Written by Workers Compensation Report managing editor Helen Jones
Vic Ombudsman Deborah Glass’s “own motion” investigation into how workers’ compensation claims are managed will focus on WorkSafe’s oversight of claims agents and their practices.
WorkSafe’s 38 approved self-insured employers would not be investigated, the ombudsman’s spokesperson confirmed to WCR. That was because “we are focusing on the major insurers as that is the key source of our complaints”, he said.
Allianz Australia W/Comp (Vic) Ltd, CGU W/Comp (Vic) Ltd, Gallagher Bassett Services W/Comp Pty Ltd, QBE W/Comp Vic Ltd and Xchanging are WorkSafe agents. Allianz, CGU and QBE would not comment to WCR on the investigation at this stage.
Glass in a November 5 media release said her investigation was the result of 370 complaints about WorkSafe agents to the ombudsman in 2014-15.
Glass said claims decisions and processes, including “failures in decision making” and “failure to consider evidence”, were among the most common complaints about WorkSafe agents. Her investigation would look at whether they had “unreasonably denied liability or terminated entitlements for people who have suffered injuries in the workplace”. It would also look at whether agents “did this for financial incentives offered by WorkSafe”. The investigation would “focus” on agents’ use of independent medical examinations. Whether WorkSafe was providing “effective oversight” of agents and their claims management would also be reviewed, Glass said.
A WorkSafe spokesperson told WCR it had started providing information to the ombudsman. WorkSafe would continue to offer the ombudsman its full co-operation and it looked forward to responding to the investigation, he said. WorkSafe and its agents managed more than 90,000 injured workers’ claims every year, the spokesperson said. “We are always looking to improve the service we provide every injured worker.”
Vic Accident Compensation Conciliation Service (ACCS) senior conciliation officer Patrick Holt yesterday (Nov 9) told WCR it would provide the ombudsman’s investigation with “whatever they request from us, so long as it’s within the bounds of the law”. ACCS’s 2014-15 annual report said the number of new requests for conciliation and reopened matters increased 0.2% compared to 2013-14. In 2014-15 there were 16,892 new requests (18,039 in 2013-14) and 2,215 reopened matters (1,120). In 2013-14 there was a 5.2% increase in new requests and reopened matters, up from 17,144 and 1,070 respectively in 2012-13.
CPSU WorkCover services director Geoff Lewin welcomed the ombudsman’s investigation, branding it “long overdue”. Lewin said the Vic disputes system had the “lowest resolution rate of any state”.
Safe Work Australia’s latest Comparative Performance Monitoring Report (CPM 17), released on October 30, said the Aust average rate of disputed claims fell to 5.4% in 2013-14, down from 6.6% in 2012-13. Vic’s was 12.7% (up from 12.2%); SA’s was 10.9% (7.2%); Tas’s 10.8% (9.1%); the NT’s 5.9% (5.8%); Comcare’s 4.4% (3.4%); Qld’s 3.4% (3.2%); WA’s 3.1% (2.5%) and NSW’s 2.4% (7.5%). CPM 17 urged “caution” when comparing disputation rates between jurisdictions due to differences in scheme design, types of decisions that could be appealed, dispute resolution models and the cost of appeals.
(This story first ran in Workers Compensation Report 1042, 10 November 2015)
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