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SIRA investigating why workers’ compensation claims are being denied

Australia’s multi-billion dollar workers’ compensation system is receiving fresh criticism from the State Insurance Regulatory Authority as more people come forward confused as to why their injury claims were denied, according to The Sydney Morning Herald.

Initially reported by The Age, The Sydney Morning Herald and ABC TV as part of a joint investigation, the inquiry discovered rampant mismanagement of Australia’s $60 billion workers’ compensation scheme, including “unethical” conduct by Icare staff, the organisation that manages and the workers’ compensation program, along with insurance giant QBE.

An uphill battle for some claimants

Brett Fitzpatrick, a prison guard at the Silverwater Correctional Complex in New South Wales for the past 10 years, filed a claim after citing years of abuse in a toxic work environment, including bullying and harassment. Yet despite providing corroborating evidence of such abuse, QBE denied the claim. Mental and emotional stress are increasingly responsible for workers’ compensation claim filings, according to the most recent figures available from Safe Work Australia. 

Speaking to The Sydney Morning Herald, Fitzpatrick said he can’t help but feel like many forces are allying against him.

“I’m trying to fight all these multiple parties … all at the same time whilst dealing with a mental incapacity,” Fitzpatrick explained. “It’s like being in a boxing match with one arm tied behind my back.”

KPMG first to launch investigation

The allegations of mismanagement are not new. In fact, consulting firm KPMG launched an investigation into the alleged improprieties several years ago. However, the joint investigation into KPMG’s inquiry intimate the consulting firm may have been less than forthcoming in its findings, papering over issues that were indicative of malfeasance. The Sydney Morning Herald reported that KPMG was paid $200,000 by Icare, the same organisation that was the subject of the probe.

The joint investigation further found that KPMG walked back some of its initial recommendations that determined Icare and QBE were in the wrong by denying some of the Silverwater correctional facility’s injury claims. For example, KPMG’s final report removed certain recommendations that it initially made and email conversations among staffers that were suggestive of collusion were also wholly eliminated.

For his part, Icare CEO John Nagle said any notion that the KPMG report isn’t fully transparent is baseless.

“The first version contained information that was basically just hearsay,” Nagle explained. “So we asked KPMG to just stick to the facts that were actually available. And so they had to amend their report. That is the report that was used. If you take out speculation and rumour, you’d have a change in the report.”

The SIRA is looking into the matter.

If you’ve been denied workers’ compensation funding, Gerard Malouf & Partners will fight for you in court. Contact us today.

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Gerard Malouf & Partners
 — Personal Injury Compensation Lawyers

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