Responding to fraud in Queensland employees’ compensation scheme

Fraud can and will occur in the world of workers’ compensation insurance. Three of the most recent charges show the seriousness of Queensland’s compensation policy fraud.

Fraud can and will occur in the world of workers’ compensation as it does in other areas of life.

Three of the most recent charges show the seriousness of Queensland’s compensation policy fraud.

Recent lawsuits against incapacity pension

Case 1:

On July 14, 2021, a 23-year-old worker was found guilty of 29 fraud allegations related to false claims for reimbursement of travel expenses for medical appointments.

The worker was sentenced to five months in prison (fully suspended), sentenced to repay $ 5,863.13 to WorkCover, and to pay prosecutor’s expenses of $ 23,908. A conviction was recorded for each charge.

Case 2:

On July 22, 2021, a 33-year-old worker was found guilty of fraud. The worker was charged with attempted fraud after filing a common law damages lawsuit alleging that he suffered persistent symptoms as a result of a back injury.

The monitoring of the worker clearly showed that the worker was exaggerating his symptoms and functional skills in the damage report.

The worker was sentenced to six months’ imprisonment (fully suspended) and lost his entitlement to continue his common law damage claim of $ 750,000. A conviction was recorded and the worker was sentenced to pay prosecution charges of US $ 28,330.17.

Case 3:

On August 12, 2021, a 47-year-old worker filed a plea of ​​fraud, one failure to report an appeal, and five charges of false or misleading information. The worker was charged with these offenses after resuming work while receiving compensation.

The worker was sentenced to two years’ imprisonment, suspended after six months of actual detention. They were also sentenced to $ 228,774.43 in reparation and sentenced.

What does the law say

The Workers’ Compensation and Rehabilitation Act 2003 (the Act) contains provisions on fraudulent offenses. These apply to everyone involved with WorkCover, including employees / applicants, employers, service providers and others.

Fraud or attempting to defraud WorkCover is punishable by a maximum penalty of five years in prison or 500 units of punishment (currently equivalent to US $ 68,925).

The main fraud provision is contained in Section 533 (1) of the Act, which states that “no person may in any way defraud or attempt to defraud an insurer”. It is important to note that this provision applies to both attempted and fraudulent acts against WorkCover.

Recognize fraud

Suspected fraudulent activity (including attempts) will be alerted to WorkCover in a number of ways including, but not limited to:

– Fraud reports submitted online through the WorkSafe website;

– Telephone calls to WorkCover (from both anonymous and non-anonymous callers);

– Notification of a person or entity involved in or related to a claim, or

– An anomaly or anomaly discovered by WorkCover in the normal course of business.

WorkCover’s duty to report to the Employee Compensation Regulatory Authority

WorkCover is required by law to immediately notify WorkCover Regulatory Services (WCRS) of a reasonable assumption regarding a natural or legal person who is defrauding or attempting to defraud WorkCover

WorkCover has its own internal investigation process when we are made aware of suspected fraudulent activity to ensure that only genuine fraud reports or attempts at fraud are forwarded to WCRS.

Actions taken by workers’ compensation regulators

If further investigation by the WCRS shows that there is sufficient evidence of fraud or attempted fraud, it may support a recommendation to the compensation regulator for criminal prosecution.

In the 2019/20 financial year, the workers’ compensation agency received 66 referrals for investigations, initiated 25 proceedings and successfully closed 12 cases.

It is important to note that even when fraudulent referrals are investigated but not prosecuted, action is still being taken to combat dishonest behavior (e.g.

This may result in WorkCover reviewing the employee’s current compensation entitlements and deciding to terminate, suspend, or reduce the entitlement.

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