Worksafe failing some vulnerable people, Victorian ombudsman warns

THE Victorian ombudsman has warned the state’s workers compensation scheme under Worksafe must be “recalibrated’’ and was failing “some vulnerable people’’.

Victorian Ombudsman Deborah Glass. Picture: Norm Oorloff

THE Victorian ombudsman has warned the state’s workers compensation scheme under Worksafe must be “recalibrated’’ and was failing “some vulnerable people’’.

Although ombudsman Deborah Glass said the Worksafe system was working in the vast majority of worker insurance claims, her report has highlighted financial rewards for denying claims as a flaw.

Worksafe underwrites the scheme which is outsourced to private insurers who manage the claims, with financial incentives on offer to terminate them.

The investigation examined complex claims to assess whether;

■ agents unreasonably denied liability or terminated claims,

■ agents were denying claims in order to obtain financial rewards,

■ Worksafe has effective oversight of the agents and their claims management processes.

Ms Glass said action must be taken to address ``the complex end of the system where terminations are rewarded’’.

“The overall system is not broken, but the problems we identified in complex cases — some 20 per cent of the overall claims — go beyond a few isolated examples of bad behaviour.’’ she said.

“We found agents cherrypicking evidence to support a decision to reject or terminate a claim — as little as one line in a medical report — while disregarding overwhelming evidence to the contrary.

“In effect, we found cases in which agents were working the system to delay and deny seriously injured workers the financial compensation to which they were entitled — and which they eventually received if they had the support, stamina and means to pursue their cases through the dispute management process.’’

The findings come as police and paramedics continue to call for PTSD to be automatically considered as an occupational sickness, which currently must be proved by those affected.

As part of the ombudsman’s investigation, Ms Glass considered a joint submission by the Police Association of Victoria and the Community and Public Sector Union on claims involving post traumatic stress disorder.

Police Association secretary Ron Iddles has called for the onus of proof to be reversed pm claims involving PTSD.

“Treatment delayed is treatment denied,’’ Sen Sgt Iddles said.

“The ombudsman report is further evidence of what we have been saying all along — that the process is more brutal than the psychological injury at times.’’

The Victorian Government has been urged to introduce new laws to change the way it handles post traumatic stress disorder claims by emergency service workers.

The Victoria’s ombudsman received 370 complaints in 2014-15 over workers’ compensation claims.

Insurers acting as Worksafe agents at the time of the investigation were Allianz, CGU, Gallagher Basset, QBE and Xchanging.