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Ombudsman finds WorkCover used “unethical” practices to deny long-term injury claims

In a report released this week, Victoria’s ombudsman determined the WorkCover system has failed long-term injured workers. After an 18-month investigation, Victorian Ombudsman Deborah Glass reported WorkSafe officials often left injured employees without benefits or compensation in cases where claims were valid.

The WorkSafe agents, the report found, often made “unreasonable” and “unethical” decisions regarding claims, terminating cases for financial incentives or without cause.

“They’re terminating claims in wholly unreasonable circumstances,” Glass said during an interview with ABC Radio Melbourne.” Agents are making decisions to terminate claims, for example, or require unfair return to work practises that are not only unreasonable and unjust, some of these cases are downright immoral and unethical.”

Agents rewarded for denying claims

The ombudsman report further found WorkSafe agents were applauded by supervisors when those agents denied or rescinded WorkCover coverage to those receiving long-term benefits from the agency.

The Ombudsman reviewed emails within the agency and found employees communicating with supervisors, calling cases where claims were terminated as “wins” and the opposite as “losses.”

Glass referred to the system as a “complicated set of financial rewards and penalties” within the agency that promoted kicking injured employees out of the programme while discouraging continuing coverage for long-term injured workers. She said the investigation uncovered agents ignoring medical advice and selectively choosing information to justify terminating a complex injury claim.

The report focused on those who had been covered by WorkSafe for 130 weeks or more, which constitute around 25 per cent of all WorkSafe claims. The ombudsman reported WorkSafe employees were unwilling or unable to handle disputes, leaving many workers without compensation.

“The report reveals disturbing examples of injured workers who have been unfairly treated and unjustly denied their legal entitlements,” Attorney-General and Minister for Workplace Safety Jill Hennessy said in a statement.

“It also demonstrates a systemic problem with the current model of claims management for complex claims, and insufficient oversight and review mechanisms.”

The report, which covered five WorkCover agencies including EML, CGU, Allianz, Xchanging and Bassett, also found some agency employees harassing injured employees. One agent surveilled a care worker with a severe back injury, filming the woman to check for evidence she was faking her claim. When the woman asked the agent whether she was being followed, the agent lied and told her she was not being followed. The agent failed to find evidence the claim was not valid.

In response to the report, the state government said they would take 13 recommendations from the ombudsman, including putting in place a unit tasked with reviewing disputes and to launch an independent review of the claims management process.

For advice on any workplace compensation claims, be sure to contact Gerard Malouf & Partners Compensation, Medical Negligence & Will Dispute Lawyers.

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Gerard Malouf & Partners
 — Personal Injury Compensation Lawyers

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