An investigation into the handling of workers compensation claims by one of Australia’s biggest insurers, QBE, gives a rare insight into practices including altered evidence, doctor shopping and missing files.
The revelations come after a joint investigation by Four Corners, The Age and Sydney Morning Herald into the $60 billion workers compensation system found questionable practices that were making workers sicker.
Mr Fitzpatrick spent a decade working as a prison guard at the Silverwater correctional facility in NSW, which houses some of Australia’s most dangerous criminals.
Mr Fitzpatrick and two of his colleagues lodged a claim of bullying and harassment by their employer, Corrective Services NSW.
A series of doctors agreed Mr Fitzpatrick had suffered a work-related psychological injury.
“Unbeknown to me at the time, my employer had instructed the insurer to decline the claims,” he said.
An investigation by consulting giant KPMG assessed the conduct of QBE and Corrective Services in relation to the handling of the three guards’ compensation claims, after a QBE insider alleged the insurer and the department had colluded to deny the claims.
The KPMG draft report, handed to icare in April 2018, cites a disturbing conversation in which Corrective Services urges QBE to reject a claim so that the prison guard is “left short of money and has to return to work due to… financial hardship.”
Corrective Services told QBE:
“Sometimes it’s cruel to be kind and hit them in the pocket.
“And when he’s not getting any money and he’s married with kids and most probably his own home, he’s most probably got to think ‘well f*** sake I’ve got to do this’.”
QBE replied: “Yeah… I think he’s close to that now.”
Mr Fitzpatrick was shocked when he read the report, which cost more than $200,000 to produce.
“My employer and insurer were just openly talking and laughing about the fact that they were going to decline these claims and how they would go about doing it,” he said.
“That, to me, indicates that this perhaps is systemic. They didn’t try to hide it at all.
Final report watered down, some recommendations removed
The report was commissioned by the country’s biggest workers compensation scheme icare, which outsources its management of workers compensation claims relating to Corrective Services to QBE.
The workers compensation regulator SIRA has now commissioned its own investigation after it came to light that the final version of the forensic report was tamer than the draft report.
The report showed that QBE initially recommended the claims be accepted but then reversed that decision after participating in a meeting between QBE and Corrective Services which resulted in the employer altering a statement of events.
The draft version of the report referred to missing files and recommended a review of QBE and/or the Department of Corrective Services email servers to try to find out why the statement was changed and “why details aren’t included in the files or provided as evidence to KPMG as part of its forensic investigation”.
It also referred to emails where the employer directed QBE to use specific independent medical examiners to assess the claims and directed QBE to ask one of the doctors certain questions.
KPMG included a traffic-light rating system in the draft report that assigned a series of red ratings to the allegation that QBE “essentially followed the employer’s desired actions on the claim” and “evidence held on file did not support a sound rationale for the claims management actions, inactions or delays on the claim.”
In the final report, a number of recommendations and findings were removed along with the conversation outlining the plan to deny the claim.
The traffic light rating system had also been removed. A covering letter to icare says “this report does not include our recommendations for phase four — further investigations which icare has determined not to undertake.”
There was no overall finding of collusion due to lack of documentation, but it called for a further investigation.
However, it did say that QBE, and its legal team “appear to be attempting to fit evidence to a particular narrative and specific tailored evidence.”
Draft report contained ‘hearsay’: icare CEO
The CEO of icare, John Nagle, said he didn’t believe the report had been watered down.
“The first version contained information that was basically just hearsay. So we asked KPMG to just stick to the facts that were actually available,” he said.
“And so they had to amend their report. That is the report that was used.
“If you take out speculation and rumor you’d have a change in the report.”
Mr Fitzpatrick is now getting workers compensation, but it has taken a huge toll of him.
He uses a cold-water immersion breathing technique to help deal with his depression and anxiety.
Mr Fitzpatrick is also seeking damages in the NSW District Court.
“I can’t tell you how many times in the last five years I’ve been knocked down, and as the years go on, the more times you get knocked down, the longer it takes to get back up,” he said.
A spokeswoman for Corrective Services NSW said “we do not condone the language used by the staff member in their dealings with QBE” but failed to answer why the staff member was still in the job or what other action had been taken.
A spokesperson for QBE said no action was required because: “KPMG determined that there was no evidence of fraud or collusion between QBE and the employer, no evidence to support allegations that QBE was involved in the alteration of evidence and no evidence that QBE did not adequately investigate the medical aspects of the psychological injury”.
QBE did concede that some administrative practices “could be enhanced” and that efforts had been made to strengthen record-keeping practices.
KPMG said it “believes the final report accurately reflects the information gathered during the forensic claim file review. We stand by the quality of our work, including our key findings, which were consistent between reports, which ultimately recommended the case in question be reconsidered.”
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