Workplace anxiety and workers compensation claim

TentativeSteps · ‎06-03-2022

Because of the stigma I’ve avoided taking out a claim, having used considerable leave over the years to cope instead, but have bitten the bullet and lodged a claim going back to a recent event (not years but presumably that is helpful to explain what pushed me into a claim) which is well documented. Anyone understand why all I ever read is how difficult claims are because employer always claims it was ‘reasonable management action’ and insurer investigators buy this? Is it standard to be rejected to simply be pushed into an apparent toothless tiger conciliation and therefore the courts disregarding model litigant requirement and knowing employee cannot live without a wage? Have read Ombudsman reports wanting to have insurers improve their actions but has anything improved other than immediate reasonable medical costs being paid to start recuperating?

white knight · ‎06-03-2022

Hi, welcome

I've had a few claims of WC in the past. I also spent 18 years as a WC and road accident investigator. So I know the industry well in all areas including fraud, genuine claims and the "animal" the system is and why it is an "animal".

"Animal" meaning the WC system has evolved over time to become an unfair system on genuine claimants. The reason (although not necessarily justified) is that the claim rates are very high per employee numbers brought about by those that over state their symptoms and see it as a way of earning vast amounts of income from eventual pay outs from a court for damages, rather than swap professions or work with the (flexible and compassionate) employer, if that was the case.

The result of this excessive claim rate and subsequent huge pay outs has downloaded to very high WC premiums for employers. The more claims the higher the premiums. Even so, the average employer especially large ones dont care- you become just a number on the scrap heap and that shows clearly with lack of eagerness to assist you.

All this results in a difficult experience for claimants, genuine or not, you are all in the same basket. Little wonder once a case arrived on my desk I knew the insurer wanted a result that pointed to fraud rather than a accurate and fair assessment. I cant say anymore about that.

So what can you do? Well it varies from state to state but if your claim is denied (common but not always) that doesnt mean they are not liable. But it does mean that you have an automatic hurdle in that you need to take private legal action to demand compensation or any other action including seeking records for any defence you need. This is where people go wrong, by not commissioning a WC solicitor you are depriving yourself of representation that is crucial to fighting for your rights. Yes, your rights arent automatic. The WC road is a difficult one to navigate on your own and the insurance company has their own responsibility to- keep costs as low as possible, prove fraudulent claims for what they are, prove the capability of the claimant compared to their claim and make profit.

Taking leave instead of making a claim is commendable but that doesnt mean it has serve you better. Honourable actions dont mean you'll be rewarded in this world and you wont be able to refer back to your leave periods as being due to a workplace injury.

So, thats the system, the "animal" the reason it doesnt reward genuine claimants with genuine help.

TonyWK

Guest_7403 · ‎07-03-2022

I've been through the claims process....found it to be pretty straight forward.

The employers pay their insurers for this very coverage....its not an issue for them to have you apply and be granted a successful claim....its probably an irrational thought that you have that they are out to reject you at all costs.

Dont read the bad stories online about big insurers being out to catch you out or lawyers and drama fuelled issues that drag on for years....its not like that if your claim is legitimate.

Follow the process, give them the information they request and await there response.

TentativeSteps · ‎07-03-2022

Thanks for your view - I’ve only heard of our employer (govt) treating mental health injuries claims badly & stating everything as reasonable management action unless someone’s been verbally abused and witnesses exist but we all know the subtle pervasive aspects of ‘bullying’.

TentativeSteps · ‎07-03-2022

Thanks for replying. Great insight you offer. Your part, ‘…and you wont be able to refer back to your leave periods as being due to a workplace injury’ is of interest to me. It was to get distance to breathe after realizing the employer’s processes were a sham in dealing with complaints. Why wouldn’t I be able to refer back to that in that there’s proof of their sham complaints process and therefore rolling with the punches rather than report anything but the cumulative effect gets you to the ‘straw that breaks the camel’s back’ stage which is where I got to resulting in the claim (but believing the latest issue and build up to it are standalone reasons for my mental injury, albeit emails will no doubt be scrutinized to find reasonable management action).

white knight · ‎07-03-2022

You could retrieve emails etc but overall it would be difficult to prove you took leave for a workplace injury rather than document or collect documents eg submitting a claim.

What I'm saying is your actions in taking leave instead is a credible action but does nothing towards any future claim as you made the choice not to claim.

A comparison is- if you lost your job and decided at the 6 week waiting period for the dole that instead you waited 6 months when you run out of money, centrelink would process your claim from the day you submitted it. No backdating. No different because it would see numerous claimants state that they didn't submit a WC claim and took leave instead.

We live in a world of written evidence not verbal claims.

This is really a solicitors domain so take my knowledge as someone that knows the system but not as someone with legal qualifications.

I hope I've given you some insight.

TonyWK

TentativeSteps · ‎07-03-2022

Ok, stoicism is of no relevance overall and clearly bad for one’s health it turns out.

white knight · ‎08-03-2022

That's right. I know too well the injustice of the legal system not in its intent but in its failure to protect the genuine.

I'm sorry you are in such a jam. It's similar to when I separated from my first wife. I left her with 80% of the savings and with the remainder paid off small debts like credit cards and washing machine. When I went to commence paying child support I told them if that arrangement only to be told it was irrelevant, it all occurred before the claim.

We learn the hard way. So, having said all that you might be doing your mental health a disservice by focussing on it. Bigger problems to fry.

Can we help you with any of your other issues?

TonyWK

TentativeSteps · ‎08-03-2022

Thanks again - not a jam as I was wanting to understand sick leave relevance as I’d read somewhere that’s a red flag but it was probably HR related and it is what it is - you take leave to cope and build further resilience - it’s been before, during and likely after this claim but here’s hoping the claims process and RTW might see them change their ways as HR processes don’t.

TentativeSteps · ‎09-03-2022

The main thing I’m hearing is investigators always find a reason to reject MI claims stating everything is ‘reasonable management action’. Common sense in reading relevant emails shows it’s not RMA to intimidate provide no transparency when asked for info on how to do my work etc so I’m confused apart from ‘don’t speak to investigators, They twist your words’.

And then there’s the part where you end up with an IME with a diagnosis - from the event that caused you to take leave to cope. It seems like HR/OHS issue to be sorted at the same time as running a claim for being injured. What is the role of the investigator exactly?