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Prince

Dodgy workcover claim ?

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I try and keep an open mind about people and do see the good in them but I work with an employee who is putting in a workcover claim as he said he injured himself to total incapacity for the past four weeks.

He said he strained his groin when he got up for his office chair and then after two weeks at home he said they think it’s his hip after the mri.  Now he says they think it’s his back and will get another mri. 

He was on his final warning a week before the incident as well. 

I am pretty sure his work  was not a contributing factor so hoping it won’t be accepted but you never know   

Am I gullible !

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2 minutes ago, Prince said:

Am I gullible !

No, you sound like a right A-sole. The poor guy is crippled due to a work incident & HR wants to string him up!

 

Seriously though. :) 

It could be real, but certainly doesn't sound like it. 

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Never underestimate how easily people who are seriously unfit and make no attempt to look after themselves can hurt themselves doing daily activities. 

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I do believe there is a chance he may be injured. medical results will tell.  I don't believe it is work cover though. at least I don't think it is

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But if he can show that in any way his work contributed, say having to get up or of his chair........

When I was doing my apprenticeship, one of the guys was quite proud of the fact he got workers comp and two days of work for stapling his finger.  He didn't expect how hard we all laughed at him, cause when we staple ourselves we pull it out, put on a band-aid and go back to work.

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2 hours ago, Prince said:

I do believe there is a chance he may be injured. medical results will tell.  I don't believe it is work cover though. at least I don't think it is

I call crap... He sounds dodgy. PS: I saw him out running 42 k's at lunch time. ;)

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5 hours ago, roxii said:

Never underestimate how easily people who are seriously unfit and make no attempt to look after themselves can hurt themselves doing daily activities. 

Yeah I once had a Boss who hurt himself jumping to the wrong conclusion

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A woman in my office took a full year off after she broke her ankle outside of office hours. She got Statutory Sick Pay for the first 6 months then she managed to string it out for another 6 months using up annual leave and various other benefits. It was only when she'd squeezed every last drop of benefit from the situation that she decided the pain was tolerable enough to sit at her desk and start doing light office duties again. Some people have no conscience.

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I’ve seen the same situation at my work a few times over the years, then I think ..... how is their “possible” compo bludging my problem? Then I just get on with my own life

Edited by Mike Del

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Had to manage an employee who ended up with bilateral knee ops care of shutting the gate at home after he reversed the car out to come to work. Pre-existing condition...never!

What shits me at the moment is the pharmacy issued ‘sick’ certificate. Have to accept it. Money for jam for the pharmacists. Cough cough i’m sick, no probs $30 mate and I’ll give you something the employer has to accept. Rort.

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12 hours ago, The Customer said:

A woman in my office took a full year off after she broke her ankle outside of office hours. She got Statutory Sick Pay for the first 6 months then she managed to string it out for another 6 months using up annual leave and various other benefits. It was only when she'd squeezed every last drop of benefit from the situation that she decided the pain was tolerable enough to sit at her desk and start doing light office duties again. Some people have no conscience.

SSP is only about £90 p/w, seems hardly worth scamming for.

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12 hours ago, The Customer said:

A woman in my office took a full year off after she broke her ankle outside of office hours. She got Statutory Sick Pay for the first 6 months then she managed to string it out for another 6 months using up annual leave and various other benefits. It was only when she'd squeezed every last drop of benefit from the situation that she decided the pain was tolerable enough to sit at her desk and start doing light office duties again. Some people have no conscience.

 

3 minutes ago, FatPom said:

SSP is only about £90 p/w, seems hardly worth scamming for.

In my case I actually have about 1.2 years of S/L at full pay. It may be worth a thought if I get sick of work. :)

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20 minutes ago, Ex-Hasbeen said:

 

In my case I actually have about 1.2 years of S/L at full pay. It may be worth a thought if I get sick of work. :)

That's completely different to SSP

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this guy was on his final warning just a week before the 'incident' on a Monday morning. He also has been in the process of painting his house, but I will give him benefit of the doubt, but I will tell work cover I don't accept the claim as I still don't believe it fits the definition of a workplace injury. plus and even if it gets accepted, we aren't paying for his back surgery if he has to have it. 

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14 hours ago, Mike Honcho said:

HR people the world around are all the same. You'd think it was their money. 

thanks for your input.  very insightful. 

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1 hour ago, FatPom said:

That's completely different to SSP

Pretty sure there is no SSP in Aus. Not that I've heard of anyway. At one point you used to be able to take leave at half pay to double the length you could take off, but it still came off the bank you had accrued. 

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13 hours ago, Mike Del said:

I’ve seen the same situation at my work a few times over the years, then I think ..... how is their “possible” compo bludging my problem? Then I just get on my life

Because it just makes all the insurance premiums higher, and then harder with more hoops for legitimate claims.  Not to mention that the company might not have the funds or ability to backfill in a short term position, so the remainder of the workload falls to those left. 

So I think it does affect me.  

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16 minutes ago, Turts said:

Because it just makes all the insurance premiums higher, and then harder with more hoops for legitimate claims.  Not to mention that the company might not have the funds or ability to backfill in a short term position, so the remainder of the workload falls to those left. 

So I think it does affect me.  

Additional to that, if the staff member is a poor performer (which it sounds like), the rest of the team get pissed off and that affects everyone.

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1 hour ago, Ex-Hasbeen said:

Additional to that, if the staff member is a poor performer (which it sounds like), the rest of the team get pissed off and that affects everyone.

yes, I think also the nature of the claim has a few annoyed. It is a week by week basis as well. A review by the doctor each week, then a another mri etc, so we can't fill it. he said he is so incapacitated he can only sit at home in pain every day so my offer to take him a laptop to do some admin fell on deaf ears.  It is also stressful on his assistant who witnessed it and drove him to the doctors (his own personal GP).   stressful time for all. 

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3 hours ago, Turts said:

Because it just makes all the insurance premiums higher, and then harder with more hoops for legitimate claims.  Not to mention that the company might not have the funds or ability to backfill in a short term position, so the remainder of the workload falls to those left. 

So I think it does affect me.  

Maybe in yours and others situation Turts but I did clearly state I was commenting on my work situation, and commented what my response is to my situation. We are self compo insurers who  recently got a big kick up the arse after a Government enquiry discovered we'd been operating our compo scheme illegally to the company's benefit and the staff's detriment. Dozens of claims later determined to be 100% legitimate knocked back and in most cases the employees in question loosing their jobs. Not sure how bad a company has to behave to loose it's Comcare self managing licence, we've had about 4 last chances.

Edited by Mike Del

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8 hours ago, FatPom said:

SSP is only about £90 p/w, seems hardly worth scamming for.

True, but she has the kind of profession that you can freelance in when not at your regular job.

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8 hours ago, Ex-Hasbeen said:

Additional to that, if the staff member is a poor performer (which it sounds like), the rest of the team get pissed off and that affects everyone.

This. Dead wood brings everyone one down. If you hate your job that much, move on and let someone with more enthusiasm join the team.

Edited by The Customer
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20 hours ago, Mike Del said:

I’ve seen the same situation at my work a few times over the years, then I think ..... how is their “possible” compo bludging my problem? Then I just get on with my own life

 

5 hours ago, Mike Del said:

Maybe in yours and others situation Turts but I did clearly state I was commenting on my work situation, and commented what my response is to my situation. We are self compo insurers who  recently got a big kick up the arse after a Government enquiry discovered we'd been operating our compo scheme illegally to the company's benefit and the staff's detriment. Dozens of claims later determined to be 100% legitimate knocked back and in most cases the employees in question loosing their jobs. Not sure how bad a company has to behave to loose it's Comcare self managing licence, we've had about 4 last chances.

Sorry,  i didn't get the very specific situation of yours on which you were commenting, at the first instance  

Understand now that your particular situation is quite different than, possibly, most. 

 

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All good Turts 👍

One of the things my employers used to do In their capacity as Comcare approved self managers was to basically denied every claim, half the  workers would give up there, the other half would appeal the decision. That in house appeal would also be denied, and only about 10% would proceed to court. Straight away they have got rid of 90% of their claims. The company lost every single court case as far as I’m aware but most of the time they would capitulate the day before it was due in court anyway.

One of the worst I recall was a guy who clearly fell at work and suffered a bad ankle injury. Work sent him to their nominated industrial doc who said bruising and back to work tomorrow with mild pain killers. The next day the worker was in a lot of pain so he went to his doctor and had an X-ray..... ankle broken and off work imeadiatly, operation and pin followed. His compo claim was refused for 3 months because the employer had posession of their original docs report stating only bruising and claimed it was a factor that the workers doc didn’t see the worker until 30+ hours after his fall. During the appeal process the employer managed to find 2 more doctors who refused to look at or take X-rays but backed up the original company nominated doctors bruising diagnoses. Fortunately this was one of the cases where the company capitulated on the eve of a tribunal hearing. 

I can state without doubt the motivation of my employer to act like this had nothing to do with the cost of medical expenses, lost production or anything like that, it’s 100% about departments and managers lowering their Injury Frequency Rates which they are all judged and compared on (inc bonuses). They would regularly spend 60k - 80k to avoid liability for a simple hernia. 

I’ll add that that gov enquiry certainly cleaned up our compo policies and it’s quite reasonable now... although our company doesn’t cover us for compo if we are injured traveling to or from work which I thought was included if you are employed under an EBA or an Award. 

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12 hours ago, Mike Del said:

All good Turts 👍

One of the things my employers used to do In their capacity as Comcare approved self managers was to basically denied every claim, half the  workers would give up there, the other half would appeal the decision. That in house appeal would also be denied, and only about 10% would proceed to court. Straight away they have got rid of 90% of their claims. The company lost every single court case as far as I’m aware but most of the time they would capitulate the day before it was due in court anyway.

One of the worst I recall was a guy who clearly fell at work and suffered a bad ankle injury. Work sent him to their nominated industrial doc who said bruising and back to work tomorrow with mild pain killers. The next day the worker was in a lot of pain so he went to his doctor and had an X-ray..... ankle broken and off work imeadiatly, operation and pin followed. His compo claim was refused for 3 months because the employer had posession of their original docs report stating only bruising and claimed it was a factor that the workers doc didn’t see the worker until 30+ hours after his fall. During the appeal process the employer managed to find 2 more doctors who refused to look at or take X-rays but backed up the original company nominated doctors bruising diagnoses. Fortunately this was one of the cases where the company capitulated on the eve of a tribunal hearing. 

I can state without doubt the motivation of my employer to act like this had nothing to do with the cost of medical expenses, lost production or anything like that, it’s 100% about departments and managers lowering their Injury Frequency Rates which they are all judged and compared on (inc bonuses). They would regularly spend 60k - 80k to avoid liability for a simple hernia. 

I’ll add that that gov enquiry certainly cleaned up our compo policies and it’s quite reasonable now... although our company doesn’t cover us for compo if we are injured traveling to or from work which I thought was included if you are employed under an EBA or an Award. 

self insurers suck balls. Care to name and shame your employer?

They are a punish for providers to deal with, making us fill out paperwork for every appointment we see an injured worker (which we don;t get paid for) or put up with paper pushers coming and sitting in on medical and physio appointments and providing very interesting interpretations of the appointment and advice in reports for the employer. And as you outlined above, acting immorally and illegally towards their workers to achieve KPIs around days lost for their managers. They want to do the standard insurer practice of making the claimant give up as it's all too hard. Once again, Unions or lawyers are needed on the workers side to make sure employees are aware of their rights and the employer's obligations. adding to the expense and litigation costs and taking away from actual rehabilitation and retraining of injured employees.

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Yeah, I'm not surprised to hear that sort of stuff, but it sucks balls!  Every second shit is out there for themselves........

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2 hours ago, Parkside said:

self insurers suck balls. Care to name and shame your employer?

Sent you a pm Parkside

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20 hours ago, The Customer said:

True, but she has the kind of profession that you can freelance in when not at your regular job.

Ah I see the point you're making now.  That would take the pi$$.

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On 13/07/2019 at 4:06 AM, Ex-Hasbeen said:

Pretty sure there is no SSP in Aus. Not that I've heard of anyway. At one point you used to be able to take leave at half pay to double the length you could take off, but it still came off the bank you had accrued. 

SSP in the UK is a Govt payment that's made to you via your company's Payroll. It only kicks in once you have exhausted all your own options at work (sick leave, half pay, whatever your contract/policy states).  I've been on it when my back was at its worse.

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We had a guy on 75% pay for many years after his weekend cricket back injury was signed-off as a workcover claim when he said that he hurt it at work picking up a PC.  It was his third day at work in the job.  He told  his colleague he hurt his back at cricket on the weekend.

 

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