Work Cover

[dadpad]

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.

[DJ’s Timber]

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

[echnidna]

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

[dadpad]

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.

[echnidna]

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

[dadpad]

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

I am of course aware of that echidna.

I have made a complaint to the VWA advisory board.

[Terry B]

I am of course aware of that echidna.

I have made a complaint to the VWA advisory board.

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.

[E. maculata]

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.

[dadpad]

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

In the meantime I have no income.

[Iain]

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

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.

[woodbe]

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.

[Pulse]

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

[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.

[Doughboy]

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

[dadpad]

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.

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.

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.

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.

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.

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.