to resolve the vexed question of psychiatric impairment.

Here, not only does WorkCover WA use ‘impairment’ as a surrogate term for ‘disability,” but also Approved Medical Specialists (AMS) are mandated to use the Psychiatric Impairment Rating Scale (PIRS), which was constructed by an expert group of NSW psychiatrists.

The PIRS comprises six subscales, each of which is said to delineate and evaluate discrete areas of functional impairment: self-care and personal hygiene; social and recreational activities; travel; social functioning (relationships); concentration; and employability.

Data on the reliability and validity of the PIRS has yet to be published by NSW WorkCover, although it did fund such a study in 2003. [Davies, 2008] Could it be that the results were inconclusive (or even worse than that)?

Furthermore, the final calculation of impairment rating using the PIRS is skewed towards the lower scores, thus reducing the overall amount of compensation paid. [Davies, 2008]

But at least workers with psychiatric impairment/disability are afforded a mechanism of sorts for assessing their entitlements. Why are workers with chronic and disabling pain being denied the same opportunity? Continue Reading

The Scheme Project

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The Scheme Project

I met with Kris Vanston yesterday after making my pledge to The Scheme Project last week and an exchange of some cyber chit-chat. We realised we had something in common, we want to better the Australian WorkCover system.

What is The Scheme?

(Sound file and excerpt from www.thescheme.com.au)

The Scheme Thumb
We’ve all heard the sensationalist news reports, however the true statistics behind injured workers are alarming; less than 0.5% of injured workers are the ‘fraudsters’ you might see on TV (Victorian Ombudsman’s report 2011), yet most injured workers are spied on by private detectives (yes, really), they’re made out to be guilty until proven innocent, each year costing taxpayers over $14 million in Victoria alone. It seems everyone involved in the system is growing tired of it’s inefficiencies, ultimately though, it’s the injured workers that gets left behind. Insurance companies are delaying and denying claims that should be processed because they can make a profit from it. Recently, CGU (one of WorkCover’s insurers), had locked up over 10,000 files in a hidden cupboard and manipulated invoices which made the company $2.5 million in profits. Now you have to ask yourself. How much more of this behaviour is not being reported? How much information is so incriminating to bodies such as WorkSafe or insurance companies, that they are willing to pay to suppress it? We are here to find out! Sign our Petition below and have your voice heard! We thank you for your continued much needed support. Continue Reading

Subject: Fair Assessment for Compensation?

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For those subscribed to this Fair Assessment For Compensation post, I have had a reply and it is posted here!

AN OPEN LETTER TO WORKSAFE AUSTRALIA

(CC’d The Hon Gordon Rich-Philips)

SUBJECT: FAIR ASSESSMENT FOR COMPENSATION?

My name is Soula Mantalvanos and I am an injured Australian worker ever since an unfortunate incident in March 2006 where the fitball I was sitting on burst and I fell on to concrete. I was diagnosed after 4.5 years, with a painful condition that is often misunderstood; it is Pudendal Neuralgia (specifically Pelvic Chronic Pain).

MedicalPanels

Obviously you will be able to imagine the difficulties I have had in the WorkCover system with such an injury. Six years down the track, at the age of 43, I am left without weekly payments and an impairment score of 0%. I seriously question whether I’ve ever been assessed fairly.

In the Preamble of the National Workers’ Compensation Action Plan 2010-2013, a paragraph (b) recommends providing “fair” compensation for work-related injury, illness and death. As far as I can ascertain, “fair” means “marked by impartiality and honesty, as well as free from self-interest, prejudice, or favouritism.” Does this definition coincide with that intended by WorkSafe Australia? Continue Reading

Performance ‘fit for modified duties’

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Did you all hear I’m back at work part time? Much thanks to our flexible home/office setup and Theo’s immense help. Regardless, how lucky am I hey? But oops, hang on, I have to correct myself. It’s not lucky for me, it’s lucky for the WorkSafe Agent. And I must clarify because from their point of view I didn’t get myself back to work, it had nothing to do with my research, the practitioners I found, their treatment and great therapies (or my hip pocket!). Nope, nothing to do with nerve blocks and medication, but rather, my high activity levels. Yeeees, I have been a full time artist and I’ve been caught red-handed!!!

Excited as I was to finally be seen as ‘fit for modified duties’, I was looking forward to receiving the WorkSafe Agent’s promised ‘dispatch’ mail. I expected to see copies of my new job description, Doctor’s capacity report and a letter explaining I would no longer be entitled to weekly benefits. What also came though, was a ruthless bundle of papers including video and photographic surveillance from February this year, that although amounted to a bunch of thin air, somehow became the reason I was ‘fit for modified duties’. I knew where this was going… Continue Reading

John Quintner’s point of view

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I’m forever searching for a decent explanation as to why the AMA Guidelines used to assess injured workers in the WorkCover system are so poor and out of date, especially when it comes to assessing chronic pain (and in my case of pudendal neuralgia measures a total score of 0!!).

Along my social media travels, searching for answers and researching for treatment or updated information regarding my condition, I have met John and had the pleasure of some great discussions. Dr John Quintner is a consultant physician in rheumatology and pain medicine and has kindly offered to share his published opinion on the matter. Thanks John!

Here’s an excerpt, or download the full pdf document. Continue Reading

‘Chronic Pain Disorder’ medical panel opinion?

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(For a further update on this issue please read Expired and fallen through the cracks)

What does it mean? Well, I’m struggling to get a clear understanding to be honest, even after being stamped with the ‘condition’ and living with it (apparently) for almost 5 years. To date, it seems to have panned out as psychological condition, gynecological condition, we don’t have to pay anymore medical expenses, blank stares, you can refer the matter to court, (and on and on it pathetically goes).

Let me explain myself further (and hopefully I might inspire some wonderful WorkCover specialist to shed some light), here I go:

From what I’ve gathered Chronic Pain Disorder basically means big general pain bucket and, its time to update the Wrongs Act 1958. And I’m stating very obvious information here because our Government has missed a very small detail… its 2012!!! So let me clear my throat… I’m going to have to make it loud… uuuuhuuuum:

Hello, anyone out there? If you are, it’s time to update the Wrongs Act of 1958 and the AMA Guidelines (1990s). Injured workers have injuries that can be addressed more appropriately, giving them a greater chance of getting back to work and lessening instances of permanent damage if the practitioners in the system can identify and use current information.

So what am I saying (and I speak from my own experience obviously)?

After my 130 week payment termination (how convenient for an injured worker to have no income during this time!!! Oh whoops, sorry, I should mention I did have the option to go to Centrelink), I attended Conciliation to dispute this termination of payments and from there was forwarded on for assessment to the Medical Panels (Medical Panels are constituted pursuant to the Accident Compensation Act 1985 and the Wrongs Act 1958 as stated on the website). I was assessed as having a Chronic Pain Disorder, basically, there is no specification for Neuropathic/Peripheral pain, or Neuralgia let alone any specific Pudendal Nerve issues or associated medical term so I was dumped in the big general pain bucket.

(At this point I’d like to break down the chronic pain disorder meaning even further. From my injured-worker-who-is-requiring-support-and-proper-treatment perspective this ‘opinion’ also means: we don’t know anything about back pain, we are not up to date, we don’t care about being up to date, too hard basket, vague, we can see you’re in pain – this’ll do)

So after gaining this vague label (and this is the second one because your WorkCover case number provides the first!), every decision the WorkSafe Agent and associated bodies, made since (or didn’t) stemmed from this opinion. So my follow up Independent* Medical Assessments (IMEs) were with Orthopedic Surgeons and Psychiatrists and yes, you guessed it if you’ve read through quite a bit of this site, they found no injury. Did anyone refer me on to a Neurologist? No. (Did I ask, yes, was I ignored, obviously or perhaps I was caught up in another case manager change over). Did any practitioner really look into my issue? No. They followed the big general pain bucket style, I was thrown in again and again.

However, some medical expenses support continued and also my weekly entitlements. Until last year that is. Firstly, the request for my wonderful, reviving peripheral stimulation device was ignored so I had to seek an answer through the Conciliation process (and yes of course my surgeon and I requested permission but as if I was going to wait 1 year for the faffing around, so I would like to take this opportunity and thank my private health insurer for paying 90% of the costs and continues to be my main medical support through my biggest progress period), and also, some massage reimbursements that suddenly died off too. Shortly after this, all remaining medical expenses were terminated leaving me with $zilch therapy support! In my letter I was told the decision was based on my ‘last’ Independent Medical Examinations (IME’s). What’s strange about that is the referred reports were exactly like all previous IME’s and I had been receiving medical expenses after those reports. This termination letter was quite sudden… out of the blue. It even ignored the most recent report that was due to come from an IME, a Psychiatrist** but had not yet been sent to the WorkSafe Agent or myself, not that it would have made a difference as the psych reports all say I’m fit for duty but it adds to the my point of poor support from this system, and makes me question the far from WorkSafe protocol of asking for a report and not using it. The decision to terminate medical expenses had obviously been made and I have no idea why and never will.

But. I have a hunch why this may have happened suddenly, and here my big general pain bucket opinion reappears. During Conciliation for the above mentioned two disputes (unpaid reimbursements, and seeking a response for the request of my stimulation device), the definition of my ‘Chronic Pain Disorder’ suddenly transformed and became a ‘Psychological Condition’. Apparently, this particular Conciliator thought that for some time, my WorkSafe Agent had it wrong and I was not meant to be having massage treatments or physiotherapy for a ‘Chronic Pain Disorder’ because it was a ‘Psychological condition’ (yes I know I’m repeating myself but that’s the way it was told, and actually repeated again, and again…).

My stomach turned when my Conciliator looked at my WorkSafe Agent representative and in a curious, happy manner said, that’s a fight for another day and continued on to resolve the mistaken unpaid reimbursements and to seek an answer in relation to my request for the stimulation device. At the time I didn’t understand it (and couldn’t for the life of me think of what might be funny either) and nor did I understand later when I spoke to this Conciliator on the phone and he repeated yet again, that I had a ‘Psychological condition’ and even added his confusion as to how a stimulation device can treat a… yes, he said it again, a ‘Psychological condition’. No where did my WorkSafe Agent or the Conciliator, dispute having paid my Neurosurgeon’s appointments???? I won the dispute for my massage reimbursements on account my Insurer was ‘honouring’ their having paid them previously but I was firmly told there would be no more massage treatments or therapy support and certainly no stimulation reimbursement. They were however continuing my General Practitioner and Neurologist’s appointments (but not treatment, get it? Neither do I!)

And the fight for another day? It came. I disputed the final decision made by the WorkSafe Agent to refuse reimbursement for my stimulation device and also tried to dispute the medical expenses termination. I didn’t get very far. Even though I had a professional Conciliator this time, my only choices were to go back to the Medical Panel for reassessment (yes, head back to 1958 and the 90’s!) or I was offered the choice of taking my WorkSafe Agent to Federal court.

My point.

Accurate diagnosis is critical to an injured worker’s support and chances of recovery. That’s impossible if our System uses the Wrongs Act 1958, the 20 year expired AMA Guidelines and unprofessional and uneducated employees.

Conclusion.

So, now I have a brilliant stimulation device implanted, it revived me and gave me the ability to research my issue and that led me to a Chronic Pelvic Pain Physiotherapist, in the General Public system (that’s right, so she’s free), who finally diagnosed me correctly (and you may have guessed I don’t have a psych condition, pain disorder, or Gyneocological condition!). I’m currently having treatment and begun to make some progress, which is giving me hope that soon I might be able to work part time again. My WorkSafe Agent has not contributed to any of the effective treatment and worse still, doesn’t even want to know about it. Of course I tried, the first thing I did when I was diagnosed was call my (passing through at the time) Case Manager to tell him my exciting news and provide the WorkSafe Agent with my Physiotherapist’s details in order to help other injured workers. In one phone call I got the following details:

  • My Neurosurgeon didn’t know how to write reports in order to get me reimbursement for my implant,
  • WorkSafe don’t want to be seen paying for implants,
  • Why would they call the Physiotherapist when she was not treating me for my work injury (back to ‘Psychological Condition’),
  • You have a ‘Gynecological Condition’ (!!!!).

I wrote to our WorkCover Minister.

And please, once again, anyone from anywhere in the system, if I have any of this information wrong or misunderstood, please make a comment. Clarify some detail, answer my queries, give injured workers some hope.

* Read my definition of independent
** I have learnt not to read the reports from ‘IME’s’ especially Psychiatrists as the awful assumptions, judgements and pathetic template style assessment really bothers me, but my husband read this particular report (when it finally arrived months after my termination decision was made) and had to share one bit of information. I was described as tall! I’m 157cm!!!!????… no, not so tall no matter how much I stretch!!

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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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