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Treatment Reimbursement Fight Continues

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I’m still fighting for reimbursement of my peripheral and sacral stimulation implants.

Insurer X (let’s call them that but really what I call them is irrelevant – they’re all the same!) are investigating valid reasons to support my treatments (or rather seeking reasons NOT to). Having already rejected liability for my peripheral stim implant (2011), Insurer X, with all their grace are asking for further information in regard to my sacral stim (2015).

One of the questions forwarded to my specialist reiterated to me once again how backward this system is. The insurer is searching for ‘negative’ factors?!

Any psychological risk factors that may negatively impact on the success of the IPT procedure.

After this first lot of info was provided by Vicpain, Insurer X requested more:

Insurer X can pay the reasonable costs of elective surgery required as a result of a work-related injury or illness in accordance with Victorian workers’ compensation legislation.

Further information required Insurer X requires you to provide a brief report on your perspective of the trial outcome and reasons for proceeding to permanent implantation in 2015.

As well as this ongoing battle for quite a few thousand dollars, our new business struck telco issues and callers phoning the landline would hear we were no longer connected.

This has been ongoing for the last 4 months! We had to get a new number.

Needless to say, this was a financial disaster for Theo and I and we notified Insurer X to ask what consequences there are for an injured worker if their wage falls short for a period of time.

I have been advised that a reduction in earnings is a fluctuation.  As I advised, for S93CD claims prior to 5 April 2010, only one fluctuation is allowed in a 12 week period.  Whilst I thought that this reduction would be one fluctuation, if Soula’s earnings were maintained at this reduced level, it would be considered a series of fluctuations from her previous earnings.  Therefore, this would result in a decision to cease her entitlement under S93CD.

Soula would then need to reapply (submit a new post second entitlement application) for her reduced wage.  The problem with this is that as Soula’s injury pre-dates 5 April 2010, the S93CD application’s are mandatory referrals to the Medical Panel.

I appreciate this is a very complicated outcome from a reduction in earnings.  However, a reduction in earnings results in an increase in WorkCover benefits and the legislation and requirements around S93CD entitlements, especially for injuries sustained pre 5 April 2010, are very challenging.

At this point, I found myself wishing I could kick myself and Theo for being brave, for trying to persevere with a chronic illness, for starting our lives over, for going without seeing family, friends, for committing to a 1km radius for 95% of my days and for not staying in our beautiful home, in our home town of Collingwood, on my full entitlements.

I have just learned why injured workers have been reported to put their neck braces on before stepping outside.

If an injured worker is not supported in their attempts to return to work, then why would they risk trying to find new work? Remember, I can’t work in my previous employment scenario so in order to find new ways to work, I have to attempt many different things (as I have, as both Theo and I have).

Many of the work ideas we’ve tried haven’t worked and it wasn’t until many months that we could know this for sure. Each time we tried and each time we were not successful, Insurer X was not there. In fact the first time our attempts failed, Insurer X completely retracted all payments and I was left without any support for almost a year until the matter was processed at the system’s snail pace.

This can’t be fair.

Worse still… I’m paying a premium as a self employer through this whole process.

Welcoming the biggest US beauty brand to Australia – Rodan + Fields

Author:

Who says injured workers and people with chronic health conditions can’t work?

Welcoming the biggest US beauty brand to Australia – Rodan + Fields.

Give me an opportunity to be involved with a company that doesn’t pride its business on photoshopped images, that embraces ageing, while also offering a business model that allows me to be involved within my health limitations… and I’ll be attempting it!

Continue Reading

I Got Paid

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Home-love-wood-engraving-Soula-Mantalvanos

Have you all been holding your breath as I have the last couple of months? Well, you can breath out and feel happy for me – I got paid!

The financial ease is beyond documentation even though it falls far short of what I’m due (a most usual scenario with injured workers).

The fear and doubt that the compensation won’t continue will be ever-present. Being treated repulsively for years can never been forgotten – it’s a kind of irreversible trauma.

I will forever doubt these monsters. Trust was never incorporated into this relationship.

So am I settled, is it done, and am I feeling ecstatic?

Nope. There’s grief and anger to get through now. Grief for the life we lost due to the insurer’s dirty tactics. Anger for having to unnecessarily begin a whole new life miles away from everyone and everything we love. Continue Reading

What it means to be believed

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It means security. It means quality sleep. It means closure. It means, I was entitled.

It means everything I touched this morning, didn’t pose the question ‘how will I afford to replace this?’

And.

It means I rose above the monsters and didn’t let them defeat me. They didn’t get to keep something that belonged to me. Sadly they did destroy Theo’s and my most valuable belonging – our home.

I’ll be adding to this post as the insurer responds to the Medical Panel Opinion which finally arrived and states: Continue Reading

Only because of their stupidity…

Author:
Post-box

“…that they’re able to be so sure of themselves.” wrote Franz Kafka in The Trial.

I really relate to this quote right now because I just can’t make sense of my current pending status.

I’ve now been waiting 8 weeks for 5 professionals to answer two questions… that an assigned WorkSafe insurer had the right to set.

That’s bloody confusing in itself.

Further to, I’m wondering a couple more things:

  1. how these 5 professionals, the Convenor, and the staff at Medical Panels convince themselves this process is helpful to me and other injured workers, and
  2. whether they enjoyed their Christmas as much as I didn’t

I called the Medical Panels to follow-up the report and express my anxiety on the matter. I’m feeling I’m going to explode. I’ve been breathing in so much my stomach feels like it has rocks in it and my neck feels like it’s fused with my shoulders. Continue Reading

Worksafe, who are you really helping?

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Worksafe’s Mission is:

Actively working with the community to deliver outstanding workplace safety and return to work, together with insurance protection.’

When speaking with a WorkSafe employee today it was made quite clear to me that Soula’s insurer is doing everything possible to delay potential reimbursements.

Yes, the WorkSafe employee agreed with me that the ‘hoops’ Soula is to jump through are all a waste of time, money and energy.

However, I was told to call back again in three months to see how they could help. What!?

When asked why I cannot be helped now, I was told that this is the way the system works and we have to go through the motions regardless that we both agreed it was a waste of time. (FYI. all your/our workcover premiums fund these meeting, interviews, medical visits)

The insurer has asked a financial question of us. We have answered it. The system however, says that Soula has to see a Medical Panel and 2 psychiatrists. Then she has to wait two months for their medical opinion before the insurer can focus on the financial question!

WorkSafe, you are not protecting our insurance rights, you are protecting the insurer!

My life as it is within Workers’ Compensation – it’s a dog’s breakfast

Author:

In my current state of bewilderment, this may be the best way I can describe my life as it is today.

I shouldn’t bag a dog’s breakfast, as unlike that which the workers’ compensation system has dished out to me – a dog’s breakfast is nutritious, and dogs love eating it.

But the vision of pieces of food strewn apart, sliding about and sloppy, and pretty much dumped in a bowl destined to last a few seconds before it’s consumed without much thought or agenda, reminds me of what the system dishes out to me as an injured worker.

The system’s employees I’ve come into contact with lack any compassion, and all too often even some basic thought processes (i.e. common sense) appear to be absent. Their awareness of my predicament is shallow and their span of attention shorter than the time it takes a hungry dog to finish its breakfast.

I can imagine the bowl … I can see it all very clearly what it contains – a damn mess.

In technical terms I have outlined my current position within the system:

  • My 93cd second application has been submitted, rejected and referred to the Medical Panels (it was late, but who cares?)
  • This is the second 93cd application as the first time the insurer managed to reject the Medical Panel opinion – I know that is unheard of but somehow they were allowed to get away with it
  • I have been given no reason as to how or why the insurer was able to:
    1. contest the Medical Panel’s decision;
    2. ignore the conciliator’s instructions (well, point 385 of the recent Ombudsman’s investigation does me some idea of these machinations);
    3. get passed Workcover Assist’s instructions;
    4. offer 10 months part payments for the duration of the application process and suggest I re submit another 93cd application (what I’ve now done after selling my home!);
  • I have complained to Worksafe employees, who have notified us over the phone that the Medical Panel referral still stands and the letter of confirmation and explanation is coming to me by mail.

Continue Reading

This injured worker is about to burst

Author:

Art & Chronic Pain - A Self Portrait

(Image from my book, Art & Chronic pain – A Self Portrait)

I’m going to erupt!

I feel I’ve been left without any avenue to vent the poor treatment I’ve experienced as an injured worker. I can’t make it any simpler :

I had a work accident and after declaring I had a p/t work capacity, I’m now left with $0.

That’s $0.

  • $0 financial help for any future treatment (currently undergoing thousands worth)
  • $0 wage top up
  • $0 superannuation
  • 0% return to work training or assistance
  • 0% guidance, and
  • 0° (except for this blog) to reasonably seek the promised help that I personally paid a 100% premium for in Victoria.

Wait, I have more to vent and please stay with me because you’re my only avenue remember? Continue Reading

Injured workers rising above

Author:

(By Rosemary McKenzie-Ferguson)

Bags of Love Op Shop will open on the 31st July 2015

It has taken a lot longer than any of us at the Centre would have liked- however after many tears and a lot of frustration and loads of laughter and an rather risqué fashion parade the Bags of Love Op Shop will open on the 31st July 2015 .

It is yet another first in the wonderful world of workers compensation as the Bags of Love Op Shop is run completely by injured workers for the benefit of injured workers as each of them rebuild their lives in ways that has never been seen or done before.

“Bags of Love” aim to provide basic food supplies as often as is possible to ease the burden on the injured worker and the injured worker families.

There won’t be any speeches, and there won’t be any ribbons cut and the Australian stock market won’t have a sudden movement to indicate the importance of the opening of the OP Shop. Continue Reading

Interactions Between Injured Workers and Insurers in Workers’ Compensation Systems: A Systematic Review of Qualitative Research Literature.

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(Excerpt from Interactions Between Injured Workers and Insurers in Workers’ Compensation Systems: A Systematic Review of Qualitative Research Literature.)

Finally, some research into claims management from the Institute for Safety Compensation and Recovery Research (ISCRR), Monash University by Kilgour E1, Kosny A, McKenzie D, Collie A.

Abstract

Introduction Work-related injury is a major public health problem and a worker’s recovery can be shaped by their interactions with employers, healthcare providers and the workers’ compensation system.

Most research on the effects of compensation has concentrated on examining outcomes rather than considering the compensation process itself.

There has been little attention paid to the interactions between stakeholders and only recently has the client’s view been considered as worthy of investigation. This systematic review aimed to identify and synthesize findings from peer reviewed qualitative studies that investigated injured workers interactions with insurers in workers’ compensation systems. Method A search of six electronic library databases revealed 1,006 articles. After screening for relevance, 18 articles were read in full and a search of those bibliographies revealed a further nine relevant articles. Quality assessment of the 27 studies resulted in a final 13 articles of medium and high quality being retained for data extraction. Results Included studies focused mainly on experiences of injured workers, many of whom had long term claims. Findings were synthesized using a meta-ethnographic approach. Six themes were identified which characterised the interactions between insurers and injured workers.

The majority of interactions were negative and resulted in considerable psychosocial consequences for injured workers. Positive interactions were less frequently reported and included respectful, understanding and supportive communication and efficient service from insurers.

Conclusion Findings from this synthesis support the growing consensus that involvement in compensation systems contributes to poorer outcomes for claimants. Interactions between insurers and injured workers were interwoven in cyclical and pathogenic relationships, which influence the development of secondary injury in the form of psychosocial consequences instead of fostering recovery of injured workers. This review suggests that further research is required to investigate positive interactions and identify mechanisms to better support and prevent secondary psychosocial harm to injured workers

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Definitions of pain

What is Pudendal Neuralgia (PN)?
Most simply put PN is Carpal Tunnel in the pelvis/buttocks. Compression of the Pudendal Nerve occurs after trauma to the pelvis and is aggravated with pressure. The pain is often described as a toothache like pain, with spasms, sensations of tingling, numbness, or burning. It can be very debilitating.

What is Neuropathic pain?
Neuropathic pain is the result of an injury or malfunction in the peripheral or central nervous system. The pain is often triggered by an injury, but this injury may or may not involve actual damage to the nervous system. More…

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