Doctor and activist


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Category: Insurance

Domestic Violence Becomes a Workers Comp Issue 8/6/20

The NSW Supreme Court has held that the children of a worker killed at home by her mentally ill partner in a domestic violence incident can have compensation.

It is good that the issue of domestic violence gets publicity and that the children get compensation. But it raises the issue of whether employers are seriously able to assess the domestic situation of all employees and then whether they can ever hope to intervene in them.  Employers ran a long campaign not to have to pay for journey accidents, people injured on the way to work, on the basis that it was not a risk that they could control, yet which potentially might cause a big change in their insurance premiums and thus costs.  If we want our employers to be concentrating on making their businesses efficient and looking for hazards in the workplaces that they do control, it is slightly dubious public policy to have them sniffing around about employees’ home life.  This case is slightly unusual in that the employer was effectively a partnership bet ween the couple rather than having a distant employer, and the company had been deregistered which suggests some dysfunction  But the money accessed was Workers Compensation insurance and this will affect premiums and potentially other work situations.

It is true that a lot needs to be done about the discovery and action on domestic violence.  It is also true that mentally ill people need to live somewhere and that their carers are at risk.  Judges faced with people in dire need of help such as the children in this situation search for answers, and the Workers Compensation insurance scheme is a source of such funds. But the precedent set is not a good one.

The same principle applies when a baby gets into trouble at birth and has long-term adverse effects. If the obstetrician is found to have erred, there is a lot of money to give the unfortunate infant.  If he or she is not found to have erred, there is no money for the infant.  So now the premiums for obstetricians are very high and some retire in consequence.  4 Corners ran a show on this issue some time ago and it turned out that one doctor was responsible for about 60% of the problem births in Western Australia and had declined to speak to the show. Wow- go after him!  Who was he?  The Professor at the biggest teaching hospital of course.  Most of the difficult cases in the State were admitted under his name, and the staff of the hospital did their best with these cases. 

What is needed is a compensation system that is no fault.  Sometimes bad things happen.  Sometimes people make mistakes. Sometimes big mistakes have small consequences and sometimes little mistakes have big consequences.  With systems, it is not usually one person who makes a mistake, there are miscommunications, lack of clarity who was responsible, lack of availability of something or someone.  Accident causation theory is now an academic discipline, but the legal profession has not really caught up, let alone the political system.

A lot needs to be done about domestic violence, but I am not sure that making it a workers compensation issue will do anything more than push it into the public eye and help these children.  Employers and insurers will run a successful political campaign to change the law to exclude it.  I am not often on the side of Workers Compensation insurers, but a better solution has to be found.

www.smh.com.au/business/workplace/no-longer-a-private-matter-employer-held-responsible-for-family-violence-20200605-p54zy1.html

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COVID-19 Non-Treatment, American Style Points to the Need to Fix Medicare

10 May 2020 As Australian political parties slowly and steadily dismantle Medicare to move us towards a privatised system American-style, it is worth noting the major feature of the American system. Everyone says it is a hopeless system. It depends what you want it to do. It is the world’s best system at turning sickness […]

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Workers Compensation- WIRO the Watchdog is beheaded 11/12/19.

In the sad saga of treating NSW Workers Comp patients it is hard to know where a bad deal becomes a rip off becomes a scam becomes systemic fraud, but the NSW insurance scheme is a long way down the track.  Much worse than the Banks. The Hayne Royal Commission did not get to the […]

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My Health. Should you opt out?

25 July 2017 It is good to have a health record available for a complicated case. It saves doctors a lot of time.  When Records started to be computerised in the early 1980s the people at North Shore Hospital where I worked had a working party. I offered to help, but they said that they […]

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The Decline in Trust.

11 October 2017 It is getting harder to trust people.  Once we trusted our teachers, our doctors, our bank managers and our politicians to lead us.  And people trusted that people could do their jobs. But we became obsessed with competition instead of cooperation.  Everything had to make money. Everything was a commodity.  It was […]

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Power, Injury and Awards

26 November 2016 Power, Injury and Awards.  I work in medicine, treating mostly third party motor vehicle injuries and workers compensation injuries.  There are much fewer of the latter because there are less employees.  Many people working as couriers are ‘self employed’ contractors.  One man had to pay $75,000 for the right to deliver parcels […]

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CTP Facebook Article- The Facts 11/9/16

CTP, Compulsory Third Party insurance (Green Slips) is an area where I work. In theory, if you are injured in an accident that is not your fault, all your treatment is currently paid for by your insurer. The law says that they must pay for ‘reasonable and necessary’ treatment, which I assume to mean the treatment that would happen in good routine medical practice. Wrong.

The insurers have 3 months to decide if they are liable for the accident. If they decide they are not they will not pay. If they decide that they will pay, all treatment decisions have to be referred to them as to whether they will pay or not, and sometimes, despite MRI scans, severe symptoms and a neurosurgeon saying that their life is at risk, they will not pay. I have a number of patients who have waited over a year in agony for treatments that are both reasonable and necessary but the insurers will not pay for. They say that the patients can get it themselves if they like (obviously if they can afford it), of they can get it on Medicare (if they have Medicare and if they can find a surgeon who will operate on Medicare for a third of the money that should be paid by the insurer. Such surgeons cannot be found).

The protocol for disputes vary slightly between insurers. For example, the NRMA protocol is that you can firstly approach the claims clerk who rejected it and ask him/her to change their mind. Secondly you can appeal to their team leader. Thirdly you can appeal to the NRMA Senior Claims Manager. Fourthly you can appeal to the government appointed Medical Assessment Service (MAS), which guarantees to assess the disputed issue and rule within 3 months! Or the treating doctor can try to find a Medicare surgeon, send them to a public hospital, or write yet another prescription for pain killers. (Mostly the insurers pay for pain killers, though they do argue over some other drugs). Many GPs have simply given up treating CTP patients.

All these delays, frequently running into months can be compared to the doctors and nurses in Emergency Departments of public hospitals who have to write long explanations for the Health Minister if patients wait more than 4 hours in the Emergency Departments. So if you think private medicine is better than public- think again. We are going the way of the US. Insurers control it all.

Patients are assesses by an iniquitous system devised by American Insurance companies in cooperation, (inexplicably enough) with the American Medical Association. This has resulted in a tome, the ‘AMA Guidelines for the Assessment of Permanent Impairment’ which supposedly gives a percentage of impairment of your body, so that injured people can get compensation based on the percentage impairment that they have. Doctors can do a course in how to use this guidebook and then do lucrative medicals based on it. The reason the book was produced was to lessen litigation on how injured someone was, which would save legal costs. As pain cannot be measured, this was left out, which is just the first reason why the book is a farce. Since pain is the main thing that stops people working, to talk of impairment without considering pain is almost like having a swimming race without water- just not quite. Secondly despite the tome’s carefully crafted descriptions, doctors assessment using the guidelines vary widely. Thirdly, it is very hard to get over 10% impairment, which is the amount Mr Baird’s reforms intend to define as more than a ‘minor injury’ so there will be many people with only a few percent impairment, and thus minimal compensation, who will be unemployed and unemployable. Fourthly, the guides only talk of ‘impairment’. Any one who works in disability knows that there is quite a difference between an impairment and a disability. For example if someone is very shortsighted they are impaired, but if they have good prescription glasses they may not be disabled by that impairment. People who work with their brains are similarly less disabled than those who need their physical strength, but have the same impairment. So physical workers are again disadvantaged.
The new scheme will cut out lawyers and advocacy, and will give a statutory small amount to ‘minor’ injuries. The insurers will dump long term patients on the welfare system and continue to get a lot of money for doing not much that is useful.

I would finish by saying that I think the whole system is appalling and that the way to solve the health system problem is to raise the Medicare rebate from 48% of the AMA fee to 85%, where it was when it started, and there would be no trouble getting doctors to treat the patients who needed it. There also needs to be a single insurer, so that disputes between insurers will not delay treatment, which they frequently do, and everyone should be covered, even ‘at fault’ drivers, who still need treating despite their error.

For the present six insurers, all are bad, but they are not all as bad as each other. There are no published figures to compare them rationally, but based on personal experience, I have just changed my insurance from NRMA to GIO. The TV ad about feeling ‘confident’ about your insurer is a bad joke.
Wish me luck, as I wish you.
Here is an SMH article by Anna Patty 12/9/16 which raises the issues in a somewhat understated way.

www.smh.com.au/business/workplace/green-slip-reforms-will-leave-most-motorists-to-fend-for-themselves-20160905-gr8zca.html

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Medicare- Did the Liberals try to abolish it?

21 June 2016 This is a current question with Shorten claiming that the Liberals are trying to privatise it and Turnbull calling this a Labor lie. What is the truth?  The answer is in the history of Medicare funding.  Medibank was set up by the Whitlam government and the bulk billing frees were set at […]

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