The untold story about workcover insurance fraud

Injured at work

Whilst it is true that there are some, very rare cases of people who would seek to abuse the workcover system, almost all injured workers who file a claim for workers’ compensation benefits are legitimately hurt and in need of assistance to address the costs and financial losses incurred by an on the job accident.

Why on earth would a person even consider Workers’ Compensation fraud?

Let’s be honest here, an “injured” worker who attempts to file a fraudulent or false claim for workers compensation does not stand to gain much at all financially. He or she will receive much less income than under normal work circumstances, and after a while will be at starvation point and in debt! On top of that the person will have to constantly deal with ongoing harassment from workcover, denials for treatment and ‘benefits’ and will be sent to one IME after another – hardly a holiday I’d say! Hell, I’d give just about anything to GET OFF workcover!

 

Besides the the way workcover insurance companies treat your claim (fraudulent even if genuine) I’d be surprised if one could really get away with a false “injury”. Remember that you not only need valid medical certificates of (in) capacity, but you also need proof and lots of evidence that you have an injury, such as x-rays, CT or MRI’s. And then the greedy insurance company will in any case do everything possible to deny your claim in the first place and sent you to the most corrupt (independent) medical examiners – I mean these doctors are paid to down-play and cover-up your injury. I reckon it’s not possible to make a fraudulent claim in the first instance.

I do believe, however, that some weird, sick people may try to exaggerate their symptoms/injury to get more “impairment assessment %” and thus a little more “compensation” and this is fraud and a CRIME. And it is perhaps because of these, very few cases, that all of us, genuinely injured people, get treated like criminals and fraudsters.

Why on earth would a workcover insurance company NOT consider fraud?

On the other hand, workers’ compensation insurance companies, and even employers have a multitude of reasons to engage in this deceptive practice or fraud. The profitability of workcover insurance companies, for example, depends upon taking in as much money as possible through premiums and issuing only minimum benefit payments. As a result they will aggressively look for any opportunity to deny a claim or to reduce their liability. And as for the employers, they may be saddled with higher premiums if their workers file claims.

 

 

Because there is so little open discussion about the fraudulent actions perpetrated by workers’ compensation insurance companies and employers, it may not be obvious which deed could constitute such a violation. The following are some representative examples of workers’ compensation fraud:

  • Failure to carry the insurance coverage required by state and federal law
  • Intentionally misrepresenting an employee’s date of hire or other information, yes, even the extent and/or circumstances surrounding the injury
  • Denial of benefits without cause or valid cause
  • Allowing “bribes” to influence the assignment of chosen healthcare providers
  • Delayed payment of benefits



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3 Responses to “The untold story about workcover insurance fraud”

  1. When you say:

    “Because there is so little open discussion about the fraudulent actions perpetrated by workers’ compensation insurance companies and employers, it may not be obvious which deed could constitute such a violation.”

    I think you hit the nail on the head.

    Right across Australia workers compensation authorities are afraid and embarrassed to admit fraud by the insurers they award the scheme contracts to. These things are dealt with internally, on a secret basis.

    They concentrate on releasing information about worker fraud, but never, not once have I heard an authority make an accusation of fraud against an insurer. Why is that? It is surely not because they don’t engage in fraud – we all know they do.

    People, if you have an example of employer or insurer fraud, we need to see that information. The individuals and companies involved must be exposed. Those in an insurance team all know who the “go to” person is on their team – the one that will use dubious (or even illegals) means to close off a difficult claim.

    Let’s expose them!

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    Let's expose them! September 23, 2011 at 12:25 pm
    • Thanks for your great comment! Isn’t it interesting that many companies (especially large ones) change workcover insurance regularly…For example,I worked for 10 years in a large hospital in Melbourne and they changed from Allianz to Xchanging and I heard they are now changing again. Why would that be you think?

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      • I think that disputes aside, the main and probably only reason they change, is that they received a cheaper quote.

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