Worker's comp claim

5 Dirty Tactics Insurance Companies Use To Block Your Worker’s Comp Claim

Ready For A Worker’s Comp Claim For Psychological Injury?

Imagine your bad boss (or co-worker) has abused you for the last time and you’re ready to crack. You’ve had enough and this time you’re going to do something about it. You feel angry, disrespected, you can’t sleep properly. You snap at the merest thing (especially at loved ones) and your mental health is going downhill fast. Time to consider a worker’s comp claim?

Before you rush to your GP to start a worker’s comp claim, pause for a moment. Read this article fully. There are some things you need to know about the dodgy tactics insurance companies use. Especially when it comes to worker’s comp claims for psychological injuries.

If you’re at crisis point, it’s advisable to slow down, pause and reflect. Before getting that certificate from your GP, at least take a couple of weeks’ stress leave and think about if you really want to go down that path. At this point, stalling is your best strategy. Find out what your other options are as well.   Mindfulness and worker's comp claim

Mindfulness Is Essential

The best way to slow down, pause and reflect is to start a daily mindfulness practice. To find out how to practice mindfulness correctly, download your free resource guide, The Silence of Mindfulness: A Simple Guide To Inner Peace And Emotional Wellbeing.  

Those who have been through the system will often tell you although being bullied at work was horrific, the day they started down the worker’s comp claim path was when their nightmare truly began.  

When the insurance company receives your worker’s comp claim, they kick into “damage control” mode. That means they are highly motivated to find any means by which to avoid paying out on your worker’s comp claim. Why? Because claims related to psychological injury are expensive; workplace bullying alone costs Australia $6 billion to $36 billion per year.   Here are the 5 dirty tactics the insurance company will use against you:  

1) “Doctor Shopping:”

Your insurance company will send you to a so-called “Independent Medical Expert” (IME). In the case of a psychological injury, you’ll see a psychiatrist for an assessment of your mental health. The psychiatrist will determine if your worker’s comp claim has substance. Insurance companies are motivated to cherry-pick the IMEs whose professional opinions they prefer – those who will “sava da money.  

What this means in practice is that when you get sent to your insurance company psychiatrist of choice, s/he will grill you about your past in an attempt to find anything that provides a better explanation for your current distress than workplace bullying. Thus, if you’ve had post-natal depression 20 years ago, they’ll blame that. The same goes if you had a medical trauma in your childhood or a bad breakup with a spouse.  

How to deal with that:

Focus on what happened to you at work and keep drawing the conversation back to recent events. Imagine you’re a politician being interviewed by a current affairs TV show. You know how politicians answer any question with a response centred around their own agenda? They never seem to answer the actual question they’re asked.  

For example, in a recent ABC interview with the new premier of WA, Mark McGowan, Leigh Sales asked:  

“Many voters are disillusioned with the major parties. [Pauline Hanson] thinks it’s because you’re not listening. What do you think’s driving it?”  

Instead of answering directly, he redirected his reply to what he wanted to discuss:  

“Well, minor parties have always been around, and they’ve always attracted votes. But my role as the leader of the Labor Party is to set out a comprehensive agenda for Western Australia, and that’s what we’ve done. And it’s based around jobs, not selling Western Power, our plan for health – all of those sorts of initiatives are the sorts of things that we’re standing for.”  

She said:  

“That’s got nothing to do with what I just asked you.”  

Then, she went on to ask him the same question, phrased differently many times throughout the interview, but he still didn’t give her a direct answer.  

See What Just Happened?

See how McGowan did that? In the first part of his statement, he affirmed that he’d heard Sales by paraphrasing the question back to her. Then he went off on a tangent and said what he wanted his audience to hear.  

That’s what you must do – become like a politician and keep bringing your agenda back to the recent distressing events at work.

So, if the psychiatrist asks you:  

“How did you take the breakup with your ex-husband?” (Assuming s/he already has prior information about your hypothetical painful divorce).  

You say:  

“Well, the breakup happened 5 years ago now and although it was difficult at the time, I’m usually pretty resilient and bounced back very well. However, what I can tell you is when my boss shouted in my face, I had a panic attack on the way home, then couldn’t sleep for five nights afterwards.”  

Another thing IMEs tend to do is to minimise your distress by downgrading your diagnosis. For example, if you actually meet the criteria for Post-Traumatic Stress Disorder, they’ll diagnose you with Adjustment Disorder, which is much less severe and therefore, much less expensive (yes, this did actually happen to one of my clients).  

How to deal with that:

Understand that this psychiatrist’s report is only one piece of the puzzle. In order to get a more balanced view, you need to hire a good lawyer who refers you to her psychiatrist who will more likely give you a diagnosis that matches your actual condition.  

In addition, it helps to find a good psychologist who assesses you with a psychometric test (I like to use the Personality Assessment Inventory because it’s so thorough), then writes up a report for you, so there will be two pieces of evidence stacked against the so-called “IME.” A psychologist’s report doesn’t have as much status as a psychiatrist report, but if it contains more accurate detail and shows an in-depth understanding of your situation, it will help to carry greater legal weight in your favour.  

2) Insurance Companies Are Adversarial:

The onus is on you to prove your case, with good-enough, rational evidence. You need a clear story, well-articulated with solid evidence to back it up. This is very difficult to achieve when you’re so stressed you can’t think straight!  

The insurance company has a (not-so) secret hope that if they make the process as hard as possible, you’ll give up without seeing the claim through. Then KABOOM! The insurance agent gets a great bonus because he “sava da money” for the boss (more about that later).  

How to deal with that:

You need a good lawyer and a smart psychologist who will help to buffer you against this stress. Recently I interviewed Australia’s premier employment lawyer, Josh Bornstein and we both agreed that we’d “been there, done that” in terms of witnessing these tactics over and over again.  

It’s likely this is your first time through the worker’s comp process, which is incredibly stressful, but by having a good team on your side you’ll be one step ahead of the game, allowing you to be responsive rather than reactive. It will also help you feel safer and more confident. 

3) Manipulation Of Financial Bonus Schemes:

Insurance companies have financial incentives to reward their agents for managing a worker’s comp claim effectively. However as with all incentive schemes, they can be abused. Certain agents are not above manipulating the system or stalling the resolution of cases to maximise bonuses.  

One common scenario is that agents might be rewarded for facilitating the termination of a worker’s comp claim before they reached milestones of 13, 52 and 134 weeks. Alternatively, they might be penalised if they don’t meet these targets.  

How to deal with that:

Unfortunately, there’s not much you can do about this situation as you won’t know the specifics of financial incentive schemes for your insurance company agents. That information will be confidential. The only thing you can do is doggedly persist, which requires a clear-sighted view of what to expect when you embark on this process, which this article aims to equip you with.  

4) Stalling:

Insurance companies do as much as possible to delay paying your medical expenses / settlement. Even though it’s 2017, most of them tell you: “your cheque is in the mail.” It takes over a week for the cheque to arrive (unless it gets lost in the post – which happens regularly), then several more days to clear at the bank. I wonder, does it mean they get to make money on the short-term money market? It’s another infuriating aspect of dealing with insurance companies.  

The propensity to send cheques in the mail also means that many health professionals refuse to invoice a third party, because insurance companies are so difficult to deal with.

How to deal with that:

Don’t let the stalling stop you from getting the quality help you need. You may have to accept there’ll be delays.

You’ll probably have to pay up front for services then wait several weeks to receive any rebates.   You’ll need to map out a financial and legal crisis strategy well in advance because even if your claim is accepted (and depending on the industry you’re in, the odds may be against you), it may be months before your claim is settled – sometimes as long as 12+ months of being without an income.  

5) Industry-Specific Rejection Of Claims:

In October 2015, 44.5 % of police mental health claims were rejected, compared to just 4.7 % of claims involving physical injuries. Police work often involves dealing with a high degree of trauma – not only on the job (shootings, car accidents, domestic violence, etc..) but also because a lot of workplace bullying goes on in the police force.  

Paramedics are another industry with a high number of mental health claims and subsequent rejections. It’s all financially driven. In cases like these, the appointed IMEs will often aggressively argue that Post Traumatic Stress Disorder (PTSD) was caused by something other than what happened on the job.  

It can be so debilitating to fight against the insurance company after all you’ve already been through, that some claimants even succumb to the pressure by taking their own lives. And the insurance company / employer will never take responsibility or apologise!  

How to deal with that:

If insurance companies / employers are “outed” in the media, they tend to do some furious back-peddling. We witnessed that with the apology of Professor David Watters of the Royal Australasian College of Surgeons (RACS) for the ubiquitous sexual harassment and workplace bullying in the medical profession over decades.  

And yes, you probably noticed that his apology is about as sincere as the fake-charm smile of a pantomime villain.   It takes a lot of courage, but if you’re prepared to go to the media with your story, it might get your insurance company / employer to eat humble pie. This strategy is an advanced one and not advised if your mental health has already steeply declined.  

Should you choose to follow up on this, be prepared to network with journalists who might be interested in your story. Learning how to write a good press release is also a useful skill to develop.  

To Sump Up…

Taking out a worker’s comp claim is not for the faint-hearted and you need to be well-prepared in advance of your claim’s trajectory. Having a good lawyer and psychologist who can keep you informed of what to expect during each step of the process as well as help you through an emotional, financial and legal crisis is essential.  

Workplace evidence gathering and worker's comp claim

If you’re to succeed with your worker’s comp claim, you need to make sure your case is sound . Many claims fail because of a poorly written case.

Download my Workplace Evidence Gathering Kit to help you gather the right kind of evidence in the right way, then use the official letter of complaint template to help you construct a more powerful case. 

Reference Articles:

  1. The Age: “My Life Turned Into A Nightmare Dealing With Worksafe’s Insurers:”
  1. The Age: “Dirty Tactics By Insurance Companies Make Injured Workers Miserable:”
  1. The Herald Sun: “Judge Slams Victorian WorkCover Authority Conduct:”
  1. The Age: “Victoria WorkSafe System Failing ‘Particularly Vulnerable People’: Ombudsman:”
  1. ABC Four Corners: Insult To Injury:”
  1. Canberra Times: “Psychological injury claims placing stress on APS departments:”

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