Workcover insurance companies will use various fraudulent activities, these include
- inaction by insurer which contributes to fraudulent claims (1)
- obtaining medico-legal reports (such as IMEs) who have a vested interest in providing reports that favour the insurer, or lack of duty of care in not presenting medical reports that favour the injured worker (2)
- companies are able to buy self insurer status as a commercial transaction without scrutiny of good health and safety performance (3)
- pressuring an injured worker to return to work before they are ready (3)
- self insurers making it difficult for injured workers to make claims (3)
- failure of workcover insurers to assist injured worker when employer does not report injury accurately (4)
- cancellation of payments without warning (5)
- doctor shopping and collusion between insurer and doctors they appoint (6)
- delays in processing claims and allowing required surgery (6)
- accepting documents not tabled before review for injured workers to see(6)
- withholding financial entitlements (6)
- use of standover tactics or interfering with witnesses for the claimant (6)
- used video evidence that was false including cases where video was of someone other than the claimant (6)
- inconsistencies in admitting liability but only paying partial compensation (6)
- failure to advise people of their rights, providing false or misleading information and providing conflicting advice depending on which officer deals with the claim that day (6)
- claiming that the staff officer who signed a form was unaware of what they approved (6)
- providing wrong and misleading evidence to judge (6)
- possible conflict of interest between the rehabilitation provider and the insurer (6)
- failure to explain claims process to injured worker and making claimant sign papers without understanding the content (6)
- not allowing time for claimant to get specialist reports (6)
- failure to pay for services promptly making some service providers reluctant to treat injured workers
- inaction by insurers and failing to return calls when claimant asked questions (6)
- telling employers who employ claimants that their premiums will rise and that they will be audited, or outsourcing to agencies owned by WorkCover employees (7)
What I often do…
(1) Australian Industry Group, Submission No. 53, p. 10.
(2) Mr Stig Hellsing, Transcript of Evidence, 16 October 2002, pp. 44, 50.
(3) Australian Manufacturing Workers’ Union, Submission No. 35, p. 9; Dr Deborah Vallance, Australian manufacturing Workers’ Union, Transcript of Evidence, 26 November 2002, p. 375; Ms Gwyneth Regione, Australian Manufacturing Workers’ Union, Transcript of Evidence, 26 November 2002, p. 276.
(4) Ms Leah Palazzolo, Submission No. 8, p. 2
(5) Injuries Australia Ltd, Submission 27, p. 3.
(6) Injured Persons Action & Support Association, Submission No. 69, Appendix 1
(7) Mr Mark Moore-McQuillan, Submission No. 16, p. 2 and Transcript of Evidence, 21 November 2002, pp. 295, 300.