Who’s Red tape is it anyway?
It starts with a form when you go to the doctors. The doctor sees you, hears your story, checks your health, assesses what needs to happen then goes to their computer and downloads a four page form entitled “CERTIFICATE OF CAPACITY”. You watch the doc fill out the first three pages and you get the last.
Then you call your employer and they or you fill out the workers injury claim form – another four pages. The claim goes to the insurer, The call comes through in a few days, “We are sending you some forms to fill in”. the general tell us who you are forms, the not so general give us access to your medical records forms, the forms where you slot in your weekly pay and bank details, The forms to confirm your nominated treating doctor. The brochure saying what your responsibilities are and well.. they don’t really tell you where to go if you have a complaint, but there are a few lines in the other forms which do that. Nearly forgot, there’s also the form to make a claim for your medical expenses.
The doctors have a few more forms for you as well, but you might be used to those ones if you’ve been injured before, or had to go for a scan or blood test.
A few more days pass and you fnd yourself at the local stationary store buying a pack of 10 manilla folders complaining that you cant just buy one these days (don’t worry, you will need them).
The letters and emails start rolling in. The insurer has one saying that your doctor hasn’t supplied enough information to them and could you please attend one of three doctors so we can have an independent doctor review you oh and make sure you bring along your medical records. off to aldi to get one of those big bags. Your employer sends a few letters your way, We need to talk about your return to work, please keep us informed…. so and so is your return to work coordinator. The one folder becomes three labelled insurer, medical and work. The bills are kept separately for now because you know you have to send them to the insurer. The Aldi bag becomes bigger with the scans and any past scans you may have all tucked inside (if you have suffers psychological violence at work and have a psychological injury you might have skipped this part). you come back home to find a phone message from an investigator employed by the insurer to get your side of the story about how you were injured at work – diary note, more travel.
A few more weeks pass- you’ve probably ducked down again to the stationary shop to purchase a cheep exercise book which sits next to the phone at home so you can take down the phone calls from the insurer, work, union and specialist appointments. Then comes a white envelope with the insurer’s name on it, inside is a letter saying your claim has been accepted, saying your claim has been denied. if its been accepted they are asking you to reply because they need you to have a rehab counsellor, if its been denied there’s another form to fill out for an appeal. Those Manila folders were nearly a bargain for ten you tell you partner. Pretty soon whether its been accepted or denied you start wondering if you should have read all those forms you have been signing, your doctor is starting to talk to you about the calls they have received from the insurer and something called a case conference which the insurance clerk has said needs to happen at the doctors surgery (this reminds you of that letter from the insurer you got just the other day when you went to bed early to relieve the pain). you get the letter out check the date realise that they appear to have backdated the letter and go into a mild panic (they should have given you four business days over the two weeks they normally give you to cope with the postal service but they generally forget this). Then its another round of phone calls to the insurer to double check everything and while they have you on the phone they tell you you’ve been assigned to a rehabilitation provider (“Do I get a choice?” “Yes, but this is rehab is our preferred one, we’ll send you out a letter.”) then comes a phone call from the rehab, we’ve booked you in to a vocational assessment and by the way, I’ve been assigned to your case and I’ll see you for the first time at your doctors appointment- then everyone after that.” All to suddenly you realise your in over your head with all the letters, phone calls and emails so you start to look for a lawyer. Start a new manila folder, this one entitled Lawyer.
The day comes for your appt with the Independent medical examiner, all those piles of scans and letters go ignored on the Medico Legal’s desk and your life story is reduced to a 1/2 hour of questions and proddings. Another form to fill out at the end of it and you are on your way back home where, a couple more weeks later you find a letter from the insurer accepting/denying your claim (didn’t we just do that?) oh, and another one saying that your weekly payments have been cut by 15% (if not altogether).
Off to the rehab, more forms to fill out, your given a job diary and told that if you don’t apply for two,three, five jobs a week all your benefits will be cut. Then at your physio or psychiatrists appointment they tell you that the insurer has been in touch and your next visit has been denied. Back onto the insurers website and another medical claim form to fill out and wait 21 days before a reply back saying you need to see another medico legal because the insurance clerk doesn’t have enough information to judge whether you need extra visits or not.
Your work rings up and asks when you can come back to work, only they dont have any suitable duties for you to do so please just come to a meeting so we can tell you that face to face. another round of letters, emails, phone calls. the Lawyers application to WIRO has been approved and you are off to another medico legal (this one the lawyer says will be better because they should be on your side) more interviews, more phone calls, more emails.
The day comes and the Workers Compensation Commission has heard your case and forced the insurer to accept your claim (this happens in the majority of cases). the lawyer talks to you about suing for damages but first you need to get a total body impairment percentage, more medico legal appointments (for the solicitor and the insurer and possibly the Workers Compensation Commission), those 10 manila folders have grown to 20 (why cant you just buy them individually).
Just after a fairly pleasant trip to your physio therapist/specialist/psychiatrist you come home and there is a letter from the insurer saying that they are conducting a work capacity assessment and you need to go to x rehab to have a vocational assessment (didn’t you just do this?). You research online what one of these are (or you call us here at the Injured Workers Support Network-such a useful site that you just found- which you knew about it when you first had the incident) and start to panic, can they really cut me off? I am just feeling like I am starting my treatment. in a few weeks that letter is joined by another one from the insurer with the results- you can work more- you don’t need weekly payments any more, good luck and good by- oh but you can appeal to us using this form….. the letter contains one of the medico legal reports (what happened to the other one? did the insurance clerk read it? what did it say? I thought that dr was nice). you appeal to the insurer, sorry the insurer says the insurer made the right choice- but that letter comes with another form, you can appeal to the regulator which you do. a month slips by and the regulator gets back to you we agree with the insurer (not always but I need to end this post soon) and comes with another form, you can appeal to WIRO if the insurer has missed a legal step. A few weeks go by again, WIRO cant see a fault in the insurers procedures (WIRO has taught the insurers well- no offence to them, that’s what the government set them up to do). A final letter comes from the insurer, good by…
Of course what they are missing in that last letter is information about how you can continue to access medical care like your physio or psychiatrist for another two years or so but… well that’s in another claim form.