Since injuring his back as a chef, David Hockey has been fighting constant pain and an insurance company that encouraged him to work in aged care or as a farmer.
The 49-year-old has multiple back injuries and is incredulous the insurer denied his request to retrain as a bookkeeper at a cost of $2400 10 years ago. The insurance company rejected his request because sitting at a computer all day would be bad for his back.
Now, despite being unable to do any heavy lifting, his workers compensation insurer has suggested he retrain in aged care, which would cost $6100. Aged care can involve heavy lifting and the training involves sitting at a computer all day.
“This whole system is ridiculous,” Mr Hockey said.
“I now have a rehab provider saying I can sit at a course all day … to train for an industry I can’t work in … for three times the cost.”
Mr Hockey is one of almost 7000 people in NSW who have received a letter from their WorkCover insurer warning their benefits will be cut from the end of this year.
The NSW government changed the law in 2012 to cap workers compensation benefits to five years for most claimants, even if the injuries had qualified them for lifetime cover before the law was changed.
The laws were introduced to address a projected $4 billion deficit in the workers compensation scheme, which is now $1.5 billion to $2 billion in surplus.
The 2012 changes mean that only people assessed with a whole-person impairment of 21 per cent or higher will continue to receive benefits after five years.
Below the threshold
Mr Hockey’s insurer assessed his injury at 20 per cent, which put him just below the threshold.
His lawyer Sue Bowrey challenged the insurance company assessment and arranged an independent medical review, which put his whole-person impairment at 26 per cent. It is understood he will now receive cover until retirement age.
But for many of the 6996 injured workers set to lose their benefits from the end of this year, time is running out to dispute an insurance company assessment that puts them below the 21 per cent threshold.
Former motor mechanic Joe Webster, 58, disputes the 16 per cent whole-person impairment assessment his insurance company gave him.
“I’ve had doctors all say I am totally and permanently disabled and that I’ll never work again, but the insurance company doctor assessed me at 16 per cent,” he said.
Since injuring his back after lifting an electronic motor in 2001, he has had further back injuries and four operations. He now has ulcers and a heart problem related to the medication he had to take.
He was treated at Westmead Hospital for six weeks for a golden staph infection and his weight has dropped from 60 to 46 kilos.
“I’ve had ongoing problems that have flowed on from the original surgery,” he said.
The back injury has also cost him his marriage and savings.
When he received notification he would lose his weekly workers compensation benefits at the end of this year, he “felt like killing myself”.
He will be forced to rely on Medicare and welfare instead of his insurer.
“The old age pension would just cover my rent, which is $300 per week. I would not get enough money to pay for any of my medical expenses,” he said. “I’ve been just left alone, basically.”
Kim Garling, Workers Compensation independent review officer (WIRO), said the majority of injured workers approaching the maximum 260 weeks of weekly compensation payments would stop receiving them the day after Christmas.
He said many injured workers were not aware they could challenge an insurer assessment. Nor had they been told, until last month, that his office could provide funding to help them seek legal advice and get an independent medical report. Only 190 people have so far taken the option to get legal advice.
“Workers are able to obtain a second opinion from a doctor of their choice to determine the validity of the insurer-provided assessment,” Mr Garling said.
“For many months the workers were not informed of this option, nor were they informed that WIRO would provide funding for this to occur.”
Mr Garling said it will be impossible for disputes to be finalised before the cut-off if a large number of injured workers dispute the opinion of insurer doctors.
“This is a guillotine section,” he said.
NSW Greens MP David Shoebridge said the state government should extend the deadline to give injured workers enough time to challenge an unfair assessment.
“Even assuming insurers manage to get the thousands of workers needing an assessment to one of their doctors, this will give workers no time to challenge their assessments,” he said.
“This dreadful rush will inevitably see hundreds and hundreds of injured workers cut off from benefits based on bodgy assessments from the insurers’ chosen doctors.”
Sydney GP Con Costa works in occupational health and management and has been trained in how to make WorkCover assessments.
He said most doctors were not trained in how to assess whole-person impairment and many would likely accept an insurance company assessment at face value.
He has seen patients assessed by insurance company doctors to have a whole-person impairment below 20 per cent.
One of his patients was assessed at 14 per cent but this did not take into account paralysis in her foot caused by surgery, which Dr Costa says puts her impairment level at 24 per cent.
“I’m one of those rare GPs who has done the training, but if I wasn’t her doctor, my patient would have accepted her injury was only 14 per cent whole-person impairment,” Dr Costa said. “She is a shy lady and does not speak much English.
“I’ve yet to see anyone who have appealed, because the onus is all on them. The system is stacked against them.
“The system is not corrupt, but it is unfair and extremely biased.”
A NSW parliamentary inquiry last month raised concerns about insurance companies “doctor shopping” and paying “cash for comment” to ensure they received a preferred medical opinion.
“Numerous stakeholders suggested that insurers engage in the practice of ‘doctor shopping’, requiring workers to attend appointments with different medical practitioners until a preferred assessment was secured,” the Standing Committee on Law and Justice said.
Josh Mennen, principal lawyer at Maurice Blackburn, told the Committee he routinely saw clients being subjected to “multiple medical examinations at the behest of the insurer”.
Insurance Council of Australia general manager of communications and media relations Campbell Fuller said it was not familiar with the circumstances of the specific cases raised by Fairfax Media and is unable to comment on them.
“Workers compensation policyholders who disagree with a work capacity decision can seek to have it reviewed by the insurer managing their claim,” Mr Fuller said.
“If they are unhappy with the outcome of this review, policyholders can seek a merit review by the State Insurance Regulatory Authority.”
A spokesman for the State Insurance Regulatory Authority said it was monitoring insurers and working with the Workers Compensation Commission and the Workers Compensation Independent Review Office “to ensure that all claims are processed as efficiently as possible”.
“If an injured worker or insurer disagrees on a permanent impairment assessment they may be able to challenge these results in the Workers Compensation Commission,” the spokesman said.
“Registered medical practitioners responsible for assessments are regularly monitored by SIRA”.