Dealing with WorkCover Insurers

Claims Administration

While WorkSafe is ultimately responsible for regulating the WorkCover system in Victoria, claims administration is contracted out to one of 5 insurance companies.

There are also a number of employers that have self-insurer status. This means the employer employs enough people to make it financially viable to pay the costs of any WorkCover claim out of their own pocket rather than pay a premium to WorkSafe.

How did I end up with this Insurer?

Leaving aside workers employed by self-insurers, when you lodge a WorkCover claim after sustaining an injury at work, you will have to deal with whichever of the insurance companies your employer has signed up to.

Ongoing Issues with Insurers

Historically injured workers and lawyers alike have had plenty to complain about when dealing with the insurance companies. However, it seems that the experience of dealing with the insurance companies is getting worse and leading to more frustration than ever.

Many of my clients experience rapid turnover of case managers. This means it is very difficult to build rapport and trust. Many case managers seem to spend most of their working day “in meetings”, and while the person who answers the phone will try to assist with the enquiry, this often requires going through everything that has led up to the enquiry in the first place.

My experience has been that case managers are handling more claim files than was historically the case and are generally less experienced. Mistakes and incorrect interpretations of the provisions of the Workplace Injury Rehabilitation and Compensation Act often lead to interruptions and delays to injured worker’s entitlements.

What can I do about it?

When someone is in pain or only capable of restricted activities it’s hardly surprising that frustration, depression and anger often become dominant emotions. Here’s a few tips on dealing with a case manager if things aren’t going well:

·         Try not to take it out on the case manager if you are lucky enough to get through to them. They are probably overworked and trying to juggle client satisfaction with the large workload allocated to them by their employer.

·         Use email so you have a record of the interactions if things are not being actioned fast enough or at all.

·         Remember that each insurance company has a Complaints Department. Ask to speak to them if you’re getting nowhere with the case manager.

·         If you are legally represented, give your lawyer a call and ask them to get involved.

Unfortunately case managers have more files than ever to administer, and some case managers are better than others. Taking it out on the case manager won’t help, even if it makes you feel better. The problems are often due to decisions made by people higher on the food chain-and you will never get to speak to them!