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Workers Compensation Claims | Workers Compensation Claims

Is it a crime to work? A case study of WorkCover fraud

On the advice of Mullins, WorkCover Queensland referred a worker pursuing a common law damages claim to the Workers’ Compensation Regulator (the Regulator) for fraud. Recently the worker pleaded guilty to several offences, received a conviction and deferred prison sentence, and was ordered to repay significant costs to both WorkCover Queensland and the Regulator.

The worker, the subject of the fraud referral, claimed to have suffered psychiatric injuries over a lengthy period in 2016. Amongst the numerous (innocuous) causes of the injury, the Claimant alleged various workers had used the worker’s surname instead of given name and rolled their eyes while the worker was talking.

The worker lodged an Application for Compensation with WorkCover Queensland in 2016, and received weekly compensation payments until mid-2017. The worker submitted medical certificates deeming him unable to work in any capacity until late-June 2017. In early July 2017, the worker informed WorkCover Queensland that he had obtained employment with a friend. The statutory claim was finalised in early-2018.

In June 2018 the worker pursued a damages claim against his employer, and our firm was appointed to assist.

During the course of our investigations, we obtained GP records that referred to the worker returning to work while in receipt of compensation payments. We obtained taxation records identifying this undisclosed employer, and obtained records from that employer. Those records revealed the worker had returned to work in mid-March 2017, and had continued to work throughout the course of his statutory claim.

Sections 533 to 537 of the Workers’ Compensation and Rehabilitation Act 2003 sets out various fraud provisions, which provide that it is an offence for workers to:

  • fail to notify the insurer of a return to work;
  • engage in a calling (defined as activity ordinarily giving rise to pay or reward) while in receipt of compensation payments without notifying the insurer (fraud); or
  • provide false or misleading information to an insurer, the Workers’ Compensation Regulator or another “registered person” (including a treating doctor providing medical certificates).

On the advice of Mullins, WorkCover Queensland referred the matter to the Regulator.

The Regulator pursued a prosecution of the worker.

In early 2020 the worker pleaded guilty to fraud, failing to notify of engagement in a calling and numerous charges of providing false and misleading information, and received a conviction. The consequences of the conviction involved a prison sentence (suspended for a period) and an order for costs. The worker’s entitlement to pursue a common law damages claim was also extinguished.

The workers’ compensation scheme in Queensland is important in protecting the rights of workers and ensuring that those injured at work are compensated fairly and adequately for their injuries. However, the scheme is funded by employers, and for that reason it is important to ensure that access to the scheme is limited to workers that are legitimately in need of assistance.

This case serves as a reminder to all parties involved in the scheme that insurers and solicitors are constantly monitoring claims for evidence of fraud, and will in appropriate circumstances, ensure that those seeking to unfairly take advantage of the scheme will be prosecuted. This case also serves as a reminder:

  1. To workers - that fraudulent or misleading conduct will be identified and prosecuted by insurers;
  2. To insurers - that thorough and detailed investigations need to be carried out with respect to all claims;
  3. To employers - that information about an injured worker returning to work or engaging in fraudulent conduct (whether through formal or informal channels) needs to be passed to the workers’ compensation insurer.

Article written by Tony Rosenthal (Partner) and David Isaac (Associate).

 

"The content of this publication is for reference purposes only. It is current at the date of publication. This content does not constitute legal advice and should not be relied upon as such. Legal advice about your specific circumstances should always be obtained before taking any action based on this publication."