Hi, welcome

I've had a few claims of WC in the past. I also spent 18 years as a WC and road accident investigator. So I know the industry well in all areas including fraud, genuine claims and the "animal" the system is and why it is an "animal".

"Animal" meaning the WC system has evolved over time to become an unfair system on genuine claimants. The reason (although not necessarily justified) is that the claim rates are very high per employee numbers brought about by those that over state their symptoms and see it as a way of earning vast amounts of income from eventual pay outs from a court for damages, rather than swap professions or work with the (flexible and compassionate) employer, if that was the case.

The result of this excessive claim rate and subsequent huge pay outs has downloaded to very high WC premiums for employers. The more claims the higher the premiums. Even so, the average employer especially large ones dont care- you become just a number on the scrap heap and that shows clearly with lack of eagerness to assist you.

All this results in a difficult experience for claimants, genuine or not, you are all in the same basket. Little wonder once a case arrived on my desk I knew the insurer wanted a result that pointed to fraud rather than a accurate and fair assessment. I cant say anymore about that.

So what can you do? Well it varies from state to state but if your claim is denied (common but not always) that doesnt mean they are not liable. But it does mean that you have an automatic hurdle in that you need to take private legal action to demand compensation or any other action including seeking records for any defence you need. This is where people go wrong, by not commissioning a WC solicitor you are depriving yourself of representation that is crucial to fighting for your rights. Yes, your rights arent automatic. The WC road is a difficult one to navigate on your own and the insurance company has their own responsibility to- keep costs as low as possible, prove fraudulent claims for what they are, prove the capability of the claimant compared to their claim and make profit.

Taking leave instead of making a claim is commendable but that doesnt mean it has serve you better. Honourable actions dont mean you'll be rewarded in this world and you wont be able to refer back to your leave periods as being due to a workplace injury.

So, thats the system, the "animal" the reason it doesnt reward genuine claimants with genuine help.

TonyWK

I've been through the claims process....found it to be pretty straight forward.

The employers pay their insurers for this very coverage....its not an issue for them to have you apply and be granted a successful claim....its probably an irrational thought that you have that they are out to reject you at all costs.

Dont read the bad stories online about big insurers being out to catch you out or lawyers and drama fuelled issues that drag on for years....its not like that if your claim is legitimate.

Follow the process, give them the information they request and await there response.

You could retrieve emails etc but overall it would be difficult to prove you took leave for a workplace injury rather than document or collect documents eg submitting a claim.

What I'm saying is your actions in taking leave instead is a credible action but does nothing towards any future claim as you made the choice not to claim.

A comparison is- if you lost your job and decided at the 6 week waiting period for the dole that instead you waited 6 months when you run out of money, centrelink would process your claim from the day you submitted it. No backdating. No different because it would see numerous claimants state that they didn't submit a WC claim and took leave instead.

We live in a world of written evidence not verbal claims.

This is really a solicitors domain so take my knowledge as someone that knows the system but not as someone with legal qualifications.

I hope I've given you some insight.

TonyWK

That's right. I know too well the injustice of the legal system not in its intent but in its failure to protect the genuine.

I'm sorry you are in such a jam. It's similar to when I separated from my first wife. I left her with 80% of the savings and with the remainder paid off small debts like credit cards and washing machine. When I went to commence paying child support I told them if that arrangement only to be told it was irrelevant, it all occurred before the claim.

We learn the hard way. So, having said all that you might be doing your mental health a disservice by focussing on it. Bigger problems to fry.

Can we help you with any of your other issues?

TonyWK

Thanks again - not a jam as I was wanting to understand sick leave relevance as I’d read somewhere that’s a red flag but it was probably HR related and it is what it is - you take leave to cope and build further resilience - it’s been before, during and likely after this claim but here’s hoping the claims process and RTW might see them change their ways as HR processes don’t.

The main thing I’m hearing is investigators always find a reason to reject MI claims stating everything is ‘reasonable management action’. Common sense in reading relevant emails shows it’s not RMA to intimidate provide no transparency when asked for info on how to do my work etc so I’m confused apart from ‘don’t speak to investigators, They twist your words’.

And then there’s the part where you end up with an IME with a diagnosis - from the event that caused you to take leave to cope. It seems like HR/OHS issue to be sorted at the same time as running a claim for being injured. What is the role of the investigator exactly?

It's been many years since I've worked in that industry and a solicitor will advise on who and who not to engage with. Once represented you can refuse any contact for anyone so is less stressful.

WC is complicated. Best always to get legal representation.

TonyWK

Hi, I’m a nurse & new to this forum. I am currently on a weeks sick/stress leave after being bullied & harassed by my boss. She told me after incident in work vehicle (that was accident w no malicious intent) that I owed the company overtime delay I created, if I wasn’t prepared to do the overtime then maybe I should reassess whether or not I was in the right job for me!!! I have been bullied in my job before by a co-worker. My boss knows this and to be bullied by her felt like a slap in the face. The nurses union has advised me to make a worker’s compensation claim for the 32 hours that will be coming out of my accumulated sick leave.
I have never made a worker’s compensation claim and am honestly scared. I do have history if very well managed depression & anxiety.
will a worker’s compensation claim make my work life worse and possibly damage prospects? Further affect my mental health in a negative way?
Compensation for 1 weeks leave? Will it be drawn out and stressful? What should I expect?My boss has quite a list of employees she has bullied & harassed. I feel like I need to make a stand…but this is new ground for me and I’m scared.

Hi Janell

Welcome to the forum and congratulations on making your first post.

In theory, lodging a wc claim shouldn’t make your work life worse or affect your prospects. It’s your right when injured in the workplace.

However, in the real world, you’re about to allege your boss is a bully. It’s possible she may feel remorseful, but equally possible that she may get her back up.

From my experience managing claims, it could be stressful to you if your employer denies liability and fights the claim. These types of claims can be very costly, so their goal may be to make sure it doesn’t get accepted.

You will also need to jump through a few hoops to prove your injury.

Do you trust the union advisor? Do they have another agenda? Will they support you each step of the way? Just some things to consider.

Kind thoughts to you

Hi

Thankyou for your post.

As a past WC investigator and I have had 2 WC claims covering my 41 years of working, I can say that my opinion is to avoid WC unless you believe that your injury is a/ permanent or long term and b/ that you are likely to have a lot of time off that wont be covered by sick leave.

WC is a long drawn out and complicated procedure. Having a WC solicitor doesnt insulate you from the beauocracy. Being a qualified nurse might result in you finding work elsewhere unlike some specialty professions.

By all means employ a solicitor if you think you can create a case but I think its throwing money away at this point. I made a stand and was off work for 10 months. My GP refused to release me back to my profession that means seeking another career. So bear that in mind.

Your burning desire to "make a stand" is honourable but sadly that doesnt often result in justice serving you.

TonyWK