Disability

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How to Fight a Monster - Insurance Company - False Claims

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Here I am responding to accusations of non-compliance via not attaining work cover certificates from my GP and forwarding them to the appropriate parties. It should be noted that this happened in the past with other case managers so I started utilizing my rehabilitation service provider as a medium for the data, who also requires this information, and have them forward the data to the insurer. This is due to the insurer “losing” the emails in the past and my records being the only ones available, this was classified as myself being “suspicious” as I was the ”only one” that had any record of the data being sent.

This is another new case manager and they claim I have not been harassed by the insurer. Well, you can read the rest of the interaction yourself, lol.

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HI D.,

Thanks for your recent email. I am sorry that you feel as though we are harassing you, it is not the case. I have written you a letter requesting you provide a up to date WorkCover Certificate because we truly do not have one on our system. The letters relating to certificates are standardised letters and are by no means meant to attach you personally. I did appreciate the last line of your email, I also want to go forward and work together to help you with return to work.

Please feel free to call me to discuss your claim, the best next step for you would be to send in the certificate so that we can get that matter out of the way.

Thanks
S.
Claims Advisor

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Hi S.,

You will have to forgive me for not having any faith in any representative of Insurer as most interactions have been incredibly unpleasant. I also feel a need to point out that you lack the tacit knowledge of my case to state that I am not or have not been harassed by Insurer or representatives of. I have enclosed two (2) documents that you may wish to read regarding this situation. Some of the highlights of my interactions with Insurer representatives include:

• Being accused of faking and fraudulent behaviour. And treated as such.
• Misdirection leading to loss of entitlements:
• Advising me to see another GP knowing it would be difficult and invalid
• Not approving procedure until after appointment date/time resulting in going to back of cue going "overtime" for reimbursement period for wages.
• Falsification and fabrication of data and documents
• Advising me to take action on the phone and then denying that fact post event.
• Refusing reimbursements for medications and travel throughout the case.
• Documentation provided to insurer “missing”, but evidence proves otherwise.
• Documentation “sent” by insurer not received by myself or service providers, no evidence of data ever being sent.
• Claims of phone conversations with case managers which never took place, with phone logs supporting they never took place.

Now this is just the tip of the iceberg and is covered briefly in the documents provided, however it is not the main topic of these documents. These events have been made out to be my wrong doing and when I have questioned or protested being treated in such a manner, it has been followed with threats of loss of entitlements and case closure due to non-compliance. Below is a definition of harassment and the source:

Harassment - noun: The act or an instance of harassing, or disturbing, pestering, or troubling repeatedly; persecution
http://www.dictionary.com/browse/harassment

Further, harassment is also defined as aggressive pressure or intimidation. I find it difficult to believe anyone presented with the above data is able to state that the treatment I have endured dealing with Insurer and its representatives is not harassment. You can state it is not the case, but the evidence proves otherwise.

Now to the matter of the Workcover Certificates, again this is another display of complacency regarding my case resulting in adverse effects. I did what I was told to do and what I have always done. Because somebody didn’t do their job properly, I have to deal with the repercussions of someone else’s actions. I have letters sent to me stating im not complying and they are on my file as being generated. It is also interesting i didn't receive any other letters in the two (2) months I "did not provide certificates", but I digress. The fact is I have provided the certificates via email and will forward those again with the stamp dates of when they were originally sent if I can find them in my archives. I have attained a new workcover certificate which I will send to you following this email.

I am not interested in any form of phone discussion as this has been a key element of being misdirected in the past without any evidence of requests, discussion topics, etc. on an “official” basis. All communications will be done in writing with date stamps to keep everyone honest, so events such as this can be met with data and evidence that is legitimate.

Regards
D.B