Work Cover

I am dealing with a workcover claim.

The claim involves a broken leg. Nobody disputes that the incident happened at work.
Xrays show a broken bone. I have my leg in a cast.

I amto be interviewed by a private detective. CGU (the claims agent) are unable to tell me the reason for the claim being investigated.

I am mandatorilaly required to attend an appointment with a general surgon in Melbourne (2hr drive) CGU are unable to say why they want a surgeon to examine my broken leg.

Travel will be reimbured at the princley sum of .28 cents per km.

As I am unable to drive myself (I have a cast on my leg) my wife or daughter will take a day off work to drive me. They will not be reimbursed for lost wages.
I can however take the bus down, stay overnight attend the appointment stay overnight again and take the bus home. (The time tables dont match up). I will be reimbursed for these expenses or possibly not for the second nights accomadation.
or possibly take a Taxi.

I recieved a letter from CGU dated 27th december, envelope post marked 3rd january.

The person I have been asked to contact at CGU has never once been available nor returned any calls.
The accident happened on the 7th december. CGU claims they did not recieve a cklaim form until the 20th, they have 28 days to decide on liabilty.
I have had no income since the 7th of December. my wife's salary is committed to loan payments.

Thanks a lot CGU insurance you are uselss ar*****ing soles.

Sounds a bit rough, hope you get it all sorted out soon without too much more drama

All the work cover insurers are turds who immorally force innocent people to the wall. Join your union fast.

It is all a delaying tactic by CGU in the hope that I will recover, go back to work, and just forget about the claim as it just too much trouble.

The role of the investigator and the insurance doctor is to gather evidence that they can use in Court against your best interests.

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Originally Posted by echnidna

The role of the investigator and the insurance doctor is to gather evidence that they can use in Court against your best interests.

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I am of course aware of that echidna.

I have made a complaint to the VWA advisory board.

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Originally Posted by dadpad

I am of course aware of that echidna.

I have made a complaint to the VWA advisory board.

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Good luck with it. I deal with the NSW equivalent all the time as the injured persons GP. They are not very logical in who they investigate. It will end and they usually pay up in the end.

I concur with Terry, in NSW I know for sure the insurers can be non-sensical to say the least in their approach to claimants, and they ignore the employers in many cases as well.

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Originally Posted by Terry B

It will end and they usually pay up in the end.

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In the meantime I have no income. :((

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Originally Posted by echnidna

The role of the investigator and the insurance doctor is to gather evidence that they can use in Court against your best interests.

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Or to ascertain liability thus preventing the matter going to court, if you engage your own solicitor in this matter they will advise (more than likely) not to speak to the investigator.
I used to operate in a similar role with the TAC, I found their motives were less sinister, just ascertain the cause of injury to finalise the payout, it is a complicated procedure and there must be a liable party, not just take money from a communal pot.
Most were straightforward and went without incident, with the odd exception of someone trying to cheat, and I am in no way suggesting that is what is happening here.
An investigator will report back to the insurer the full details of your injury, what effect it is having on your life, treatment and progress, but I would still engage my own solicitor.
PM if you want some names.

Re read, CGU are unable to tell me the basis of the investigation......that is horse shyte, they initiated it.

I'd still advise and bill them for reasonable out of pocket expenses. If the outcome of their investigation is that you are not a crook, they just might have to pay.

If you suspect their motives, have a witness present at any interview or consultation, and demand a copy of any report. You may not get it, but it should send a message that you are not a pushover.

For what it's worth, I wouldn't be so quick to assume they are trying to wiggle out. They probably have a standard procedure for various types and sizes of claims, and yours must fit one of them. None of us want them to pay dodgy brothers for their fraudulent claims because we all pay higher premiums if they do.

woodbe.

Hey Dadpad, I too deal with workcover insurance injuries at work as an orthopaedic registrar. It is pretty normal for them to get you to see the insurance doctor as well as your own doctor. This is meant to control the purse strings for unnecessary surgery etc. The funny thing is it sometimes costs them more. We've had people who needed knee arthroscopies after we examined them. Then the company insists that we order an MRI which they pay for, then we do the arthroscopy anyway. Net result one unnecessary MRI!

What I'd do is get your employer to white a letter saying that he is unhappy with the tardiness and if needed threaten to move his policy. It is in everyone's interest to have you back at work soon.

Also get a solicitor if you need to, but be aware that it might cost you and not change the outcome. A solicitor is more useful if you were permanently disable.

Also, just be frank with the insurance company doctor, they are really just their to make sure your treating doctor is doing a good job and not wasting money giving you unnecessary treatments.

Good luck
Pulse

I thought in NSW at least the employer was responsible for the first 2 to 4 weeks of pay anyway and then the insurance company took over. Being out of the general workforce for three and a half years things may have changed a bit.

I believe insurance companies are the scum of the earth and will try to not pay anything if they can get away with it.

In the end there is always Current Affair.

In the ACT an injured person recieves full pay for 26 weeks then it drops to about 65% of the original wage.

Get in touch with CGU and tell them you have no way of getting to the doctors appointment they have made for you. Point out that they did not consult with you to organise a day and time that suits both of you and that they have been rather inconsiderate of your situation! Make sure they know about the phone calls that you have made and have never had a returned phone call to find out what you needed them for. As far as insurance companies go CGU sounds like they belong at the bottom of the pile.

It may fall on deaf ears but you never know you may well get some kind of satisfaction.

Good luck with it.

Pete

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Originally Posted by Barry_White

I thought in NSW at least the employer was responsible for the first 2 to 4 weeks of pay anyway and then the insurance company took over. Being out of the general workforce for three and a half years things may have changed a bit.

I believe insurance companies are the scum of the earth and will try to not pay anything if they can get away with it.

In the end there is always Current Affair.

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Employer is responsible for first 10 days wages and $500 medical expenses but not until the insurance company accept the claim.
I agree with the rest of your comments.

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Also, just be frank with the insurance company doctor, they are really just their to make sure your treating doctor is doing a good job and not wasting money giving you unnecessary treatments.

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My doctor is doing a bang up job. There are around 10 doctors in this town with visiting surgons, ortho's and other specialists. It is a waste of time and money to travel to see a general surgon. It has no bearing on the acceptance or otherwise of the claim.

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What I'd do is get your employer to white a letter saying that he is unhappy with the tardiness and if needed threaten to move his policy.

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Point taken, however
in the statement of injury the employer has accepted the claim. Why should there be any further need to write. CGA are just usless pricks stalling for as long as possible. If a tradie messed you around and lied like this he'd be on his bike.

I have spoken with the investigator, his first comment to me was "hows the Ankle"
I said shee et your good at this investigation stuff arnt you.
he said "why"
I said cause its my leg that broken. Nothing wrong with my ankle.

He also informs me that the reason for investigation as per CGU instructions is
To establish if the injury is in fact a workplace injury
It is, my employer has accepted the claim and stated this is so.

To establish if a 3rd party may be liable. This should have no bearing on acceptance of the claim. If a 3rd party may be liable CGU can take that up with the 3rd party any time they like.
Why couldnt CGU tell me the reasons.

I have been in touch with my employer, The investigator has been in touch with my employer however CGU "have been unable to contact the employer" since the 22nd of December.

I declined to speak with the investigator on the matter. (Tell CGU to shove it were my exact words)

No need for solicitors at this stage.
Every phone call in relation to this claim is documented. (Time date what was discussed) Every non returned call is documented. all correspondance is dated and the envelope kept attatched for (post marks and date)

Vic Worcover Authority Advisory have been usfull in making things proceed.

In a perverse kind of way I am enjoying butting heads. I 'm board ####eless as I cant go anywhere or do anything anyway so and the poms have let me down badly by not batting Tests out.

Thanks for the advice and words of suport.

I'll let you know when my head starts to get sore.

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Originally Posted by Doughboy

Get in touch with CGU and tell them you have no way of getting to the doctors appointment they have made for you.
Pete

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Done they suggested I take a taxi!

huh? Two hours there, two hours back and the wait in between. Get a wriggle on doc the meters running.

The problem here is that you are a number to them. If you give them grief they take your file from the top of the today pile and put it at the bottom of tomorrows pile, thus delaying a result even further.

If only someone could hold the insurance companies responsible, alas they are an entity unto themselves.

Pete

I think they are concerned by my complaint to Victorian Workcover Authority. certainly made them jump into gear when I told them I was registering a complaint.

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Originally Posted by dadpad

Employer is responsible for first 10 days wages and $500 medical expenses but not until the insurance company accept the claim.

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Sorry, but in the event of a workplace accident the EMPLOYER is responsible for all costs as specified by law until you again return to full employment. So that you haven't received any payments is your employer's fault and not Workcover.

To ensure that your employer can meet his obligations to you as injured worker there is the Workcover scheme which compulsory insures your employer to cover the employers liability. You claim from your employer not CGU ( the claims agent selected by your employer under the workcover scheme) but you are required to assist them in their investigations and handling of the claim.

That you are required to see an investigator may well be to ascertain if your employer complied with worksafe regulations, non compliance will see that the employer will be dealt with by law.

To often employers will blame non payment to injured workers on workcover etc, whereas the law requires them to make regular payments to you and to meet all medical expenses as they occur and then claim reimbursement from the claims agent.

So rather than slinging of at insurance companies why don't you complain that your employer is not fulfilling his obligations to you.


Peter.

Cant argue with that except to say read my previouse posts.

Hi Dadpad

A couple of points.

1. Your employer does not "accept" the claim. The insurer does. The employer can support or not support the claim and in your case they appear to have supported it which is great.

Just an aside, when I was an apprentice a fellow apprentice broke his leg playing football on a sunday, took painkillers that night and morning, was carried into the workshop and laid in the bottom of the service pit where he "broke his leg" :~ and went off to hospital.

2. It is standard practice for an insurer to have an independant assessment. Nothing improper with that and if you have nothing to hide (and seeing as you are a fine citizen of this forum you wouldnt :U ) then its no great problem. You may have seen in the past that SOME people rip off insurers.

3. Keep receipts of all your expensed including travel and accommodation so that you can claim them later.

4. Lose the attitude;

" have spoken with the investigator, his first comment to me was "hows the Ankle"
I said shee et your good at this investigation stuff arnt you.
he said "why"
I said cause its my leg that broken. Nothing wrong with my ankle.

There is always an attitude pile that sits and sits and sits. Instead of smart comments try this;

"I am new at this stuff, can you help me get it all sorted out, I would really appreciate the help.:2tsup:

good luck

dazzler

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Also, just be frank with the insurance company doctor, they are really just their to make sure your treating doctor is doing a good job and not wasting money giving you unnecessary treatments

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Certainly not my experience, which seems to mirror that of others that I have spoken to.
I'd say that the Insurance company medico is there to minimise the claim by understating the extent of the injury. :((
I'm sure that there are some honest ones, however..... be careful.

I live in Mansfield Victoria.
The insurance company will not reimburse my daughter for lost wages (we estimate between $60 and $100) to drive me to Melb for their medical appointment. I cant drive myself because of the cast on my broken leg.

I asked, they refused.

They will however fund a taxi. $600.00 approx

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Also, just be frank with the insurance company doctor, they are really just their to make sure your treating doctor is doing a good job and not wasting money giving you unnecessary treatments

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eeyup. I really need to lose the attitude.

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I'll let you know when my head starts to get sore.[/quote]
Sounds like it's pretty sore already.
Good luck with the claim.
From the other side, I had an employee who had a car accident on the way to work. (A bit strange as it happened about 20km on the other side of her house to our place)
She convinced her medico that she couldn't raise her arm above the shoulder and suffered from fatigue. Result, she had to have one hour on and two hours off each day, I had to pay her full wages the whole time. It didn't seem to cramp her social life as she could nightclub all weekend with no ill effects but, come Monday, the whole thing came back.
A phone call to my insurer and a quiet word that I wanted my choice of medico to examine her and she resigned immediately. A little later, my insurer told me that she had filed a claim in court and did I have any comments. Some of what I said could be quoted in court!! Case dismissed.
It still cost me thousands but it was nice to see her legal bills mount up without my insurer paying. Bl00dy Workcover (NSW) assumes that the boss is always in the wrong and has to pay for any idiot's inability to look after themselves or their lack of common sense, not to mention the legal fraternity's complicity to screw the boss and split the proceeds.
You are paying the price for all those illegitimates who rort the system.
Not so many
Cheers
Graeme

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Originally Posted by graemet

You are paying the price for all those illegitimates who rort the system.
Graeme

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I am not entirely without sympathy for employers in situations such as you describe. I have seen it myself (and dobbed in rorters) several times.

The point I am trying to make is the waste of time, effort and money which goes on when cases are cut and dried.

1. An independant medical opinion could be sought from a doctor in my home town.
or a regional center wang, shepp etc. But It s to be someone appointed. (read in CGU's pocket)

2. A call or 2 to the people i was working with (A government department) would have sorted any doubt about the veracity of the claim.

3. The length of time it takes for this mob to actually DO anything like mail a letter, or make a phone call.


The problem is that decisions are made on a one size fits all basis by some dill whos ONLY goal is to cover his ####. Decisions made in city offices by people who's vague knowledge of country areas extend no further than the bitumen and how to get to the ski slopes. (They keep asking me what suburb I live in.)
They also know that if they keep a claim going long enough a substantial number will just give up fighting for a fair deal and accept what they are given.

The sooner we move away from big government/big business the better as far as I am concerned.

Just thought i would resurect this thread to let all the insurance company supporters know;

It will be 2 months next Wednesday since the accident. (7th dec - 7th Feb.) Despite repeated calls to both my ex employer and the insurance company.
Despite co-operating with investigations and medical examinations ordered by the insurance company.
Despite expensive trips to Melbourne
Despite makiing complaints and following them up with the Victorian work cover Authority disputes resolution
Despite having a letter from CGU saying that my case had been reviewed and LIABILITY ACCEPTED on the 16th of jan.

Despite CGU sending me notification of the amount per week I was to recieve, Which was $4.00/ per hour MORE than I was being paid when the accident happened even with the 95% of pre injury clause applied.

I still have NOT recieved one cent of income support, or in fact any kind of support at all.

:~:C:C

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Originally Posted by dadpad

It will be 2 months next Wednesday since the accident. (7th dec - 7th Feb.)

I still have NOT recieved one cent of income support, or in fact any kind of support at all.:~:C:C

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Dadpad, sorry to hear of your injury and the frustration you are going through. As for the time it will be settled in CGU's own good time, I have been stuffed around for 5yrs and endless trips to all sorts of Dr's for body and mind. I have been to court and already had a ruling in my favour, but that didn't stop them from stopping all payments and denying any further liability. I then had to go through the whole process again, this time I went to arbitration as the laws had changed in the way that claims are handled.

My advise to you is:-

1. Get a solicitor yourself or join a union and use their's.
2. Keep records of every expense, if you can't claim it it won't matter, if you can and have no record, forget it they will not pay unless you have proof.
3. Don't give up.
4. Don't get mad, get even. Let your solicitor get mad!
5. Speak to Centerlink, see if they can help with finances. Anything you get you will have to pay back upon settlement.
6. Get your solicitor to write to your bank, they did for me and had the payment reduced by 50% untill everything was sorted out through my rough patch.
7. Try to keep appointments, no matter how inconvenient, it will count for you in court. Your solicitor will mention how they made it very difficult for you.
8. Most importantly, build a good raport with your solicitor and tell them everything, including if you felt intimidated, humiliated or anything like that, it comes down to "professional ethics and behaviour".

My file stands the equivilant of 10-12 yellow pages phone books tall, my personel records stand about 25%-30% of this, good luck and stay cool and strong.

Just as a note if you can't get in touch with your solicitor for any reason by phone, use E-mail or fax.:2tsup:

Dadpad,
feel for you, they sound like a bunch of asreholes.:(( Never had to deal with the same situation, but I've been in some adversarial situations which I've come out of okay from which I learnt the following:
Keep all corespondence.
Give and get everything in writing.
Record all conversations. (not telephone, this is illegal)
Keep a diary of everything and anything to do with your case.
Don't let them get to you, keep in mind that you will, in the end, win and that you will make them eat crow. This will make their crap easier to put up with.

Hang in there mate!

Mick

Dadpad,

I feel sorry for you, you should not have gone this long without any payments from anywhere. As an employer I would have to say I think your boss is screwing you, if the system is unchanged then workcover pays your boss to reimburse his payments to you. At the very least he should advance payments against any unused sick and annual leave if he is worried about being caught out, but in the end he is ducking his obligations. Workcover can be a pain to work through, but more often the problem is the claims assessor followed by the insurer, its the dishonest claimants that make it harder for everyone else.

John

Despite repeated calls to both my ex employer and the insurance company.
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DP How and when did they become your ex employer?
Is unusual to resigh when on compo and illegal as far as I know to terminate someone in that situation.

I had enough of cgu when they doubled my insurance for no reason one year. I got rid of them immediately and chose a different company. It was car insurance but I still don't like them or trust em. Too bad you dun have much choice there. I hope it all works out for u.