Sam Wainwright, Perth
WA insurance companies are defrauding Medicare through the state's workers' compensation system.
Not content with extracting more than $255 million profit in the last financial year, the insurers have found a way of avoiding their responsibilities and foisting it onto taxpayers.
The rort is simple: insurers are notorious for not paying doctors quickly for workers' compensation treatments, so an increasing number of WA doctors get injured workers to pay them through Medicare and claim the difference in fees from the insurers.
Neither the doctor nor the worker is doing anything illegal. But what the insurers are doing is very shady. Insurers are supposed to be liable for the entire amount of medical accounts. But Medicare doesn't investigate bills below a set level, something the insurers are aware of.
So, while charging premiums to employers for the full level of responsibility, the insurers are passing the costs onto taxpayers and pocketing the difference.
This explains a growing trend WA unions have noticed with workers' compensation claims: insurers refusing to pay weekly benefits and only picking up the medical liability. While this is technically illegal, it is believed the insurers are exploiting a loophole while WorkCover WA looks the other way.
Only WorkCover WA can tell how many millions of dollars of public funds are being ripped off. But strapped of funds and saddled with a do-nothing, pro-big business board, the government regulator isn't blowing the whistle.
This latest scandal is just one of the many crises that have struck the WA workers' compensation system since disastrous "reforms" were imposed by the ALP state government last November.
The intention of the changes was to motivate employers to practice "injury management". The then minister, John Kobelke, explained injury management as "helping workers get back to work and get on with their lives".
That is the last thing that WA insurers are interested in. What has happened is that injured workers, demoralised when faced with the impossibly complicated and legalistic workers' compensation system, are offered cheap payouts to get out of the system. Then they lose their jobs.
In addition, Work Choices has allowed employers a brutal new tactic. Many injured WA workers are now sacked as soon as they present a claim. To force the employer to send the claim to their insurer, as is legally required, the worker has to get a lawyer and battle through WorkCover WA's new dispute resolution maze.
Workers without a union have to turn to community legal services for help. One such service, the Employment Law Centre, now refuses to deal with workers' compensation issues because of the deluge.
WorkCover WA advertises a free help service for injured workers but, by law, it can only "furnish advice", not actually assist people!
The Liquor Hospitality and Miscellaneous Workers Union, WA's biggest union, has noticed a huge increase in underpayment of injured workers who successfully claim. It appears that the insurers know that the new disputes handling procedures are so complex that workers will never get their rights.
When the "reforms" were introduced last year, two massive new benefits were created for badly injured workers: the Exceptional Circumstances Medical Entitlement of $250,000 and the Specialised Retraining Allowance of more than $109,000.
There is no known instance of any worker ever receiving those benefits. Empty benefits for workers, massive profits for shady insurance companies — such is the reality of workers' compensation under WA Labor.
[Sam Wainwright is a workplace delegate with the Maritime Union of Australia.]
From Green Left Weekly, May 3, 2006.
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