Think the situation set out below won't happen again in some shape or form?
What about when government outsourcing to the private sector means access to those government databases quietly collating personal and sensitive information on all individuals living in Australia?
Victorian
Ombudsman, media
release, 12 September 2016:
WorkSafe:
complex claims process needs fixing
Victoria’s workers
compensation scheme must be recalibrated to ensure that complex claims are
resolved in a fair and timely manner, a Victorian Ombudsman investigation has
found.
Tabling the Investigation
into the management of complex workers compensation claims and WorkSafe
oversight today, Victorian Ombudsman Deborah Glass said that while the workers
compensation scheme is operating well in the vast majority of cases, the current
system fails some particularly vulnerable people.
“The overall system is
not broken, but the problems we identified in complex cases – some 20 per cent
of the overall claims – go beyond a few isolated examples of bad behaviour.
They cannot simply be explained away as a few bad apples spoiling the barrel,”
said Ms Glass.
WorkSafe underwrites the
Victorian workers compensation scheme with claims management functions
outsourced to private insurers. During the investigation period the agent
insurers for Worksafe were Allianz, CGU, Gallagher Bassett, Xchanging and QBE.
The system currently incorporates a series of financial incentives for agents,
including when claims are terminated or workers return to employment.
The investigation
examined complex and often extended claims across different industries, roles
and injuries (both mental and physical) to assess whether:
- agents
unreasonably denied liability or terminated claims
- agents
took such actions in order to obtain financial rewards available under the
contract with Worksafe
- Worksafe
provides effective oversight of the agents and their claims management
processes.
Key recommendations from
the investigation call for a review of dispute resolution processes within the
system and improvements in oversight of complex claims by WorkSafe.
“We found agents
cherry-picking evidence to support a decision to reject or terminate a claim –
as little as one line in a medical report – while disregarding overwhelming
evidence to the contrary. We found Independent Medical Examiners (IMEs) – whose
opinions agents use to support their decision making on compensation –
receiving selective, incomplete or inaccurate information. We also saw evidence
of decisions being influenced by financial incentives to terminate claims.
“In effect, we found
cases in which agents were working the system to delay and deny seriously
injured workers the financial compensation to which they were entitled – and
which they eventually received if they had the support, stamina and means to
pursue their cases through the dispute process,” said Ms Glass.
The investigation
attracted significant public interest after it was launched, with dozens of
workers and others involved in the system contacting the Victorian Ombudsman to
offer assistance or make submissions.
The investigation
involved detailed reviews of claims across all five agents. A random sample of
agent email records was examined and interviews conducted with injured workers
and their families, executives from the five agents and former agent staff.
Stakeholders including the Accident Compensation Conciliation Service, the
Australian Medical Association, the Police Association of Victoria and the Community
and Public Sector Union made submissions.
“Action must be taken to
address the complex end of the system where terminations are rewarded. WorkSafe
needs to examine its incentives – and the use of IMEs – to ensure the system
rewards sustainable decisions and to target its oversight accordingly. The
process for resolving disputes also demands careful reconsideration – it is in
the interests of workers, employers and the public at large that the resolution
of claims should be both timely and fair.
“WorkSafe has begun
addressing many of these issues, and we have already seen improvements since my
investigation began in 2015, but this work must go on. The cases we
investigated are not merely files, numbers or claims; they involved people’s
lives, and the human cost should never be forgotten,” said Ms Glass.
Notes to editors
- The
Victorian workers compensation scheme is funded by a compulsory system of
insurance that covers employers for the cost of providing compensation to
injured workers.
- Worksafe
manages around 90,000 workers compensation claims a year.
- The
Victorian Ombudsman investigation conducted a detailed review of 65 complex
workers compensation claims; most claims involved decisions made in 2014 –
2015.
- Insurers
acting as Worksafe agents at the time of the investigation were: Allianz, CGU,
Gallagher Basset, QBE and Xchanging. The Victorian Government decided in April
2016 not to renew QBE’s contract and QBE ceased acting as a Worksafe agent on
June 30 2016. EML replaced QBE on the panel of agents. EML decisions and
actions have not been examined during this investigation
UPDATE
A data breach in the making.......
The National
Cancer Screening Register Bill 2016 and the National Cancer Screening
Register (Consequential and Transitional Provisions) Bill 2016 are
currently before the House of Representatives. The bills will create the
National Cancer Screening Register, which will replace nine existing registers
including the states’ cervical cancer register.
Labor
“strongly supports” the move to establish a national register, King said today.
However,
the MP said that the bills have been “rushed” into parliament because the
government had decided to award the contract to Telstra before any debate on
the register’s merits and associated privacy and data protections.
There
was no debate over “whether it is even appropriate for such sensitive data to
be placed into the hands for the first time of a for-profit provider,” King
said……
The
decision will “put some of the most sensitive data into the hands of a private
telecommunications company.” “It’s a big question and a big call,” she said. “Not
one that we, frankly, support”.
The new
national register will hold information about every Australian eligible for
cancer screening programs. “The register is not opt-in and an individual will
only be able to opt out… of the register once it’s actually implemented,” King
said.
Data
held in the register will include individuals’ names, addresses, dates of
birth, contact details, gender and sex, as well as Medicare item number,
Medicare claims information and preferred GP or other health providers.
The
register will also contain “extremely private and intimate health data” usually
only disclosed to an individual’s GP, King said.
“Labor
accepts that this information is necessary for the operation of the register,
but we do not accept that Telstra – frankly with a questionable record of
privacy breaches – should have Australians’ most private and sensitive health
data.”
