According to a recent article there has been a significant increase in complaints in relation to workers compensation claims fraud. Fraudulent claims include claiming for a non-work related injuries, failure to declare information, altering medical certificates, etc. The recent conviction of a fraudulent worker highlights the emphasis placed on legitimate claims.

 Increasing Workers Claim Fraud – According to the recent Sydney Morning Herald article (The Dodgy Side of Workers’ Comp) there has been a 15% increase in fraudulent workers compensation claims.

Examples of worker fraud can include:

  • claiming for an injury that didn’t occur at work
  • failure to notify of return to work or change in income
  • non-disclosure of multiple claims relating to the same injury
  • false or overstated travel and/or expense claims
  • falsifying medical certificates
  • supplying false or misleading information in relation to a claim

It is crucial for employers to verify all information when receiving notifications of claims and inform State Insurance Regulatory Authority (SIRA) or their claims agent ASAP if there are indications that fraud has been committed.

SIRA’s review, assessment and investigation process includes:

  • the gathering of additional factual and background information after receiving notification of the suspected fraud
  • the examination of the allegations by an assessment committee
  • a full investigation where there is an indication that the offence may have been committed
  • investigation techniques include taking of witness statements, surveillance, issuing of notices to obtain documents and other evidence, and the execution of search warrants
  • where there is sufficient evidence to prosecute, the matter will be submitted to our Legal Services for consideration and advice
  • In some instances where insufficient evidence is uncovered to criminally prosecute a matter in court, costs might be recovered through civil action.

Just last month SIRA successfully prosecuted a man who lodged a fraudulent claim in 2014 alleging he sustained a back injury due to repeated shovelling at a construction workplace in 2007.

The offender acted in conjunction with an acquaintance who was part of the fraud, he had never worked for the company he claimed he’d been injured at, nor has he ever worked in construction

The claim cost the system $24,258, of which the worker received $4,500.

The man was convicted and sentenced to a suspended 10 month prison term, ordered to pay back the $4,500 within 28 days and to pay prosecutor and professional costs within the same period.

If you suspect there is fraud involved in a workers compensation claim lodged against your company, contact us to assist minimise the business, people and financial impacts to your business.

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