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Tag: iCare

24/11/2022

iCare- a letter to the Editor of the Sydney Morning Herald

24 November 2022

Dear Editor,
iCare was set up by private insurers on their model with the NSW government keen to minimise costs, take profits and distribute them (just before the last election). So iCare delays or refuses treatments to the needy, and was very careless about what their Pre-Accident Average Weekly Earnings (PIAWE) were. Many accident victims complained that they were underpaid, and that was before their compensation was stopped or cut because they were certified partially fit to do jobs that could not be found.

The overheads of Medicare are about 5%, iCare about 38%, so it is totally inefficient as well as incompetent with bloated salaries for the top executives who think it is a financial problem rather than a medical one and hence are unable to solve it. The real solution would be to fund Medicare as the only medical system and let the insurers have widespread income-guarantee insurance.
Sincerely
Dr Chesterfield-Evans- works as a GP specialising in Workers Comp and CTP injuries.

Here is an article from today’s SMH

EXCLUSIVE
Injured workers to lose benefits
Adele Ferguson

Greg Dayman is one of almost 400 workers who will get a Christmas ‘‘present’’ they will never forget.

The Sydney construction worker was badly injured on a building site in 2013, which left him unable to work with chronic pain in his neck, the side of his head, down his arm, torso and leg.

In 2017 he was among thousands of employees whose compensation payments to cover wages were cut as part of controversial reforms to the state’s scandal-ridden icare organisation. Changes to the legislation terminated injured workers receiving weekly wage benefits after five years unless they met a whole body impairment assessment of more than 20 per cent.
However, he still received medical or health benefits. Now he has found out even these will be cut from December 25.

‘‘It’s another upper-cut,’’ he said. ‘‘And to do it on Christmas Day, that’s just cruel.’’

Dayman is one of 395 workers facing a grim future as a crisis at icare deepens, with a document prepared by the State Insurance Regulatory Authority (SIRA) revealing the workers’ compensation scheme ‘‘has deteriorated to the point the longer-term sustainability of the scheme is under threat’’.

NSW Auditor-General Margaret Crawford will hold a performance audit into icare next year that will examine how effectively key risks are managed, including the rising cost of workers’ compensation claims and its payment processes. Dayman said he lost everything after his injury.

‘‘I lost my health, my career, and financially I’m in a position that if my specs break I can’t afford to buy them. The system dehumanises you, so you give up.’’

He does now qualify for a disability pension but will have to rely on Medicare for future medical treatment. ‘‘I have been suicidal at times because of the system and the way it treats you,’’ he said. ‘‘My time is spent trying to survive.’’

In the executive summary of SIRA’s review into icare’s Nominal Insurer Improvement Plan, dated September 26, the authority said it had a ‘‘low level’’ of confidence icare’s strategy would improve return to work rates and overall performance.

In 2015-16, 93 per cent of injured workers were back at work 26 weeks after their injury, compared with 84 per cent in August 2022.
SIRA said it believed icare’s strategy ‘‘encompasses an increase in work capacity decisions to cease worker benefits instead of focusing on improving health and recovery through return to work’’.
Richard Harding, icare’s managing director and CEO, said it was the insurer’s role to implement the law, and legislation ‘‘does not give icare any discretion to act outside that’’. ‘‘Tailored and individualised support is provided to workers transitioning from the workers’ compensation scheme,’’ he said. ‘‘This may include support from NDIS, Community Support Services and Medicare in conjunction with their GP.’’

This masthead this week revealed a third underpayment scandal of injured workers and concerns raised by NSW Treasury in August that a deterioration in icare’s finances would require insurance premiums to rise 33 per cent by 2025, or $1 billion a year, to cover the shortfall.

Against this backdrop, the icare board granted pay increases to 116 of its executives, including Harding, making him one of the state’s top-paid public servants, earning more than $1 million a year.
Shadow Treasurer Daniel Mookhey said icare’s finances were in a catastrophic condition.

‘‘They’ve lost billions. They are planning massive premium hikes. And their next step is to expel even more injured workers from the system,’’ he said.

‘‘It is a ruthless tactic stemming from their financial desperation.’’
In a statement, SIRA chief executive Adam Dent said its views on the Nominal Insurer Improvement Plan in September were made with limited detail on how the plan would be executed.

‘‘Over recent weeks, SIRA has continued to engage with icare to address information gaps, including detailed briefings on managing IT and transition risks associated with the onboarding of new claims services providers.’’

But SIRA said poor return to work performance continued to be an issue of concern.

‘‘Icare’s targets for 2023 are lower than current return to work rates, and they are projecting a further decline of 2.5 per cent on 26-week return to work rates through 2023 and 2024 as the scheme transitions to new claims providers,’’ Dent said.

Icare said its focus was building injured workers’ capacity for employment using rehabilitation providers and associated vocational placement interventions. ‘‘This includes assistance with job seeking and vocational retraining. Work capacity decision-making is applied when the worker has a demonstrated capacity for work and has been provided the right support.’’
Lifeline: 13 11 14

20/05/2022

Government protects Bonuses of iCare Executives while workers are dudded.

20 May 2022

Some things make me unspeakably angry.

In the SMH online today the government giving bonuses to executives who presided over iCare cheating injured people out of their payments and treatments.

In my real job, I treat injured workers and motor vehicle accidents. Many wait more than a year for surgery- my longest was 9 years. They are subjected to Independent Medical Examinations that find any other reason than their accident for the cause of their pain. Age, previous injury and arthritis are the commonest ones. It is stated that they are fit for work, when they are obviously not, or that they can get another job when they obviously have no physical or mental capacity to do another job, let alone compete for one.

The ongoing inefficiency of the computer algorithms making decisions without even anyone being responsible was the brainchild of John Nagle, whose other bright idea was to change his KPI (Key Performance Indicator) from getting people back to work, to having them declared fit to be back to work. Nagle resigned after a bad day at a Parliamentary inquiry. All this happened while iCare was under Treasurer Dominic Perrottet.

A friend of mine injured his back lifting on a Friday. He called his GP and visited him on Saturday. He had an MRI scan on Monday which showed a bad disc injury, saw the neurosurgeon on Thursday, had a discectomy on Saturday and went home on Monday. All fixed in 8 days. That is what should happen. It never happens in the WC or CTP system.

The Workers Comp system takes 14 days to accept liability, then has to ‘decide’ if the treatment is appropriate, so weeks go by, and if they dispute it, years. People wait 3 months for the insurer’s medical examination, 6 weeks for the result of it, another couple of months for their specialist examination and a few months for the government medical to settle the dispute. And they blame the injured people for the worse results out of the system, and give bonuses to those who managed to reduce the costs. Given the huge administrative machinery, the clerk, investigators, extra medical examiners, lawyers, dispute resolvers and the rest, all the savings come from not treating people. And those responsible get bonuses, and the government, ever keen not to upset the private sector ring-ins makes sure that they are amply rewarded for this appalling situation. Perrottet, the most recent architect of iCare, had a 2^nd inquiry by McDougall to kick the can down the road, then rose to be premier before his report was out.

Here is the SMH article:

Government votes to protect bonuses for icare executives

By Lucy Cormack

May 20, 2022 — 5.00am

The Perrottet government has protected bonus payments for icare executives, rejecting a bid to ban the practice after revelations millions of dollars in bonuses were handed out while injured workers were underpaid.

The attempt to strip bonuses from executives at the state insurer was contained in Opposition amendments blocked in the lower house this week during a vote to amend the state insurance and care legislation.

Icare has been the subject of intense scrutiny since an investigation by the Herald and ABC TV’s Four Corners in 2020 revealed the underpayment of workers while senior executives claimed almost $4 million in salaries and bonuses.

The insurer, which provides workers’ compensation insurance to 3.6 million public and private sector employees in NSW, has since been forced to repay $38 million to 53,000 injured workers.

The scandal prompted the government to amend legislation governing icare, following a review by former judge Robert McDougall, QC.

More than 200 icare employees are entitled to bonuses, including chief executive officer Richard Harding, who is entitled to an incentive of $411,000.

Opposition treasury spokesman Daniel Mookhey said there was little justification for bonuses while the insurer continued to record billions of dollars in underwriting losses.

“Employers are staring down the barrel of a decade of rising premiums, yet the government is protecting bonuses for top executives at Australia’s most disaster-prone insurer,” Mookhey said.

“We intend to stand up for employers and injured workers. We will fight against lavish bonuses for icare’s top executives in the Legislative Council next week.”

During debate on Wednesday, Minister for the State Insurance Regulatory Authority Victor Dominello said the McDougall Review had not found executive bonuses at icare were excessive.

He said McDougall noted the benefit of allowing icare to set competitive salaries to “attract appropriate talent”

The Herald last year revealed icare hired 18 new executives with potential annual bonuses collectively worth more than $1.2 million, while employee operating costs have increased from $162 million to more than $200 million since 2020.

However, an icare spokesman previously told the Herald no executive bonuses have been paid in the past two years.

Unions NSW boss Mark Morey wrote to NSW MPs last week calling for reforms to address “repeated governance, financial and operational crises”, including ending executive bonuses.

Other proposed reforms included enforcing the same procurement laws that govern the NSW public sector, from which icare is exempt, and appointing an injured worker to the board.

Morey on Thursday said the government had missed an opportunity to “clean up” the state insurer.

“How can the premier justify continued bonuses for highly paid executives when sick and injured workers have been dudded and small businesses are paying increased premiums?” he said.

Other changes sought by the government included additional powers for the State Insurance Regulatory Authority and expanded access to commutation, which allows injured workers to negotiate lump sum payments and exit the system, rather than remain on weekly payments.

However, the government agreed to withdraw its proposal to allow changes to commutations via regulation and reconsider them in future legislation.

Opposition spokeswoman for industrial relations, work, health and safety Sophie Cotsis said she was pleased the government had agreed to consult further on lump sum payments, arguing that regulation should not be used to expand the system.

The State Insurance and Care Legislation Amendment Bill 2022 will now move to the upper house, where the opposition will make another attempt to ban bonuses.

11/11/2021

iCare will repay 53,000 underpaid injured workers

11 November 2021

iCare, the State workers’ compensation insurer has admitted that it has underpaid thousands of workers and will now repay them, according to an article in today’s SMH.

This story has been leaking out in the media for ages. At a day to day level, my patients have always complained that they get a lot less in compo than they got before their injury. This has been even for workers on regular salaries. Those on casual work were in a worse situation as there was some argument about what their PIAWE (Pre-Injury Average Weekly Earnings) were, especially if they got variable hours from a labour-hire company.

When this scandal first broke, I tried to tell my patients to ask iCare if they had been underpaid and some did. It seemed that iCare could not work out what their PIAWEs were. It did not have the data. In that employers’ future premiums related to how much was paid out in claims, it suited both the employers and the insurers to minimise their PIAWE, so if a low amount was put in, there was little incentive to check it up. Now, a few years later, iCare would need a forensic accountant going through the employer’s books to get to the correct amount. This is unlikely to happen.

So while this promise is a start, it is hard to believe that it will be enough to see justice done.

Workers’ Compensation has always been seen as a cost for business rather than a moral obligation to pay for people injured at work. Generally it is about minimising the cost of the payout, rather than having an energetic injury prevention programme.

The Minister in charge is the Treasurer, so all of this happened on Dominic Perrottet’s watch. Matt Kean, the new Treasurer may be more sympathetic, and this will help, but we still need a lot better enforcement of safety to prevent accidents, and much more power to injured people to ensure that they are correctly paid.

It illustrates that active Unions are necessary to redress the power imbalances in the the system. Legislation without enforcement is just words on a page, just as apologies from banks and insurance companies for rip-offs are just sound vibrations in the air.

Here is the article:

‘My sincere apology’: iCare will pay back $38 million to 53,000 injured workers

Lucy Cormack SMH November 11, 2021

State insurer iCare will pay $38 million to 53,000 largely underpaid injured workers affected by historic miscalculation errors between 2012 and 2019.

An iCare review of 16,000 injured worker case files has revealed an average error rate of 3.5 per cent or an underpayment of $26 a week due to miscalculated pre-injury average weekly earnings.

“I would like to offer my sincere apology to any injured worker who has been affected by this calculation error,” said ICare chief executive Richard Harding.

Among the most seriously injured and affected are 523 workers underpaid a total of more than $3.9 million, or around $7500 each.

The mass pay-out follows a joint investigation by The Sydney Morning Herald, The Age and ABC’s Four Corners which last year revealed iCare had underpaid as many as 52,000 injured workers by up to $80 million in compensation.

ICare then disputed the underpayment figures, saying it believed only 5000 to 10,000 workers had been underpaid up to $10 million in total.

Chief executive officer Richard Harding on Thursday said affected employers and employees had been unable to provide the data to accurately assess underpayments. As a result, iCare conducted a “file by file review” of 16,000 cases as a sample to assess the scale of the errors.

“We’ve been advised there is a risk of overcompensation in this approach, but the desire is to get money back as quickly as possible,” Mr Harding said.

“I would like to offer my sincere apology to any injured worker who has been affected by this calculation error.”

The underpayments were caused by errors in the calculation of pre-injury average weekly earnings for injured workers dating back to 2012, when the insurance scheme was run by WorkCover.

Mr Harding said the average lump sum to be paid to the 53,000 workers will be around $700. However, some will receive thousands.

Affected workers will receive any money owed through an adjustment of their weekly benefits for the weeks already paid. Any historical overpayments caused by the same miscalculation error will not be recouped by iCare.

Revelations of financial mismanagement and widespread underpayment across the iCare stable first emerged last year, before a subsequent review into its culture and governance revealed systemic weaknesses and a failure to hold management to account.

Labor treasury spokesman Daniel Mooched said the announcement repudiated earlier claims that only a small number of people were affected.

“As always with iCare, the devil is in the detail. But today’s announcement is meaningful for the tens of thousands of people iCare underpaid”.

Mr Mookhey said the insurer must guarantee that it will not seek to recover the money from sick and injured workers through benefit cuts or employers through higher premiums.

Upper house Greens MP David Shoebridge said the pay-out to workers followed years of chasing by unions, injured workers and non-government MPs.

While he welcomed the payments, he said there was “no evidence from iCare that this payment goes anywhere near meeting their full obligation to injured workers”.

“We will continue to press iCare for a full accounting so that no injured worker is left short-changed,” he said.

Unions have described the decision to reimburse workers as a significant step but called for greater transparency about the process.

“This is hardly an organisation that can be taken at its word. iCare executives, who are better known for receiving fat bonuses, must detail their methodology,” said Mark Morey, Secretary of Unions NSW.

Last week, a budget estimates hearing heard iCare had reported a $1.4 billion underwriting loss in the past year, with the total accumulated loss of the past three years now exceeding $6 billion.

Treasurer Matt Kean, who is responsible for iCare, told the hearing new legislation following recommendations from another review prompted by the scandal would not be introduced until 2022.

30/04/2021

iCare= Hopeless in Two Reports but the Bad Joke Continues

30 April 2021

Two reports on iCare have come out on the same day- how convenient, one lot of publicity rather than two.The report of the Parliamentary Committee was one report, the other was a report by Robert McDougall, a retired Supreme Court judge.The political report looked at the disgraceful evidence given by John Nagle which showed almost no care for the injured workers and an appalling attitude of entitlement in him and his crony staff. iCare had not even known what workers’ Pre-Injury Average Weekly Earnings (PIAWE) were, and had not tried very hard to find out so that they could underpay them and minimise their costs. They relied on computer algorithms rather than staff to manage the claims, only getting staff on the case if there were problems, which there usually were, as the poor patients were having their treatments delayed or denied.
The McDougall report had its terms of reference set by Treasury, who were also the department being investigated, and they also staffed the inquiry. The Treasurer, Dominic Perrottet did not agree to be interviewed by McDougall and got away with this. Is this some sort of bad joke? The McDougall report found incompetence etc, but no actual corruption that anyone could be charged with. As such, the McDougall report was a political success. It took the heat off the Treasurer from November to now, and will result in a bit of publicity, no serious recriminations and the usual promises of future action. John Robertson, an old union hack is the new CEO, so Labor will not criticise iCare now.
My poor patients will be mucked around, be underpaid and have their treatment denied as usual. And Treasurer Perrottet will sail on hoping to be Premier as Gladys falls. What a joke!

www.abc.net.au/news/2021-04-30/damning-reports-released-over-nsw-icare/100107076?fbclid=IwAR34I_blTADSxa2OoWxrzOpvgNPZ3KUFmhQmpSFZHd4LSOIVdof0nx8yMGs

07/03/2021

iCare Doesn’t Know and Doesn’t Pay Underpaid workers

7 March 2121

The incompetence of Perottet’s iCare never ceases to amaze.

It underpaid injured workers but was not sure how many. It was initially 240,000. Then it changed its to estimate to 52,000 people underpaid up to $80 million. Then possibly as little as $5 million. In March it is 23,000 and $20 million. They don’t actually know. After 18 months 25 have actually been compensated!!!
This is all treated as some of ‘management error’ as if this makes it OK. These are a lot of abstract words, but few concrete ones. The idea of abstract words is that the concepts can be discussed better. But mostly management words are so general as to be meaningless, and principally serve to make everything non-specific and also euphemistic. No one says, ‘They did not know or care and their incompetence led to immense suffering for the families who were underpaid’. It becomes, ’There was a lack of management understanding and focus and some workers may have been paid less than their entitlement’.
Naturally no one will be punished.
All I know is that even the routine service takes about 3 weeks to get anything done. I had a patient doubly incontinent after a spinal injury. It takes up to 10 working days to get a claim approved, then up to 10 working days for them to approve an MRI and a specialist consultation. This is normal. When they delay things it is worse, and sometimes they refuse to pay at all.
www.smh.com.au/national/nsw/scathing-icare-review-finds-a-need-for-cultural-change-20210301-p576tq.html

06/03/2021

Scathing PWC Report Finds Perottet’s iCare Incompetent

6 March 2021

A 100 Page report by consulting from international PWC (Price Waterhouse Coopers ) found weakness in performance and governance, and the Board did not hold management to account.

We might also consider that the Minister, Dominic Perottet did not hold the Board accountable, and appears to show no interest at all in the injured people for whom the whole scheme supposedly exists. We might note that no doctors or patients appear to have been interviewed either- Hey, it’s all about money you know! One could ask why PWC did a report when Justice McDougall was simultaneously doing one that it coming out in April? Perhaps he is a lawyer and does not know enough about money.

The bottom line is that it was run from the top by people who only knew about money with little input about its proper function from the people at the coal face, who presumably should have some knowledge of the people that they are supposedly helping. (I say that with reservation, as the case managers that I deal with have high turnover, little insight and seem to assume that a large percentage of their cases are fraudulent, the doctors are hell-bent on inventing pathologies to over-treat and they have to follow elaborate protocols designed to ensure that no one could under any circumstances get one cent more than was absolutely necessary).

So we digest the Management-speak of this report and await the McDougall report which had terms of reference that allowed little input from patients or doctors, held no hearings and seemed to exist principally to take the heat off the Minister from last August until its April release.

It seems that there has been a generic concept since the 1980s that managers know best, that other degrees and knowledge from lesser beings or lesser ranks and incomes are not of value or to be listened to. It has come unstuck in so many situations that its time that some little boy (or girl) points out that ‘The Emperors have no Clothes’. Then we can go back to an older time, where people had appropriate training, worked their way up, knew their jobs, were promoted on merit and had small salary increments reflecting their incremental status rise. But I suppose that this would rely on people having permanent jobs and depower the whole new managerial class and their symbiotic consultants and reduce the workplace ‘flexibility’ that allows the obscene salaries at the top and insecurity at the bottom.

If Anglo society does not want to fall to more realistic societies in Germany and Asia, there needs to be a large rethink of the Harvard 1980s management nonsense that is the foundation of these sort of debacles.

www.smh.com.au/national/nsw/scathing-icare-review-finds-a-need-for-cultural-change-20210301-p576tq.html