When claims process worse than injury

by Will Ashworth07 Dec 2015

A nurse’s injury suffered while lifting an obese patient and included a spinal fusion operation in 2014 is bad enough but the claims process that followed was even more painful.

"They have refused to hand over any money," Jeannie Wilcox, who has spent five years in a bitter dispute with the insurer, told the Sydney Morning Herald. "I've seen about 18 doctors. There have been endless medical reports, procedures, forms, appointments and follow-ups. I also get constant harassing phone calls from claims managers demanding this and that. I tell them to email me, so that at least I have a paper trail, but they keep calling."

Wilcox had group insurance through her employer who put in a permanent impairment claim with Workers Compensation in Australia, the claims for which are handled by Employers Mutual Limited [EML]. The company agreed to pay Wilcox income protection but not a lump sum.

However, the insurance company hasn’t made it easy for the former nurse getting photographers to follow her around to all her medical appointments.

"One of them was so close it clipped the gum tree 50 metres from the house. When it went past I saw a guy with a camera in the passenger seat,” Wilcox said. "If EML had just accepted liability when presented with the facts, they would have saved a lot of money instead of wasting it on cash-for-comment doctors and surveillance and chasing around trying to find a made-up explanation."

To make matters worse, Wilcox’s insurance company refused to pay for her spinal fusion operation as well as MRIs. To top it off, while her husband was in the final stages of terminal cancer, she asked the insurance company for assistance paying for someone to do the cleaning and lawn mowing usually done by her husband.

They refused.

"Life and disability insurers are fighting harder now, and subjecting claimants to more intrusive and humiliating demands,” said Andrew Weinmann, a superannuation and insurance lawyer at Slater and Gordon in Australia. “Plenty of people find it too stressful, and give up on perfectly good claims."