Returning to the oh-so-irritable topic of injured workers (employees) fraud, fact is that many “media” websites and news papers, magazines (i.e Tabloids), and even WorkCover Authorities and their insurer Agents website’s and at time even politician’s “media releases” always seem to portray, fuss about, exaggerate or even rank injured worker fraud as the top costliest, vilest and most rampant fraud in workers’ compensation system.
Though stories of employee fraud are publicised frequently by insurance companies and their allies, two other types of workcover fraud – employer and healthcare or provider fraud – cost the system way more… but is very seldom published.Actually, no, there are three other types of workcover fraud – employer, provider and workcover fraud.
Injured worker fraud least costly of all workers compensation fraud
Injured worker fraud
Employee or injured worker fraud is pretty simple because the way the workcover system works has not changed dramatically over the many years. We’ve always seen the occasional problem with the false claim, the individual who is feigning injury to extend out the benefits, but these account for less that 1% of ALL the workcover fraud that is going on within the workers compensation system. The one that is seen most frequently is what is call “double dipping”, or the working and drawing workcover benefits. That’s people going back to work and not notifying the workcover insurer that they are going back to work and drawing benefits (be it medical treatment or pay) while they’re doing it. Most of the time it is because they are not aware they need to formally notify their insurer (hell I didn’t know myself after my 1st return to work) and /or rely on their employer to notify the insurer they are back at work (and to what capacity/degree). Remember also that there is a hell of paperwork (and bureaucracy) involved in the workcover process and if you are not good in English well… who can blame you?
As for those who are accused of “feigning” or exaggerating, many are also overturned in court! (We have published quite a few such a legal cases). Unfortunately the Media, Workcover Authorities, insurers and even some politicians like to make statements alleging some injured worker is guilty without proof and without the assumption of innocence before proven guilty!
In addition to that fraud committed by injured workers does tend to be the lowest dollar fraud from the perspective of the workcover insurers or authority. That means maybe $2000, $3000. You’ll see it higher than that at times, but it’s not unusual to see a $2000, $3000 fraud. Big deal.
Employer Fraud and Provider Fraud
On the other hand, Employer fraud and service provider fraud is much more rampant, high dollar, and much harder to detect. There is also less incentive to eliminate such fraud as a result of the structure of the various workcover schemes.
Employer fraud (and provider fraud) is also seldom reported in the media, even though they account for the majority of workcover fraud.
You can read more about employer fraud here: Employer workcover fraud is rampant, under-reported and considered theft
If this article were a Poll, for example:
Which type of workers’ compensation fraud is the most expensive?
- Employee (injured worker) fraud, such as malingering or faking an injury.
- Healthcare fraud, such as duplicate or overbilling.
- Employer fraud, such as misclassification of employees.
“Insurance fraud called “lowballing” committed by the workcover insurer to avoid paying legitimate medical and financial claims.”
That one, injured( and future injured) ladies and gentlemen would be my/our choice. And it would, undoubtedly be the choice of hundreds of thousands of injured Australians who have been forced onto Centrelink, welfare, Salvos, whatever, have lost their possessions and savings, have committed suicide or died of a heart attack, stroke, or ulcers brought on by psychologically abusive treatment, appeals processes, combined with severe Chronic Pain, debilitating injuries and the indignities of having been forced by the workcover insurers’ criminal activity into a state of absolute poverty.
It is a pattern the workcover insurers exhibit in denying the most serious injury claims, whether the claim itself or needed medical and like treatment, weekly pay, claims in which you, the insurer, already know the injured worker is totally disabled from employment. Ask the tens of thousands of injured workers in each State in Australia. Read the stories on this site!
The evidence is overwhelming and you, the workcover insurers are denying claims at an ever increasing rate leading directly to the increased taxation, social programs such as food banks, a drain on available public resources, no recovery for the injured workers, and in general dumping your most costly claims onto society at large.
All the while you, the insurance companies, enjoy exorbitant salaries, have billions in the bank, collect bonuses as a percentage of denied claims, and by doing so have caused the death of thousands of injured workers in Australia.
Have a nice day.
[Post dictated by workcovervictim and transcribed on behalf of workcovervictim]
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