Updated: 4th January 2008 (Author Andrea Madeley - VOID Founder)
SHAME FILE - EMPLOYERS MUTUAL LIMITED ~ WORKCOVER SA
APPARENTLY RULES DON'T ALWAYS NEED TO BE FOLLOWED
An internal investigation into the conduct of Employers Mutual Ltd outlined with crystal clarity that our Workers Compensation System is not only incapable of looking after the needs of injured workers but it is seriously lacking integrity when dealing with the families of our deceased workers.
Here is a scenario that could well be a reality for someone else one day...
A woman loses her partner of some 14 years to a fatal workplace accident. She and her boys are not only dealing with the grief and sadness that comes with a sudden loss like this but also the frustration that invariably accompanies the 'system' one has to steer through. As the weeks and months began to move on, things seem to be spiraling downhill for this lady.
One thing that becomes evident very quickly when a support group like VOID is born - no call or contact ever leaves one feeling warm and fuzzy.
Sometimes people hold onto their feelings for a long time - hence, why sometimes we are contacted by folk who after 30 years feel like they can't cope anymore and need someone to share their story with. Other times it is the very recent deaths and those families who find themselves completely at a loss as how to work their way through the nightmare. It very much depends on the support network within a family of course.
Unfortunately there are all kinds of misconceptions out there when it comes to workers compensation.
In general, there appears this notion that when a worker is killed at work, the next of kin (wife or defacto and children) will be well looked after...and while people still need money to pay their bills and feed their families, yes, this does refer to monetary compensation.
The reality is very, very different. First of all, for those who have lost a life partner or someone they dearly love, just the idea of being compensated for the 'death' leaves a very sour taste in the mouth...but it can get far worse than that. Sometimes, within family networks we sometimes see anger emerge due to the compensation issue. Suddenly a widow can find herself being more and more alienated from her dead partner's family - especially if there was any pre-existing friction (and let's face it, this kind of thing is not that uncommon).
So what we have here is a defacto widow who was now having to think about how she was going to pay the bills AND cope with confused children AND cope with the emotional trauma she herself was feeling. On top of all of that (like she needs more) add further unrest with fractures of extended family.
Enter WorkCover (or perhaps more specifically EML) as they begin their investigation into entitlement.
Every claim must be investigated - I doubt anyone takes issue with that. Interviews must follow. Widows need to begin thinking about lawyers to help them fill in the forms and generally these lawyers are present during these interviews. Lawyers filter through the legal aspect ...
She was an easy target - a grieving defacto widow in the grips of grief and confusion. The investigation into her entitlement appears to be focused on whether or not her relationship with her deceased partner was 'current' ... there seems to be dispute surrounding that. The barrage of questioning strike a deep painful blow over and over.
None of this is personal - of course not. It is in the best interest of our Workers Compensation Scheme to save some money and question any entitlement. It is in their interest to save money - it is a business after all. More to the point, it is a business under a rather dark financial cloud.
It may not be 'personal' to them but it sure as hell feels personal when one happens to be trapped in their hot seat.
We begin to wonder where do these companies draw the line? Is there a limit to how far they will go to save money? Is there a better way to conduct these investigations whereby they don't need to further traumatise the most vulnerable people?
If the department is given evidence that may raise question as to the eligibility of a claim - just whose responsibility is it to verify that evidence?
For example - let's say we have an ex-wife who thinks she may be entitled to be compensated for the death of her ex-husband even though he made a decision long ago to end that relationship. Or perhaps we see the result of family friction where siblings of the dead worker didn't much like his defacto? It's not unfathomable...mix their own feelings of loss with money and perhaps this is why people do things they maybe would not ordinarily do...say things they would not ordinarily say, or indeed write letters they would not, under normal circumstances, write.
Point being - the department is now faced with a quandary. The choices are pretty straight forward. The department can either take this so called evidence and decide it must be right (because that equals non-entitlement and that = saved $) OR they could take some simple steps to verify it. This may mean visiting the deceased workers home, meeting and talking to his neighbours ... confirming that he had a cupboard full of clothes there?
However, let's be clear about this, it is not in their interest to prove entitlement to claims. There is no moral obligation here. The department is known for its tactical methods of investigation. Of course this relates to fraudulent claims. Death in the workplace is a little hard to 'fake' though ... we do wish the department could dissect that tiny detail?
So those least able to are forced to defend themselves. These cases can take months ... actually more often they take years. In the mean time what do these people do about the lost income and mounting bills? The lawyers don't come for free either .. why are they forced to spend their entitlement on legal fees - to defend something that was always only ever based on scanty gossip?
I mean is this fun for them? Is there a bonus at the end of the year as to which employee managed to rub the most salt into the most injured worker's wounds?
On the 4th May 2007 I sent a letter addressed to Employers Mutual's Long Term Claims department. I had already had some contact with this department at a WorkCover Forum so it seemed more logical to go straight to EML than through the WorkCover channels. The letter outlined a need to arrange a meeting with VOID members on the many and varied concerns widows have in dealing with this department.
The letter also went into some detail with regard to the conduct in one particular instance where I believed ethical lines of conduct were crossed. What we had asked for was an apology for what this poor woman had been put through. Irrespective of protocol and systems - there was absolutely no need for such appalling methods. A meeting then could perhaps offer some vision into a more thoughtful process of scrutinising fatality claims.
The letter went unanswered until it was sent again on the 28th May 07. There was a CC copied to one board member of WorkCover - just to be sure that the situation was being acknowledged by someone.
Late in the day of May 28th the phone rang and it was the recipient of the letter.
One of the very first things said - "I won't be putting any of this in writing..." Of course it's not difficult (in hindsight of course) to understand why. The conversation that followed left a lot to be desired...
I was being told that my perception of 'this woman' (referring to the grieving de facto widow) was all wrong ... that perhaps she's not being completely honest with us (meaning the group VOID). There was a great deal of innuendo surrounding her honesty and the question came, "How long have you known her?" Which I guess was a fair question but having spoken to her on the phone for hours and hours on end and having had her spend an evening here with other widows from the group, I - in fact, we all felt very concerned for her well-being. I felt that I knew her reasonably well. She certainly did not strike me to be a liar ... in fact, if anything I felt she had a great deal of integrity in the light of her circumstances. I realise that is just my opinion but my opinions on others is precisely how I gauge them...and thus, that was my reply to the question.
The conversation turned sour - it seemed so wrong to be listening to an attack on someone's character when she was not in a position to defend herself. However, this conversation went so much further...it began to cross some pretty sensitive lines in terms of discussing evidence.
I did of course contact our member to warn her of this and the possible rejection of her claim. At that point we needed her to fight. There would hopefully come a time when she could rest and heal but right now she had to summons her strength. I also contacted her lawyer and alerted him. He was not in the least shocked. He's been dealing with the antics of WorkCover for some time - none of this is out of character he assured me.
I respectfully keep the identity of this widow quiet here because I know she has been through a great deal. I am very proud to say however that she did summons that strength and she did fight. She laid a formal complaint against the department and the senior staff member who did not follow procedural legislation that prohibits the disclosure of evidence to someone other than the claimant or the lawyer handling the case.
When queried on the matter, everything was denied - of course. In fact the comments that came as a response to the "Please Explain" was that I was lying and causing trouble. Unbelievable. First they accuse the widow of lying and now 'me'. That went down like a ton of bricks. It made no sense at all why I would trump up such a story ... to inflict more pain and confusion onto someone who I already knew was at breaking point.
An investigation was requested by the widow. Even if one disregards the moral issues, there were specific laws that were overlooked here.
The end result? Gosh, well...we were well warned by others who have found themselves in this wish wash of bureaucracy not to hold our breath.
We'll admit now that our faith in process was misguided and foolish but you have to try don't you? Give them the benefit of the doubt ... and when mistakes are made, mistakes should be rectified.
It is clear that we have some very questionable behaviour occurring within this organisation and even more clear, that they choose to do little to rectify the problem. Internal investigations &%$#@ ... perhaps the solution here is to have these things checked externally?
I suppose I am in the very fortunate (or perhaps unfortunate) position of knowing precisely what was said...and more importantly the spirit of the conversation on the phone that night. That's what makes this so difficult. I guess I was like most South Aussie's ... I was under this naive impression that our Workers Compensation system would look after the people that needed to be looked after. It's just easier to have faith in systems, especially when the Government oversees these departments.
The original letter sent on May 4th only ever really asked for an apology to the woman who was being put through an ordeal that never needed to happen. What on earth is it about the word sorry? Are we really such an arrogant society that we can't admit when we've crossed the line?
Welcome to our workers compensation system people - I am deeply saddened to report that it is every bit as under par in character as it is in financial management.