There have been some recent, publicized prosecutions for Worker’s Compensation fraud, and it’s important to note that there is no identifiable pattern of fraudulent activities. The watchful eye of the investigations team will take action on any number of different activities from making false claims for travel reimbursement or other expenses, exaggerating symptoms and failing to notify the insurer of ‘engaging in a calling’, or attending work, or work type activities – even if those activities are voluntary.
A recent case was reported in Townsville where a former Security Guard pleaded guilty to eight fraud related charges when he was receiving Workers’ Compensation benefits for an injury whilst working at Bunnings. The worker claimed that he didn’t think he needed to tell the insurer because he was of the opinion that the work he was doing was “rehabilitation”. The worker received more than $20,000.00 in benefits from WorkCover Queensland, however was paid a total of $4,429.00 during his employment. He had also reported to doctors that he wasn’t able to work, despite having worked in the days prior to the medical appointments. As if this wasn’t bad enough, the lies continued when he was confronted about the work and said that he had only worked two shifts, despite having worked for several months. As a result of his actions, he was ordered to pay almost $30,000.00 restitution which included court fees and investigation costs. A conviction was also recorded. For more on this story click here.
Had the worker simply told WorkCover Queensland he had been offered work, or wanted to give the work a go whilst he was engaging in his rehabilitation, he would not have found himself wrapped up in a criminal prosecution. WorkCover Queensland would have adjusted his benefits accordingly, but he is now significantly out of pocket and left with a conviction for a dishonesty offence.
A fraud conviction has long lasting consequences. Employers may be reluctant to retain or hire an employee who has been found to be dishonest, even obtaining personal insurances will be difficult – a car insurer will be hesitant, if at all willing to extend an insurance policy to a person who has been convicted of a dishonesty offence.
Whilst I can’t comment on the particulars of the above matter, I have previously acted for clients who have found themselves in some hot water with insurers, or where we’ve found out that someone is about to be in hot water with an insurer. It puts us as legal representatives in a very difficult position, as this is where our duties conflict, and the usual consequence is that we can no longer act on that person’s behalf. There have been occasions where a client has been genuinely injured, yet a poor decision on their part has resulted in the loss of a claim. There are of course some who will brazenly be dishonest.
When dealing with WorkCover, it is important to always keep them up to date with what is happening, report new symptoms, or difficulties with a return to work program. If you feel up to returning to work, or engaging in some work type activities, make sure you discuss this with your claims officer. Always follow the advice of your medical practitioners, and, if you are encountering any difficulties with WorkCover or the claims process and just want to have a chat about any concerns, our office is always ready to have a chat.
Honesty will always remain the best policy.