Victorian Ombudsman shines light on WorkCover Insurers

Today, the Victorian Ombudsman delivered its report into the conduct of WorkCover Insurers. Whilst the Ombudsman acknowledged some good decision making practices of WorkCover Insurers, she also found some startling practices and internal processes that were in place, designed to unfairly terminate or reject injured workers benefits. Some of the more startling findings were -

1.  Not changing decisions made despite knowing that their decision was 'difficult to maintain' or 'not strong', presumably in hope that a worker will walk away from the issue after conciliation. 

2.  Having monetary amounts of rewards in place for achieving targets to terminate claims, including prizes for staff who terminated the highest number of claims. 

3. Ignoring all relevant medical evidence to ensure financial targets are met, such as not paying more than 134 weeks of weekly payments.

4. Doctor shopping for independent medical examiners until they find one that is prepared to say what they want, and then ignoring all other opinions to the contrary.  

The Ombudsman has made a range of recommendations, which WorkSafe has committed to implementing. If the recommendations are in fact adopted there will be a range of opportunities for improved outcomes for injured workers -

1.  Amending the WIRC Act to give Conciliators more power.

2.  WorkSafe to be transparent about what key indicators attract rewards for Insurers.

3. Ensure there be actual evidence when agents terminate weekly payments after 130 weeks. 

A copy of the report is available here -  https://www.ombudsman.vic.gov.au/getattachment/0eb3f52a-6488-46f5-beb0-5cf051db359d