REPORT FRAUD

The Insurance Commission has a zero tolerance approach to fraudulent activities and will pursue those engaged in fraud or attempts to defraud. The following case studies present examples of successful outcomes of fraud prosecutions.

CRASH INJURY FRAUD

Claimed $1451.30... fined $1945.35 including costs

In 2016, a claimant was involved in a car accident and claimed a total incapacity to return to work. Surveillance footage obtained showed the claimant working on two separate occasions in March 2017.

On  22 June 2017, the claimant submitted a Past Loss of Earning Capacity (PLEC) request for an advanced payment from 28/02/2017 to 11/04/2017, stating that he had not worked during this period. His settlement offer also mentioned this same period of alleged incapacity.

Payslips obtained and a witness statement confirmed that the claimant had returned to work on 27 March 2017. The claimant attempted to obtain a total of $1451.30 net compensation from the Insurance Commission he was not entitled to, for period 27/03/2017 to 11/04/2017.

The claimant pleaded guilty to providing false or misleading information and was fined $1,000 and $945.35 costs.

Fined $3000 plus costs

A claimant alleged to have suffered from severe depression, with associated neck, low back and total body pain after being in two car crashes on 30 April 2015 and 7 March 2016. Surveillance footage of the claimant over 7 days between 09/11/2016 and 05/06/2017 showed that the claimant had a physical capacity contrary to their claim.

The claimant pleaded guilty to providing false or misleading information to a medical specialist and was fined $3,000 and ordered to pay $2,044 costs.

Read more examples of FALSELY DECLARING AN INABILITY TO WORK

WORKERS COMPENSATION FRAUD

Failure to disclose a return to work

A claimant working as a clinical nurse at a public WA Hospital lodged a workers’ compensation claim after a workplace injury. Prior to the injury, the claimant was also employed part time at a nursing home.

The claimant received compensation to cover his wages from 2010 to 2012 and top-up payments for his second job. While receiving loss of wages payments from the Insurance Commission, the claimant returned to employment at the nursing home, allegedly defrauding the Insurance Commission by failing to declare his employment. During medical assessments, the claimant also failed to disclose his work.

A Fraud Investigations enquiry revealed the claimant was overpaid $112,175 in compensation payments. The claimant was charged with Fraud by Western Australia Police and civil recovery action commenced to recover overpayments.

Referred to Corruption and Crime Commission

In 2012 a prison officer, was struck in his lower back by a large metal object. He reported the incident to his employer but only sought medical treatment a week later due to a gradual increase of pain over that period. The claimant responded well to treatment and was deemed fit to return to work, undertaking modified duties.

In 2013, the claimant’s injury recurred and he submitted a medical certificate to the Insurance Commission from another company. The Insurance Commission nor the employer were aware of the secondary employment.

In 2013, Fraud Investigations conducted surveillance of the claimant participating in a surfing competition despite claiming to be unfit for work due to his recurring back injury. The claimant resigned when presented the evidence. Fraud Investigations referred the matter to the Corruption and Crime Commission due to suspected dishonesty by a public officer and to WorkCover WA to investigate alleged breaches to the Workers Compensation and Injury Management Act 1981.

SERVICE PROVIDER FRAUD

In 2009, a nurse providing care to a catastrophically injured claimant, billed the Insurance Commission for services that were not provided, as did her husband. The nurse's husband was found guilty of eight counts of fraud and fined $1000. The nurse pleaded guilty to fraud charges, was given a two-year intensive supervision order and required to pay back nearly $20,000.