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When It Pays to be Dumb

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Since my last follow up appointment with my pain specialist, I’ve been full steam ahead investigating his pain management recommendations.

Together, we reassessed my situation – the pros and cons, can do’s and can’t do’s, and among my specialist’s recommendations was a prescription for compounded pain medications.

Although what I’m blogging isn’t actually funny at all, I thought you would enjoy me sharing the response I received today from my insurer in regard to my pain specialist’s prescription.

At the very least, we could have a huge laugh together. After all, we’ve been through alot of this insurer rubbish together and I feel you could do with the laugh too!

The effort my insurer makes to appear stupid and ignorant in their daily work, and the effort they make to voluntarily communicate their ignorance, today, for some reason (let’s call it this fab new medication) made me want to laugh.

The reimbursement of my two stimulation devices are being ‘officially’ knocked back and so together with this medication knock back, Theo and I will be heading back to conciliation.

But, let’s have a laugh together first shall we? Continue Reading

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.

What it means to be believed

Author:

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

Injured workers, here comes the royal commission we’ve been waiting for

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Senate Passes Resolution Calling For Royal Commission Into Banking Industry

Injured workers, if there’s just one more email or letter to write, it’s this one to Senator John Williams. I’ll personally be sending all my insurance related posts to the Senator.

(Hansard transcript of Senate debate on the Banking and Financial Services motion.)

Senator WONG (South Australia—Leader of the Opposition in the Senate) (12:25): I move:

That—

(a) the Senate notes that:

(i) confidence and trust in the financial services industry has been shaken by ongoing revelations of scandals, which have resulted in tens of thousands of Australians being ripped off, including:

and further down the post

Senator GALLAGHER: And only a royal commission that you, Senator Williams, have been arguing for, for some time. The response from the government has been completely inadequate. Listen to the stories of those people whose lives have been affected, whose houses have been lost, whose retirement savings have vanished, whose businesses have folded and who have been arguing for years—eight to 10 years, for some people—for some sense of justice. This is what this motion seeks and that is what a royal commission will find.

… read the full transcript of the Senate debate.
Write to Senator John Williams (senator.williams@aph.gov.au)

My email to Senator Williams written 28 December, 2016

(The email also included many of my insurance related posts)

Dear Senator Williams,

I am a self employed injured worker. My ordeal has gone on nearly 10 years. My husband and I have just begun a new life in Queenscliff after having to sell our home and move from our beloved family, friends and community in Collingwood where we lived for 17 years.

I’ve experienced horrid treatment as an injured worker but the ultimate blow came when we had to sell our home because of an insurer excuse that to this day I still can’t really understand (neither can the Ombudsman, my lawyer or a friend’s contact working at the Vic Bar). I’m sure you will understand it and certainly the Ombudsman’s report, point 385 helped shed some light but unfortunately I’m still here without any compensation or treatment help and worst of all, my chronic pain continues.

I’m doing everything I can to live with my health issue and so is my husband – we’ve even started a new business that is completely customised to my abilities in the attempt we can work. Everything is on the line.

Below are all the posts I’ve written on my website. It’s the only way I felt I could communicate what was happening and help others in the process.

I’d happily speak up anywhere, anytime, and you are welcome to use any of the following information to argue the horrid experiences injured workers have had to bare.

A horrid equation: Medical + Legal = Medical Panels

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From where I’m standing, you could never believe our Government has set up a system to support injured workers.

This very system that was established (apparently) for the injured worker is very well calculated and excruciating to navigate and whilst navigating it, the injured worker usually remains unfed and untreated.

My complete process from application to outcome and reimbursement of weekly payments (if I ‘win’) could go on almost a year. And there was a year before that when the system threw me into a disillusioned hole when it pulled the rug from under me after I declared a part time work capacity.

If you’re an injured worker reading this – don’t ever declare a part time capacity until you’re sure you have a solid one.

Whichever way you look at the situation for injured workers, the equation always adds up to unnecessary, unfair and insensitive treatment.

While I wait for the Medical Panels to send me their decision, their faces, movements, questions and gestures swirl around my head and I try desperately to guess the outcome.

Even at 2am, I fail to guess. It should be simple to go to an appointment and explain your personal health status shouldn’t it? It’s simple for my pain team.

However it isn’t simple for the Medical Panel because it’s not an appointment, it’s an assessment – they’re not the same. From my experience, this assessment is a full blown investigation and that so severely changes the experience… and my heart rate. I doubt I need to state that this scenario changes my pain levels but if I do, head back to page 1 of this website and start reading again. Continue Reading

The need for toughened glass

Author:
med-panels-revised-letter

Crap happens in life but it’s how you’re treated when the crap happens that makes a difference and helps you manage as best you can.

I’m not talking about chronic pain in this post but rather my treatment by the worker’s compensation system (system) as an injured worker. That’s the major, most frustrating, tragic event to have happened in my life.

I’m sick of the injured worker stigma dished out from the very system itself. It’s true that the fish stinks from the head and in the case of worker’s compensation, that saying is 100% applicable.

I had two appointments to get through on Tuesday at the Accident Compensation Conciliation Service (ACCS) in order for the Insurer’s questions to be answered about my work capacity (I realise how absurd it sounds to have physical and psychiatric assessments to work out capacity but I have no choice in the matter). I know the answers to the questions but that makes no difference to anyone in this dreaded system.

I didn’t need to be assessed, I have a great pain management team, my husband understands my health issue, my family and friends understand and I even have a magical employer who understands and has pulled out all stops to make up a position and whole business for me to be a part of!

None of that matters. None of that counts. The system knows better… apparently. Or at least the system thinks it does.

Who are the system?

It’s this kind of scenario, can you imagine a monstrous haunted house? Now imagine that inside it reside: WorkSafe, their Insurers, the ACCS, WorkCover Assist, many medical ‘professionals’, various other related ‘professionals’ and let’s not forget the lawyers, barristers etc.

As an injured worker, it feels like I’m in the dungeon of this house.

On Tuesday, Theo and I attended two appointments planned for me at the ACCS. Three physicians and two psychiatrists were assigned to assess me. In order for them to assess me, it is a requirement that these medical practitioners have not seen me and vice versa. I hadn’t. I checked. I checked thoroughly.

A few minutes before my physical assessment, the receptionist had news for me. One of the psychiatrists had ‘seen me’ before. I was mortified at the thought that I had made such a mistake. Injured workers can’t make mistakes – it’s unforgivable. I was mortified also at the thought of the consequences – the insurer might have to make me pay for it! The ACCS, their professionals and the insurer would be furious for the time I wasted.

But worse than this was the treatment that followed. I tried really hard not to take a photo when I was in the waiting area at the ACCS talking myself out of feeling like I was a criminal as I faced the toughened double glazed office enclosure the staff were sitting in. There’s a walk way too that’s behind glass that leads the professionals to the assessment rooms (yes, their path is different – an escape with a view) – I struggled to find a reason for this and didn’t succeed. I felt offended. Continue Reading

My dog’s breakfast is proving to be quite a serve of offal

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A never-ending feast in fact (if such food takes your fancy)!

It is the eve of my appointment at the Medical Panels. Tomorrow I will see the 12th lot of medical practitioners and the 8th lot of psychiatrists that I’ve had to see to obtain no less than four medical panel opinions.

If you haven’t come across my history, here, entertain yourself – it’s quite a few mouthfuls, even for a large dog!

To summarise the situation, my three medical panel opinions all ‘confirm’ that I have a Chronic Pain Disorder (no mention of neuropathic pain), that I have a total 0% whole person impairment, and that I have a limited capacity to work – and that will be the case for the rest of my life. They do not appear to have considered the diagnosis of pudendal neuralgia (which at least does attract an impairment rating).

This poor excuse for a diagnosis (Chronic Pain Disorder) not only awards me the whopping sum of $0 for my impairment lump sum, but also makes my two stimulation implants irrelevant to my supposed ‘psychological condition’. It allows the WorkSafe insurer to offer me a 10 month settlement on my first 93cd application and avoid paying me partial weekly wages for the rest of my life for reasons I’m yet to fully comprehend. Apparently it has something to do with payslips.

Theo called Worksafe again today seeking to find out the reason why the insurer didn’t accept my medical slips as recommended by the Conciliator (it had been three weeks since he heard the reassuring news – ‘I haven’t opened the email yet’). There was no answer forthcoming, other than the vague protocol response.

In a recent letter in response to our Worksafe complaint about the matter, I received this explanation:

‘In accordance with the Act, the matter was referred to the Medical Panel who provided an opinion on her medical condition and incapacity. (Insurer) accepted the opinion of the Medical Panel on the issues of the nature of her medical condition and her incapacity, however rejected the application on the basis of the value of Ms Mantalvanos’ earnings.’

Theo raised a fair question today:

Are we going back to the Medical Panel for adjudication of a financial matter?

Continue Reading

Worksafe, who are you really helping?

Author:

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

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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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