80 The Ombudsman and the Battle to Make the Health Insurers Obey the Law Part 18, Section 4: 3 November 2024

mm

Unpicking The Ombudsman Email of 5 April 2022 (3)

 

24.15 Ombudsman Uninterested in Awful Behaviour by HCF

“You advised our Office that HCF were now no longer accepting any claims from Lift.”

Translation ↓

On page 15 of my letter dated 21 February 2022, I gave the Ombudsman details of the HCF scam. “Adding to the seriousness of the “scam” in which HCF is engaged are two other equally serious factors. ·           It has placed a “block” on its computer system to try and prevent any claims at all from being lodged for services provide by Lift Cancer Care Services; and ·           It simply ignores claims at random, not responding in any way to the fact that they have been lodged. I reiterate something already known to the Ombudsman about a FUNDAMENTAL DUTY OF ALL HEALTH INSURERS.  That fundamental duty is the duty to permit claims to be lodged and to provide a response – positive or negative – to those claims.  If the response is negative, a reason contemplated by the relevant legislative provisions MUST be provided.” In this portion of the email, the Ombudsman explicitly acknowledged I had told it HCF was ignoring its duty to enable claims to be lodged.  I had thought the Ombudsman would be concerned that HCF was breaking the law.  The response by the Ombudsman amounted to - “How very uninteresting. Why should we be interested in this?” The regulator had zero interest in law enforcement.  Was the Ombudsman corrupt or “merely” very lazy.  I formed the belief they were probably corrupt as well as lazy.

****

 

The Ombudsman “Investigation”

“Our Investigation* Investigation revealed …” * The bold lettering replicates the bold used in the email

Translation ↓

The Ombudsman wanted to create the false impression that it had investigated my complaint and rejected it – so the Ombudsman lied.  The Ombudsman carried out no “investigation”.  The Ombudsman wanted to give the impression Lift was to blame for the behaviour of the HCF.  Instead of investigating the facts, the Ombudsman was a mouthpiece for the health insurers. Perhaps the most misleading aspect of the email lies in the heading “Our Investigation”.  It proclaims the Ombudsman had conducted its own investigation.   When I got this email, I certainly thought the Ombudsman had done an investigation. I researched the Ombudsman Act many months later.  I then realised there HAD NEVER BEEN any investigation by the Ombudsman.  Section 20P of the Ombudsman Act forbids “investigations” by the Ombudsman except in limited circumstances. The Ombudsman can conduct investigations if mediation has failed – and the Ombudsman never suggested mediation in our case. The Ombudsman can conduct an investigation if it is “not satisfied with the outcome of” an investigation done by the health insurer. The 5 April email insisted HCF had done no wrong, so the Ombudsman was definitely not dissatisfied with “the outcome of any investigation” conducted by HCF. After realising it was impossible the Ombudsman could have conducted any investigation at all, I noted the careful wording immediately beneath the heading “Our Investigation”.  It is deliberately deceptive.  It does NOT say “Our investigation revealed …”.  It says “Investigation revealed …”. Given the heading “Our Investigation”, these words give the impression the Ombudsman did an investigation - but very carefully avoids saying this. Government agencies are careful in their word selection and the way they use those words.  My conclusion given the omission of the word “our” before the word “investigation”, is that the only “investigation” was that conducted by HCF. This word formula was meant to deceive.  I was definitely deceived when I received this email. **** The courts don’t substitute their own decisions for decisions reached by bureaucrats, but they do exert some controls over bureaucratic decisions.  If a decision is so unreasonable  that no bureaucrat could have made it, the courts say no valid decision has ever been made. In the case of my complaints, the Ombudsman was able to conduct an investigation of its own – but only if it was “not satisfied with the outcome of” of an investigation conducted by HCF.  Quite obviously, Ombudsman WAS satisfied with the “investigation” conducted by HCF.  Once it became “satisfied” with the “investigation” carried out by HCF, the Ombudsman became unable to do its own investigation – and it clearly didn’t. The Ombudsman decision not to carry out its own investigation falls within the court concept of invalid decisions that no reasonable bureaucrat could make.  The Ombudsman’s refusal to investigate my complaint was invalid.  Given the documentation I had given the Ombudsman, it was legally impossible for the Ombudsman to accept the HCF lies.  The evidence I sent to the Ombudsman in February 2022 refuted any HCF assertions that it had asked Lift for further information which had never been provided.

****

The Ombudsman Blames the Victim

“Our Investigation Investigation revealed that due to claiming issues with various insurers LCC had applied to the Department of Health to have their ‘Tier 2’ hospital status removed.  Removal of this status allowed LCC to bill patients for services directly rather than having to submit claims directly with a patients insurer.  This application was approved, and explains why you were required to pay upfront for services and then claim directly from your insurer from December 2021 onwards”

Translation ↓

Having falsely claimed it had conducted an “investigation” into my complaints, the Ombudsman then resorted to a well know tactic – blame the victim. The Ombudsman told us something irrelevant.  Before Lift could ask us to pay on Margaret’s treatment days, the Health Department had to change its hospital registration status. I doubt the Ombudsman told us this for an innocent reason.  This was designed to blame Lift for making us pay for treatments HCF refused to pay for.  The Ombudsman wanted us to think if Lift had done nothing, we wouldn’t have had to pay for Margaret’s treatments.  This was misleading on multiple levels.  The Ombudsman was unconcerned that HCF ignored the law. The Ombudsman was unconcerned about the need for Lift to be able to pay its own expenses.  If Lift ceased to be able to operate, none of its patients could have got treatments.  Without the treatments, Margaret and other Lift patients would probably die earlier than they otherwise might. The Ombudsman thought it was preferable for Lift patients to die because this meant it would not have to enforce the law.  The Ombudsman was unconcerned about Lift patients dying so long as it could avoid doing its job.

 

****

Above - Margaret at Anne Ryan's home in Ireland 13 December 2017

                                                                       ****

 

 

Above – Maeve O’Byrne 13 December 2017; in her funeral eulogy, she forgot that Margaret had ever known me and that she had been our marriage celebrant.

                                                                       ****

 

Above – Anne Ryan.  In her video funeral eulogy, she forgot Margaret had ever known me.  She gave me and Margaret the finger.

 

Above – Peter Hussey.  In his video funeral eulogy, he forgot Margaret had ever known me.

 79 Amanda: 1 November 2024

One of the finest friends I have ever had was Amanda.   

I knew Amanda long before I met Margaret.  

We never had a relationship, although I wanted to.

****

Many years ago, I wrote The Healer for Amanda .

 

THE HEALER It so very odd that we never see ourselves for what we really are. If we train as lawyers we assume we are lawyers. I was a truck driver once and I thought I was a truck driver.   All truck drivers think they are truck drivers. All shop assistants will tell you they are shop assistants.   That may be why Amanda thought she was a lawyer. She had trained as a lawyer so obviously she was a lawyer.   Like most of us, Amanda didn’t know what she was.   But she saw the colours seeping out of people as soon as she could see.   Sometimes the colours raised her up, Sometimes the colours were filled with dark. Often the colours indicated what already was or that which might happen, The future flitted amongst the dancing colours of the people Amanda met.   It was unusual to see dark bands of evil But this did happen.                 Evil has its own special colours Amanda knew their evil rhythms even while still a child.   From the beginning she tried to touch the colours, Tried to alter their shape.   That is one way that lives are altered.   Helping others is always hazardous, By helping others, she changed her own life. Touch the now of anyone and you change the future         For at least two people, Sometimes many more.   Sometimes Amanda’s did more than gently touch the colours around those she met.   When her husband was seriously ill She had to do more than touch his colours, Then she needed to instil a brand new religion, A blazing faith that life is truly worth living.   With most things she set her mind on, Amanda was a great success. But she still thought she was a lawyer. She thought she was a lawyer because she had always been wrong about what she was.   So these words are just for you Amanda.   The golden glow that wraps itself around you has nothing to do with you being a lawyer. A mixture of reds, green and blues pulsates within the gold.       It too has nothing to do with you being a lawyer. The smiling room when you enter has nothing to do with you being a lawyer. The shine wrapped around your face has nothing to do with you being a lawyer. The life jumping through your hair isn’t caused by hair product It too has nothing to do with you being a lawyer.   Your children love you but not because you are a lawyer. The flowers you plant do not sigh with relief because you are a lawyer.   The room lightens because you are a healer. Your friends tread more lightly because you are a healer. People seek out your company because they know that you are a healer. Your unborn children already love you because you are a healer.   I love you because you are my wonderful friend And also because you are a healer.                    Like everyone else, I love you because you are Amanda        Because you are special Because the universe would deeply mourn your loss if you left it.   Happy birthday to The Healer, Happy birthday to my friend who just happens to be The Healer, Happy birthday to the Beloved One

 

****

Photo above is Amanda in 2013.

Many years ago, I also wrote this poem called Light for Amanda.

LIGHT I suspect you are unaware you walk in the light every moment of your life, It surrounds you, It is part of the air you breath,   But you probably don't notice it   So let me tell you about Light.   You were welcomed by the harsh Australian sun.   Although Indifferent to young or old, It poured its essence into you, You absorbed the harsh, unblinking light You were swathed in the ever present heat blankets, In the shimmers of light and heat the Sun made itself solid on our Earth.   Looking at the Sun can be difficult, Perhaps this blurred your ability to see your own Light.       Surrounded by so much imitation light, It is difficult to distinguish it from the real thing.                   Your vision was also dimmed by other sources. The glow of Shayne and Anita’s love helped with the blur.  They knew more than the usual doting parents did.   You were special because you were their daughter But there were other things too. When Light spoke to them, it revealed and did not conceal. Shayne and Anita gave you their love And then they gave you some more. Light can have that effect on us all,   Especially when we know the truth.   Light often seems a burden. Those who populate the gloom and the black of night are frightened They fear the Light. Those who are scared often lash out. When you huddle in the shade you want to believe the Shadow World is real, That the Shadow World is something more than a wretched Huddling Place.   When you are chained to the Dark You fear the Light. Because it denies the reality of the shadows.   When the Shadow dwellers encounter Light, they lash out at its source. By trying to destroy Light They hope it will validate their inner emptiness..   Amanda, you are familiar with the attacks by the Fearful, You have sometimes blamed yourself for them. You tell yourself it must be your fault. Why else would people be so fearful?   Whenever you think this you are wrong.   This is why they are so fearful.   It is not just that you walk in Light. They are afraid because you emanate Light.   Light comes into the world through you because it has no choice. You have genuine beauty. The Light that pours out of you The Light that surrounds you, Gives shape to what is.   Your existence belies the false light of that other place, That place where hearts sink into the slime, That place that tries to convince us that life is unable to offer anything but dark, That we do not even deserve more.   You walk in Light Amanda because you have no choice. That is why you exist. Your job is to destroy the Shadow World You do that simply by living.   I love the Light. That is why I have always loved you Amanda.

 

78 It’s a Long Way from Lancashire to Here - Part 4: 1 November 2024

The photo below shows an aerial view of Fisherman’s Bend hostel.  Our hut J 3 faced the intersection of the two dirt roads.  We had a close up view of the chain link fence topped by barbed wire.  Once we climbed the fence, we were free to play in the swamps immediately in front of our hut.

                                                                   ****

 

The photo above shows the Nissen huts at Fisherman’s Bend Hostel.  We lived in hut J 3 for 4 complete years from December 1952 to December 1956.  At Fisherman’s Bend, most the “streets” were unpaved dirt, goat tracks - muddy slogs in winter and dusty ordeals in summer.

The photo above shows the inside of the hostel laundry.  I don’t know who the lady is in the photo.

****

Life at Fisherman’s Bend hostel was so very hard.  Life in Liverpool must have been ghastly if Cliff and Josey thought life in Australia was an improvement.

****

At the start of 1953, Bill started school at Saint Joseph Primary School in Port Melbourne.  I attended the Hostel “kindergarten”; it was located in one of the Hostel buildings which happened not to be a Nissen Hut.  At age 5, Bill took the bus to school unaccompanied by any designated adults.  He endured “Bubs” (now called Reception) in 1953 and started Grade 1 in 1954.  I started “Bubs” in 1954 and graduated to Grade 1 in 1955.

Saint Joseph was located on the corner of Rouse and Bay Streets, Port Melbourne, one block back from the Port Melbourne waterfront.  Saint Joseph moved to Stokes Street, Port Melbourne in the early 1960s.  Although Saint Joseph no longer exists, Saint Joseph Catholic Church is still located at Rouse Street, Port Melbourne. 

Saint Joseph was operated by the Brigidine Sisters.  The Brigidines are an order of nuns founded in Ireland.

The Brigidines running Saint Joseph Primary School in the 1950s were sadistic, cruel and heartless women.  I attended Saint Joseph’s from 1954 when I was 5 until the end of 1956 when I was 7.  Like all boys at Saint Joseph, I was often strapped with a leather strap that all the nuns had with them all the times.  Perhaps the most vicious of this bunch of extremely vicious nuns was a woman called Sister Peta.  Sister Peta was short and fat and always nasty.  Once when she strapped me, she left a welt that lasted a week.  It was shaped like a question mark, it crossed the palm of my right hand, then it crossed my wrist and ran up my forearm.  I was age 6 or 7 when Sister Peta did this. 

All the boys at Saint Joseph were treated the same way and I was not singled out for any special treatment by the nuns. 

Neither Cliff nor Josey seemed to think being viciously strapped by Sister Peta was unusual in any way.  Luckily for me, they never complained to the school about this behaviour.  My punishment by the nuns would have been much worse if they had complained.

After we left the Hostel we were taught by the Sisters of Mercy, who most definitely showed no mercy at all to any of the children they taught.  No matter how harsh the Sisters of Absolutely No Mercy were, the Brigidines were noticeably crueller.  The Brigidines made the Sisters of Mercy look as if perhaps they might perhaps have had a tiny bit of mercy in their hearts.

****

 

The number of children in the classes at Saint Joseph was huge.  This photo of the 1957 Grade 3 class contains 56 children.  All of the children in this photo were in my 1956 Grade 2 class, but the 1956 Grade 2 class was larger than the 1957 Grade 3 class.

I remember the boy who is positioned third from the right in the op row of the photo.  He was big, heavy and very aggressive.  He tried to beat me up one and I fought back.  Sister Peta strapped me as well as him.  I cannot remember the name of the little thug but I think he was from Malta.  Because I was so much smaller, he thought I would let him do what he wanted.  He misjudged me.

****

 

This photo of the 1957 Grade 2 Grade 2 class contains 65 children.  Because my classes at Saint Joseph had so many children in them, I taught myself how to read and write.  The sister wrote the alphabet across the top of the blackboard and I taught myself by writing one complete page per letter for every letter in the alphabet.  The teacher ignored me unless she felt the need to strap me.

****

Because Saint Joseph’s was a Catholic school, we all had to be taught how to be good Catholics.  I am certain neither Cliff nor Josey were asked if they wanted this to happen.  Their views – if they had any – were irrelevant.

On Friday 26 October 1956, all members of our Grade 2 class – most of the children shown in the Grade 3 class photo above - had to have their first Holy Communion.  This involved several weeks of specific instruction from the nuns on how serious the ritual was, its miraculous significance and the precise manner in which we had to accept the communion wafer.  We were forbidden from touching the communion host with our fingers.  We had a rehearsal before the big event where we had to line up in the Church, walk solemnly to the altar rail, pretend to receive communion and then go back to our Church pews.

I was fidgety while waiting in line at the rehearsal, so the nun running the rehearsal slashed me across my bare legs with the wooden handle on her feather duster.  Wearing short pants was compulsory for us at Saint Joseph, so my legs were an easy target.  I had red welts across my legs as I walked up to the altar rail to practise receiving my communion host.