A recent investigation conducted by Victorian Ombudsman George Brouwer has uncovered a series of problems with the agencies that manage WorkCover payments for injured workers in Victoria. Complaints about WorkSafe to the Ombudsman have increased almost 30 per cent over the past three years, prompting the investigation.

“Many of the complainants who approached my office raised concerns about having to repeatedly submit the same documentation to the agents and delays in service this was creating,” Mr Brouwer said.

In one case, an injured worker had to wait months to receive more than $20,000 in back pay, because Xchanging lost her documents and maintained only minimal records of her claim.

In another case, a worker who required a kidney transplant because of a work-related illness, and was unable to walk to the bathroom, had to wait more than a year for Gallagher Bassett to act on a claim for the costs of home modifications.

Mr Brouwer’s investigation found the agencies had manipulated incentive schemes, delayed payments to workers and mismanaged files. Insurer CGU was found to have hidden about 10,000 invoices in a locked cupboard in order to obtain lucrative WorkSafe incentive payments.  CGU has since been fined $2.8 million and ordered to repay the $2.5 million for the manipulation known as ‘gaming’, which Mr Brouwer said was “clearly improper”. Mr Brouwer’s investigation uncovered evidence that CGU staff, including managers, were manipulating the scheme, benefiting by $2.5 million before the practice was detected.

During interviews with the Ombudsman, workers from CGU admitted some files were binned if they lapsed the due date for payment, because there was no system in place for recording when the account was lodged. This meant the agent would wait for a duplicate account to arrive to process that within the allocated time period, avoiding a fine by WorkSafe and claiming a bonus payment for processing the payments on time.

“If I was a person punching accounts and I have to hit a certain level, that’s checkin in that day, and the timeliness is really thoroughly checked and it’s a tight measure…I could throw a whole batch of those in the bin, walk over to the security bin…and they’re gone,” a manager at CGU told the ombudsman.

WorkSafe has six authorised claims agents – CGU, Allianz, Gallagher Bassett, GIO (no longer an approved agent), QBE and Xchanging. WorkSafe  has committed to modernising its IT systems and holding its insurance agents to account

 

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