By Charlie McLean, Emilia Roux and Sienna Martyn
Injured workers seeking compensation for a range of problems have accused insurance companies of the widespread practice of cherry-picking, consulting doctors to deny workplace injury claims, a Central News investigation can reveal.
Some have even alleged the practice within the NSW worker’s compensation scheme is tantamount to corruption, and want to see an independent arbitrator brought in rather than the current system.
“There is a direct conflict of interest… It’s a system that has lost its capacity to care,” said long-term clinical psychiatrist Mark Ryan, who has treated injured workers for several years.
Ryan often sees patients who have shown him reports from IMEs that he says are obvious “cut and paste jobs”, an indication of what he views as a general lack of compassion and attention toward injured workers.
“I think it is just appalling,” said Ryan, “people are getting disenfranchised again and again, they’re getting a double whammy or triple whammies of the hurt and damage that they’ve experienced.
“It’s not based on care, it’s based on these other outcome factors, you know, the key performance indicators of how soon can we get them back to work and how soon can we get them off our books and nothing about getting them better.”
Over the course of our investigation, Central News contacted over 50 injured workers from around NSW, with more than 94 per cent saying their mental health was worse after entering the worker’s compensation system. Many revealed they had contemplated suicide.
One of these was 58-year-old warehouse worker ‘Jake’* from the Central Coast.
Since 2007, Jake has had numerous injuries working in a warehouse for supermarket giant Woolworths. In 2019, his contract was terminated after he had been off sick for almost a year.
I actually came to regret my grandchildren. I wanted nothing to do with them, I just couldn’t, because they were so full of movement and joy, it was just too much for me.
When he returned to work after his first injury Jake claims he was subjected to repeated bullying and harassment from co-workers and friends who accused him of malingering.
“I don’t know how many friends I lost because they start thinking you’re a bludger,” said Jake.
As his mental health began to deteriorate, he found himself increasingly withdrawing from those closest to him.
“I actually came to regret my grandchildren. I wanted nothing to do with them, I just couldn’t, because they were so full of movement and joy, it was just too much for me,” he said.
Like many injured workers, Jake feels he has been treated unjustly by a system he believes chooses profits over people.
Compensation for injured workers within this system comes in a number of forms; compensation for loss of wages, medical and rehabilitation treatment, return to work assistance and compensation for non-economic losses.
At the end of 2021 icare – the state insurance provider for the majority of workers in NSW – reported that $1.16 billion in weekly compensation payments had been spent the previous fiscal year with an addition of $740 million spent on medical expenses and rehabilitation support.
One aspect of the system that has contributed to the grievances felt by injured workers like Jake, is the role of Independent Medical Examiners (IMEs).
IMEs are medical professionals that injured workers are referred to, in order to evaluate the progress of their injury. Their reports play a big role in determining the treatment an injured worker is entitled to and the amount of compensation they will receive.
Insurance companies have the freedom to select their own IMEs, something personal injury lawyer Scott Dougall believes is a systematic oversight.
He told Central News it allowed insurers to strategically select IMEs who consistently diminish the severity of injured workers’ claims, something known in the industry as ‘doctor shopping’.
“We would know in advance what that doctor is going to say… that it’s not work-related or you don’t need that surgery and you are fit to return to work,” said Mr Dougall.
“[In many cases] it was sort of like the insurer had that person pegged, they knew what their views were about certain issues and so they tended to engage with them quite regularly.”
‘Audrey’, whose identity we have chosen to protect for privacy reasons, is another injured worker who suffered alleged workplace bullying she says left her with psychological problems.
She believes she was a victim of doctor shopping in 2019 when she was asked by her insurance company to be assessed by an IME.
Using the report from her IME, Audrey’s insurance company cut funding for her psychologist who she says was the only thing keeping her from, “jumping off a cliff”.
But Audrey’s complaints about her alleged mistreatment by the IME were dismissed by the Health Care Complaints Commission.
According to court documents unrelated to Audrey’s case the same IME has been the subject of dozens of complaints since the year 2000, although all were dismissed. A spokesperson for the Medical Council of NSW told Central News, the number of complaints was still high for an “individual practitioner”.
A crucial function of IMEs in assessing injured workers is to decide what is called a Whole Person Impairment (WPI) percentage or score. These WPI scores reflect the extent of a person’s long-term injuries. The higher the WPI score, the greater the compensation payout an injured worker receives.
But many injured workers allege the WPI scores produced by IMEs are influenced by the interests of the insurance companies that pay to receive their reports.
Former nurse Glenda Saville has received numerous WPI scores from various IMEs, regarding her mental health injury claim. IMEs approached by Glenda’s lawyers have given her WPI scores as high as 24 per cent, while IMEs contracted by her insurer GIO have given her WPI scores as low as 5 per cent and even 0 per cent in one case.
I was a single mother. My kids were doing their HSC … I had no money to help for their formal.
In 2020, the Personal Injury Commission reviewed Glenda’s case and labelled the conflicting medical reports a “confusing hodgepodge of opinions”, finding faults in the medical reasoning on both sides.
The commission evaluated a WPI score of 19 per cent for Glenda.
“If the courts from the very beginning had appointed a doctor,” says Glenda, “then there would have been none of this and I wouldn’t be subjected to this game.”
This “game” has led to 50 separate legal actions and forced Glenda to survive without income for six years. During that time she has lost her home, the job she loved and her relationship with her children has suffered greatly.
“I was a single mother. My kids were doing their HSC … I had no money to help for their formal,” says Glenda.
These traumatic accounts raise questions concerning how the conduct of insurance companies is regulated in NSW.
The workers compensation system in NSW is subject to a co-regulation system comprised of three main bodies – the State Insurance Regulatory Authority (SIRA), the Health Care Complaints Commission (HCCC) and the Australian Health Practitioner Regulation Agency (AHPRA).
Within the system, there are three types of insurers: the state insurer icare, self-insurers and specialised insurers.
SIRA is the government organisation responsible for regulating insurance company powers within the worker’s compensation system.
Greens MLC and ex-personal injury barrister, David Shoebridge, has been a vocal critic of SIRA which he believes has failed to hold insurance companies to account.
“SIRA has proven itself to be an ineffective regulator to use the powers they have to penalise insurers who are failing to pay claims and breaching the guidelines by directly doctor shopping,” said Shoebridge.
“When I was young and naive I would occasionally refer to things to SIRA… I no longer do that”
Under the co-regulation system, injured workers are encouraged to send their complaints about IMEs to any of the regulators. However, when it comes to IMEs, each regulatory body says they do not have the power to penalise them.
“I was passed around to different regulators who all said it wasn’t their job to deal with this,” Audrey says.
Central News contacted each of the aforementioned regulatory bodies for comment.
According to Mr Shoebridge, a few simple reforms could make a huge difference to a system that he says is “easily gamed”.
“Everyone is trying to game the system in one way or another, lawyers are trying to maximise return for their clients, insurers are desperately trying to minimise their claims to maximise their returns, you have employers interested in minimising their premiums but also not taking on the responsibility of injured workers” said Mr Shoebridge.
“A better system would be an independent pool of doctors who meet some basic minimum standard and have the doctor not be remunerated by the insurer or the worker”.
*Not his real name
Main image by Charlie McLean