Posted on 06 Dec 2019
The Victorian Ombudsman’s second investigation into five commercial insurers behind WorkSafe has highlighted the questionable behaviour of agents.
It revealed practices including selective use of evidence to cut-off entitlements, doctor shopping, reliance on independent medical experts over treating doctors and surveillance to discontinue benefits, even when the activity is approved by a physiotherapist.
“Many are made to wait several months or must rely on litigation to access simple and much needed services such as rehabilitation following surgery or psychological support due to not being able to return to work,” Ms Lay said.
“The report cites more than 850 conciliation requests from workers due to the insurers’ failure to respond to treatment requests.
“When a medical and like expenses referral is received, the insurer should make a decision within 28 days. Often this deadline isn’t met and the delay compromises the inability to recover.”
Ms Lay said she had seen a significant number of psychological claims rejected on the basis of reasonable management action or performance reviews at work.
“Insurers rely on this defence, even when no record of performance management action being taken was available. About 60 per cent of psychological injury claims were rejected using this defence,” Ms Lay said.
“When people’s ability to get back on their feet is this difficult, there can be dire consequences. Quality of life is lost and some can no longer afford to keep a roof over their head.”