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WorkSafe 2: Follow-up investigation into the management of complex workers compensation claims

WorkSafe 2: Follow-up investigation into the management of complex workers compensation claims

This is the first time in my five years
as Victorian Ombudsman that I’ve investigated the same issue, twice. Victoria’s workers compensation scheme, WorkCover, provides a range of entitlements
to people who are injured at work. The organization responsible for the scheme, WorkSafe, outsources the management of injured workers compensation claims to five agents. In 2016 I tabled a report into how agents
were handling complex claims. These mostly involved workers with long-term injuries who’ve been off work for two years or more. My 2016 investigation concluded that
while the overall system was not broken, it had failed some particularly vulnerable people. While WorkSafe and its agents have
made some changes since then, my office continues to receive hundreds
of complaints about them. Having now re-investigated the situation, I can say categorically that not enough has changed. If anything, the evidence suggests the impact of my
last report was to drive practices underground. From the evidence in this report my last investigation only scratched the surface. The system is failing to deliver just outcomes
to too many people; agents continue to make unreasonable decisions, the dispute resolution process can be time-consuming,
stressful and costly, and WorkSafe is too often unwilling or unable to deal. The workers affected in the cases we reviewed
included nurses, teachers, police officers, aged care and childcare workers, truck drivers,
baggage handlers, and tradesmen. The emotional toll is clear.
These cases involve people’s lives. The cost, not only to them and their families, but to society as a whole, should not be forgotten. We uncovered a range of concerning practices. Unreasonable decision-making by agents who
came to conciliation not prepared to negotiate beyond a paltry sum; maintaining decisions they knew would
be overturned by a court; and by agents conducting surveillance of workers without adequate justification. We found unfair return to work practices, including agents requiring workers to participate in occupational rehabilitation at
inappropriate stages of their recovery. Cases which resulted in the termination
of a worker’s entitlements were considered wins by agents. Staff openly discussed the amount of money these terminations would make for the business. In many cases, WorkSafe failed to provide
proper oversight of agents. Many of the decisions we saw were not only unjust, unreasonable and wrong. Some were downright immoral and unethical. I have made 15 recommendations to the
government, and to WorkSafe, all of which they’ve accepted. It is clear that the balance between
financial sustainability and fairness has tilted too far away
from supporting injured workers. Nothing short of wholesale change, will bring back
the humanity the system needs.

Author Since: Mar 11, 2019

  1. | 👀 ]™
    Western Australia is another state with disturbing examples of injured workers who have been unfairly treated and unjustly denied their legal entitlements. It also demonstrates a systemic problem with the current model of claims management for complex claims, and insufficient oversight and review mechanisms.
    Case Study: Senior Bridge Inspection Officer and Public Officer e61028 seriously injured in active duties (physically/mentally, financially/emotionally)

    Site Location: BRG 4251
    – Fourteen Mile Brook Road
    Hotham River, Wandering 6308
    in the state of Western Australia, AUSTRALIA
    Occupational Safety and Health Act 1984

    23K. Duty to inform employee who reports hazard or injury

    (1) This section applies where an employer receives from an employee a report of a kind described in section 20(2)(d).

    (2) The employer must, within a reasonable time after receiving the report — (a) investigate the matter that has been reported and determine the action, if any, that the employer intends to take in respect of the matter: and (b) If an employer contravenes subsection (2) the employer commits an offence. [Section 23K inserted by 51 of 2004 s.8]

    DUTY OF CARE {MRWA Document Number 70/01}

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