Problem
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Suggested strategies
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Wages not paid on time by agent
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- Make sure medical certificate is current and forwarded, if there is a pattern of “ we didn’t get it” call the agent after faxing to ensure they have received it
- If problem is persistent - i.e. more than 3 times within a 3 month period consider making a verbal complaint to a supervisor
- If this doesn’t resolve the issue contact Work cover’s help line
- If further problems make formal written complaint to WorkCover and Agent’s complaint service detailing what happen and when.
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Wages not paid by employer
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- While the goal of RTW same employer remains, the wage to the injured worker is usually paid through the employer. The employer pays what they are required to pay, i.e. for the amount of hours the person is certified to work - the agent pays the remained through the employer. When no pay is received it is usually necessary to call the employer initially. If the matter still isn’t resolved satisfactorily call the agent.
- If the problems persists call Work cover’s help line and/or speak to your solicitor
- Some rehabilitation providers can help with issues of wages and entitlements
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Wages do not appear correct
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- Discuss with agent and find out the basis of their calculations
- If you have documentation to support what you claim is correct forward a copy to agent
- Consider discussing with your solicit.
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Expenses for travel to medical appointments and or medication are not reimbursed by insurer or there are extensive delays
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- Initially call agent and your claims manager and check that they have been received and when they will be processed.
- If payment is not forth coming consider call WorkCover.
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Insurer ignores a request for a procedure or support service - e.g. home help, treatment referral.
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- Make sure NTD has identified the service need on medical certificate
- Make sure NTD has made specific referral for the procedure or service
- Make sure agent has received and on what date
- Identify the Workcover guideline time frame agent is required to make a response
- When that time has passed call agent and continue at least weekly for 3 occasions.
- If there is still no response call Workcover's support service.
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A support a service or referral refused by the agent
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- Make sure the reasons are in writing
- Try and find out why - often the feedback is given to the provider of the service if they make the request rather than the injured worker.
- Attempt to get a copy of the document rejecting a service - Discuss with service provider - sometimes agents want more information and the onus is on the provider to forward the requested information
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Agent refers for an Independent Medical Assessment and the opinion is significantly different re management of the injury from that of the NTD and other.
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- Discuss with NTD including implications.
- The NTD ultimately has responsible for managing your injury and the agent can attempt to influence a course of treatment however they cannot enforce it.
- If treatment does not appear to be progressing however “independent assessments” are sometimes arranged which aim to reassess the liability of the insurer of managing the injury and claim. Sometimes the opinion on of the Independent assessor is that the injury has now resolved, or is no longer work related is the basis of the agent declining the claim. All treatment and wages are then terminated.
- Good communication between treating professionals and the agent can reduces the chance that the agent will take this stance. Sometime however actions are directed top down and there is very little an individual claims officer can do.
- If a claim is declined it is fairly essential to get a legal opinion of options
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A Work Capacity Assessment is carried out and the findings are inconsistent with your injury experiences, feedback from your treatment team from your perceived real work capacities and work experiences
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At this point time there are no mechanisms in place to challenge work capacity decisions except on procedural grounds – I.e. not enough time allowed to attend assessment, assessment not submitted within time frames.
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The issues involved with the newly established Work capacity assessments ( including the right to legal representation to contest assessment findings) are currently being worked out
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