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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?

Elsewhere the document endorses “Engagement with members’ stakeholder networks to inform, consult, involve and collaborate with them and report back outcomes to SIG-Workers’ Compensation.”

Can you please inform me as to who are the stakeholders representing the interests of injured workers such as me? Perhaps PainAustralia? Perhaps Consumer Health Forum. Have they been consulted? If not, is there any reason for this?

I would also like to point out that many injured workers might be in the same position of being denied a “fair” assessment by virtue of the unavailability of a “Pain Impairment Rating Scale” similar to the PIRS (Psychiatric Impairment Rating Scale) which is currently in use.
I have found in my six years of experiencing pain that many of the independent medical practitioners being used for impairment assessment have retired from active clinical practice and their clinical skills are not up-to-date; thus none have been able to diagnose, assess or rate/score me accurately.

Ideally, I believe, assessment should have been carried out by my own independent medical practitioners who are engaged in active clinical practice within the field of my medical condition, Pudendal Neuralgia. These practitioners are up-to-date with diagnosis and clinical assessment techniques. These are the people that have made a difference to my pain and these are the practitioners/specialists who have made an accurate diagnosis and instituted proper treatment, and who best have the chance to help me get back to work.

My final question for the SIG-Workers’ Compensation: The principle of fairness mandates that people in chronic pain be assessed for monetary compensation under a similar impairment rating scale to those with psychological and psychiatric conditions. Have I been assessed in this manner? I believe I have not.

To conclude I would like to add that during my Impairment Assessment, I had a Neurologist, Orthopedic Surgeon and Occupational Physician, all male, examine me. They were thorough in measuring my implant scar and the Orthopedic Surgeon showed his knowledge by asking the Neurologist if he was going to do the ‘Perineal’ test (thankfully the answer was ‘no’). Taking this into account and them pricking me up and down with no response, and wishing me ‘a miracle’ on the way out I gathered these specialists did have some understanding of my issue. However, I feel the independent medical examiners in my case were embarrassed by their inability to perform a fair assessment of the extent of my impairment, there being no comparable rating scale to the PIRS!

I document my story via a website. Please note this letter and your response will be posted for public view on www.pudendalnerve.com.au and shared via social media.

Soula Mantalvanos

June8-10_2007SelfPortraitBrace_sm

pudendalnerve.com.au

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  • John Quintner

    Soula, I have been thinking about the various responsibilities of Medical Assessment Panels (MAP) convened by WorkCover. Firstly, MAPs comprise experts from the medical specialties that are deemed relevant to the accepted injury. However, many people who sustain spinal injuries are awarded a diagnosis of “soft tissue injury”. In the absence of a identified source of nociception (tissue injury), this constitutes a pseudo-diagnosis, as does “chronic pain syndrome”.

    If after reviewing the available evidence, a MAP cannot make an acceptable diagnosis, surely it needs to communicate this fact to WorkCover and request that the treating doctor(s) properly address this question. The MAP may even choose to suggest a direction for any further investigations thought to be necessary to make a diagnosis.

    As members of the MAP did physically examine you, did they, or did they not, take on the responsibility of arriving at an independent diagnosis of your ongoing symptomatology? If the MAP was unable to formulate a scientifically credible diagnosis, it defies logic that it could fairly rate your level of impairment.

    • Soula Mantalvanos

      You write with such sense John and I thank you so much for your time, effort and understanding, but the WorkCover system and its MAPS don’t have such vision. They assess within their limiting guidelines and I don’t think much thought goes beyond that. My understanding, looking back over these 6 years is that all practitioners fully understood and had knowledge that they could not assess me accurately and they either picked the closest ‘box’ the system provided or wrote ‘none, 0%, I cannot find’, and didn’t give me another thought.

      Words like ‘logic’, ‘fairly’ ‘responsibility’ are not part of this system’s requirement.

      Since not receiving a reply from my above letter, I’ve now forwarded it to my case manager (the one looking after my $0 payments) and he has replied he’s not sure what he can do with it but has forwarded it on to his superior. I’ll keep everyone up to date… when/if I hear.

      • John Quintner

        In Burmese Days, George Orwell writes, “It is devilish to suffer from a pain that is all but nameless. Blessed are they who are stricken only with classifiable diseases! Blessed are the poor, the sick, the crossed in love, for at least other people know what is the matter with them and will listen to their belly-achings with sympathy.”

        • Soula Mantalvanos

          See now that’s vision. But you’d never see someone with such brains on a panel for Worksafe… Orwell types are too busy with the ongoing work they made from their talents and from learning and educating themselves continuously.

          • John Quintner

            Soula, to be fair to my colleagues who choose to sit on MAPs, I would like to point out that they are constrained by the requirements of the relevant Act (which in my opinion serves to reinforce outdated body/mind substance dualism) and by the huge knowledge gaps that exist in Pain Medicine. Even so, because the findings of MAPs cannot be challenged (let alone tested), it is incumbent upon MAPs to produce diagnoses that are both rational and scientifically credible. I suspect that in your case, the problem of underlying diagnosis has not been properly addressed.

            The other important issue to consider is whether the authority that has convened said MAPs possesses the knowledge and experience to recognize spurious diagnoses (e.g. “soft tissue injury” and “chronic pain syndrome”) made by MAPs and declines to accept them. I suppose this is the ultimate test as to whether or not injured people are being treated in a fair and equitable manner by the relevant compensation authority.

          • Soula Mantalvanos

            That still doesn’t explain why they chose to assess within such unfair and inaccurate constraints. Why won’t you do it? Why won’t the many other doctors i’ve come across do it, why did they withdraw all stating they refuse to be told how to write reports? Yes the system should aid these specialists but when it doesnt the quickest fix and best way they can send a message to the governing bodies is to walk away. If no one abides by unfair criteria there will be no choice but for governing bodies to address the issue. Instead what’s happening now is an injured worker has to somehow gather funds, help, and hire a lawyer to get to court to, maybe, have a chance at a fair hearing. One guess who’s benefiting here…

          • John Quintner

            Soula, you know the answer to your question. Governing bodies will intervene only when the costs of the system are thought to be too high. In the meantime, people in pain DO have a voice through social media, which was not available to them 10 years ago. You and others have exposed fundamental flaws that exist in the WorkCover system. Keep up the good work!

          • Soula Mantalvanos

            I sure do! and yes, social media is a wonderful welcome for us all. Let’s see where it all goes. And thank you for sharing your wisdom.

  • JQ

    Soula, you have exposed the fundamental flaw in Workcover’s so-called impairment assessment.

    • Soula Mantalvanos

      I’m curious to see what happens. It’s not like this wasn’t recognised by WorkSafe or any other party associated with impairment… what’s everyone been doing? Assessing injured workers without feeling the need to be honest? Not one of my examiners added ‘I cannot assess this worker’ or ‘she may need a neurologist’… they just kept on writing, ‘I can’t see anything from my examination’. POOR, very poor.

  • Vanessa

    fantastic letter!! Awaiting the appropriate and fair response you so richly deserve xx

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Definitions of pain

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 aggravated 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.

What is Neuropathic pain?
Neuropathic pain is the result of an injury or malfunction in the peripheral or central nervous system. The pain is often triggered by an injury, but this injury may or may not involve actual damage to the nervous system. More…

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