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
Employers must verify claim details and report suspected fraud to SIRA or their claims agent. Steps include gathering background information, committee review, and full investigation if offences are indicated. Methods involve witness statements, surveillance, document notices, evidence collection, and search warrants. With sufficient evidence, cases go to Legal Services for prosecution; if not, costs may be recovered through civil action.
SIRA recently prosecuted a man for a fraudulent 2014 claim of a 2007 construction injury. He had never worked in construction or for the company. The fraud cost $24,258, with $4,500 paid to him. He received a suspended 10?month sentence and must repay $4,500 plus costs within 28 days.a
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