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Expired and fallen through the cracks

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Milk with Expiration date: 1990

For over a year now, I’ve been seeking an employee in the WorkCover system who has a thorough understanding of my case and not one that walked into a mountain of papers new to his/her job (and would be walking out again in just a few weeks). After 5.5 years in this WorkCover system I’ve found it extremely difficult to find anyone who can speak openly and be frank with me and who I feel understands me or my injury. It’s no surprise really, when the Hon Gordon-Rich Philips chooses not to promote clearly he also manages WorkCover amongst his vast portfolio . I’m left to thinking this is the land of wusses!

After a few battles regarding my massage treatments, peripheral stimulation implant and finally receiving a letter form my WorkSafe agent stating I would no longer be receiving medical reimbursements/support, I began a hunt for a deserving explanation.

For a second time, I wrote to the Hon Gordon-Rich Philips, but this time approaching him before beginning a dispute with the ACCS. I went off the Hon’s first letter of reply where he states the following: As this matter is currently going through the dispute resolution process provided by the Act, it would be inappropriate for me to comment on the specifics of your claim.

Almost two months later, I received a reply. It came with one very inaccurate detail, a few template sentences but most importantly a contact. I was impressed! The Hon states I withdrew my application for dispute of my medical expenses but the withdrawn dispute was for my implant reimbursement. I didn’t complain about the Hon muddling up the details, mine is a huge case and the error does clarify how confusing, messy and complicated this system is. Even the Minister and his associates get the details wrong. Might also be hint of disorganisation from the coming-and-going of case managers and let’s not forget the complexities of the system… what are you going to do with an injured worker who’s injury isn’t stated in the guidelines?

But back to my main point, the answer I was seeking. I called the contact the Hon advised and it led to a conversation with my WorkSafe Agent’s Injury Management Advisor (IMA) and for once, I seemed to be having an open and honest conversation with a WorkSafe Agent employee. It’s hard to say it was honest because this system has taught me not to trust anyone, sadly. It felt like a great relief to be speaking to an educated, intelligent, experienced and capable person (a Psych who is continuously studying the National WorkCover systems). I didn’t get invalid and poor excuses or worse still, lies. Every point I made was dealt with and the conversation was about me, my case and my specific issues. I was bewildered when the IMA responded with, “I know, I know you’ve done… I know you’ve seen… I know Dr so-and-so” and the grand finale was that the IMA was going to answer why my medical expenses support had ceased?

The following day, yes, the following day, I had my answer (and another very civilised conversation). In two phone calls my frustration was greatly reduced, I had someone tell me they understood how much the system has frustrated me, how much the system frustrates many injured workers, I had been told I was doing all the right things, and she understood I was not being commended for it, the conversation went something like this:

  • You’re right, your issue is not in the AMA guidelines and I spoke to the impairment doctors about this and they confirmed it true. I asked if you were to be assessed under the guidelines four and five would it be better but they don’t include your issue either
  • This is a system and like any other it can’t cater to everyone
  • Yes it can get better, we have a long way to go but it is a better WorkCover system in Victoria. The Victorian system doesn’t operate from taxpayers money but rather dips into the premiums companies/businesses pay (with larger organisation may make contributions of millions per year)
  • WorkCover was initially set up for workers, the system is not like other insurance companies, it must abide and is bound by Parliamentary laws
  • WorkSafe Agents don’t have their own doctors/examiners, these are independent doctors that choose to work for the agent (yes they choose to assess injured workers with limited guidelines, this is legal!!)
  • WorkSafe Agents are bound by  Parliamentary laws (not a set of their own)

And as for my answer:

  • Each injury/claim is allocated an amount and your injury has reached the end of its allocated funds
  • I know it’s frustrating, doing all the right things but you fall between the cracks
  • You could take the matter to Court but of course the Court functions under Parliamentary rules and follows the AMA guidelines

So in summary? For the last year I have had two attempts at conciliation, called, emailed and spoken to many incapable people, written to the Minister twice, stressed and been frustrated when all that trouble could have been saved with one phone call. The difficulties I have are mostly explained with the fact my injury isn’t acknowledged within the WorkCover system. This knowledge also explains why my horrible condition measured 0% at my impairment assessment.

I promised myself I wouldn’t swear on my blog but honestly how f*****g hard was it for someone with some b***s to speak to me in the first place?

I didn’t win anything, nor will part of my medical expenses be reimbursed (except my GP visits for capacity reports) but I know now not to bother with court, and I don’t have that torment inside that some incapable person is making excuses in mumbo jumbo lingo to me. I have my answer and more peace than rage. I’ve done my bit, and can now go back to focusing on myself and with closure perhaps get a little bit more pain relief.

I’m left wondering about the doctors who sign up for this system though, who assess injured workers with out of date and limiting guidelines. Worst of all I can’t believe our Government passes such laws. They created a system for workers (IMA certified comment) and chose to do it this way. Sure there have been some great amendments but wouldn’t it be more beneficial for everyone if the guidelines were updated… in the last 20 years!?

The Hon thanked me in his letter for bringing my matter to his attention but I was more looking for ‘We’re working on this, I know the guidelines are 20 years old we are trying, There were discussions about WorkCover..’ and suggestions where an injured worker can get answers, a little less tragically than I had to. I understand this is a tough portfolio but what’s tougher is being injured, unable to work quite possibly for the rest of your life and having a system that is not only limiting but also adds to your pain, adds obstacles in your attempts to cope and deal with your injury.

Do I need to point out it’s important for injured workers to communicate their issues with the Hon Gordon Rich-Phillips and that he is approachable? I’m not sure it’s worth hounding your insurer or WorkSafe.

Speak up people!!!! It’s easy in this day of technology. The Hon’s details are:
gordon.rich-phillips@parliament.vic.gov.au
www.rich-phillips.com.au
www.facebook.com/gordonrichphillips
twitter.com/#!/RichPhillipsMLC

Of course I had to thank the Hon Gordon Rich-Phillips and make sure he understood my problem afterall I was excited, I had just found out what it was!

Subject: thank you
Date: 20 June 2012 5:28:26 PM AEST
To: gordon.rich-phillips@parliament.vic.gov.au

Dear Hon Gordon Rich-Phillips,

I wanted to thank you for replying to my letter of frustration and for referring me to (IMA details).

After a lengthy, open and honest conversation with (IMA), who was well aware of my case and previous frustrations, I finally received a clear understanding and an answer to the snap ending of my medical expenses support and why my stimulation device could not be funded.

You thanked me in your letter for bringing the matter to your attention. I still want to make sure my issues are clearly understood in the event a change can be made as obviously the lack of support is very unhelpful for an injured worker with an issue such as mine. The problems I am experiencing with my support are completely due to the fact that my injury is not specified in the AMA guidelines and therefore can’t be acknowledged anywhere by anyone in the WorkCover system (or by associated practitioners). This is also how my horrendous injury is given a 0% impairment score.

It’s a little steep to accept this when you’re living in Australia but I’m hoping somewhere at some point this will be tackled in Parliament for injured workers who unfortunately will follow and suffer the same neuropathic injuries.

Can you please just imagine having a health issue and visiting a Doctor whose experience and knowledge was limited to the 1990’s? I expect you simply wouldn’t go.

If there is any chance of helping, please do. Once again I will document this information on my blog in hope of helping other injured Australians with similar issues. Please advise me if you prefer this information not to be publicised (obviously the Insurer’s name will not be mentioned).

Kind Regards
Soula Mantalvanos

Feedback

10
  • John Quintner

    Soula, you should be able to download the Guides from your State WorkCover authority’s website. If you send me your email address I will give you a copy of a published article I wrote on the subject. Mine is: jqu33431@bigpond.net.au

  • John Quintner

    Soula, I believe it is the very uncertainty of pain that is responsible. Insurers do not like living uncertainty. Hence the appeal of “cook book” impairment assessment. People’s biological predicament can be reduced to a numerical percentage by simply following the instructions in the “bible” – the AMA (US) Guides to the Assesment of Permanent Impairment. Never mind that the Guides were not designed to determine monetary awards for compensation. This is made clear in the Introduction.

    • admin

      Do you have a copy of the \’bible\’ by any chance John? I think I should include it on my site. I like you\’re \’cook book\’ term… I could have an exhibition of all the images that come to mind dealing with this system. Thanks for your great comments.

  • John Quintner

    Soula, people in pain have no chance at all. The compensation systems have effectively denied them a voice and locked them out! This has happened over 25 years and will be difficult to reverse. However, if they accept a “Psychiatric Impairment Rating Scale” why not a similar “Pain Impairment Rating Scale”? Of course for psychiatric conditions, “impairment” is being used as a surrogate for “disability”. Body/Mind dualism is alive and well!

    • admin

      pathetic, ignorant, backwards… do you really think it\’ll never change? is it too difficult or perhaps they just give up hope with chronic pain as most people too. we\’re not worth it. too expensive better off dumped and pushed over the edge to either give up or suicide. (would love to know the suicide stats related to w/c).

  • John Quintner

    Soula, posting my comments on the Minister’s website souls be a complete waste of time. A powerful and independent medical profession once acted as an effective buffer between government (and its bureaucrats) and patients (sufferers). This is no longer the case, as evidenced by the alacrity with which the medical profession embraced the introduction of spurious but lucrative impairment assessments. Until such time as the systems of compensation fall apart and/or cease to be cost effective for insurance companies, nothing will change.

    • admin

      you\’re right! completely. but where\’s their conscious? impairment assessments? pf! what crap. my last neuro assessor at impairment wished me \’a miracle\’ on the way out then rated me 0%. idiot! and my last independent examiner had a pile of surveilance in his file of me. independent my damaged and scarred butt cheeks!!!
      you sound like you have great grip and accurate views, of course this doesn\’t help. i still think our government should be ashamed. they are the ones who make the legislation insurers follow. they assign these agents to do their dirty work. how is it we can\’t go to the ombudesman for these matters but for non gov insurance we can? disgusting!
      take care of yourself.

  • John Quintner

    It was unfortunate for people suffering chronic pain that the WorkCover systems in Australia moved from a Disability-based assessment to an Impairment-based system, as you found to your cost. In my opinion, the WC system is a dinosaur that is propped up by medical practitioners who have surrendered their professional independence in return for financial rewards. They are controlled by claims officers etc who make sure that their assessments accord with the AMA (US) Guides, minus the Chapter on Pain Assessment. In fact, impairment assessment is used as a surrogate for disability when applied to people with mood disturbances. I think they call it a “Psychiatric Impairment Rating Scale” in some jurisdictions.
    No that we know that stress response systems can be activated by psychological as well as physical stressors, the body/mind divide has been transcended.
    Where to from here?

    • admin

      Hello John, thanks for your great comment, so well stated. i think you should post that on the Hon Gordon Rich Phillips fb page!

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