Injured worker fraud least costly of all workers compensation fraud


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

Workcover Fraud

If this article were a Poll, for example:

Which type of workers’ compensation fraud is the most expensive?

  1. Employee (injured worker) fraud, such as malingering or faking an injury.
  2. Unsure.
  3. Healthcare fraud, such as duplicate or overbilling.
  4. Employer fraud, such as misclassification of employees.
I would NOT have been able to answer your poll as, in my humble and injured opinion, the most serious and costly fraud is left out of the available answers. That would be number 5.
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.

As they said in the old days. “The jig is up Gentlemen.” In other words, you – the workcover insurance companies- are caught red handed denying claims that lead to the injured workers’ deaths. Only a matter of time before you are all behind bars.

Have a nice day.


[Post dictated by workcovervictim and transcribed on behalf of workcovervictim]



9 Responses to “Injured worker fraud least costly of all workers compensation fraud”

  1. That’s a good idea to make a formal complaint to the medical board.
    This unethical and unprofessional behaviour of some IME’s has to stop.

    Labeling a person, especially a health care prossional can have dire consequences for their career. The psychological damage is also profound. No wonder injuried workers have adjustment disorders.

    When I asked my caseworker for a second opinion she laughed and said they were an insurance company and do not offer a ‘doctor shopping service’. According to her I am not entitled to second opinion and what the IME says, goes.

    I will keep all the receipts, appeal to QComp, whom will hopefully see through Workcovers behaviour. I am based in QLD.

    Trinity, I can so sense your frustration, it’s like a slap in the face and being called a liar. The clever report writing tries to make out its either a normal degenerative process, or that the MRI report is irrelevant. Good luck with the next IME.

  2. Thanks Hunting Workcover and Helping hand,

    Your advise was really helpful. Appreciate you taking the time to write.

    I looked up the concillation process, so will appeal workcover’s decision. I have started collecting my medical records from prior treating docs, they all charge $50 admin fee then photocoping charges. As if we can afford it.The only people not to charge was Workcover!

    I sold some furniture so I could go to see a specialist. He was actually totally amazing and so helpful. I was upfront with him, that I have been labeled as having abnormal illness behaviour. He told me this is a regular label that IME’s love to use and knew of the one I was refered too. He called him a Dinosaur who charges $2500 for each report.

    He looked at MRI, was shocked to see the extend of the injury and said it can be fixed. This is all I ever wanted.
    I telephoned Workcover, of course they were not interested as case is closed. This Dr even telephoned Workcover to tell them I needed surgery.

    Thank you for welcoming me to the family.

  3. I recently had a IME, they reported I had abnormal illness behaviour as there was no pathological cause for my symptoms.

    The irony is that I have had two MRI’s showing internal degrangement, have had surgery which has not worked, a blood test showing high levels of inflamation, other specialist reports saying my prognosis for recovery and return to work is poor. Etc etc…

    The result is: Workcover terminated all treatments, will not pay for pain relief, stopped my weekly payments, and given 0 % permanent impairment rating.

    I will not be able to return to my pre injuries employment, something I spent years training for and passionately enjoyed.

    I will try not to sink further into depression, but this is easier said than done when I cannot afford the antidepressant and anagesia medications anymore.
    I do admit to past feelings like my life insurance would be more beneficial to my family.

    I feel freaked out that I can no longer work.
    I am not entitled to Centrelink.
    I am selling whatever I can around the house. Homelessness looms, my beloved dog will need to be rehomed.

    All because a IME Dr wanted to appease the hand that feeds him.

    My only glimmer of hope is this website, I know I am not alone in this nightmare, that Workcover is an insurance company and doesnt care about people, just monetary outcomes.

    So I try not to take the biased IME’s and behaviour of Workcover too personally.

    The advise on this site has kept me going on more than one occasion.

    Thank you everyone for sharing your thoughts, feelings and knowledge.
    I will be not a victim of Workcover but a survivor.


    • IME’s doctors are known among many of us injured workers to be rubbish, liars and cheats! i don’t know your entire story, however is it work related?(your here on this website so im assuming its work related). Even if its not work related, you are entitled to centerlink. you may come under compensation ( a module C form you may need ). this all comes under disability pension section.

      Some forms you should request immediately:
      –Claim for Disability Support Pension or Sickness Allowance.
      –Income and Assets.
      –Authorising a person or organisation to enquire or act on your behalf.
      ( Husband/Wife/Mum/Dad/Sister/Brother/Relative)
      –Proof of bank balance
      (print off your bank balance)
      — Identification (Drivers License etc.)
      –Your Medical evidence is required. ( not the IME garbage! )

      – please note: centerlink (& staff) are related to workcover, there are some storys out there that center treats injured workers / disabled people in inhumane ways. just be careful when dealing with them. document everything! its best to speak to the manager (if possible).

      keep positive

      • @Cloudjuice – hell no, you’re not alone, welcome to our big injured and ill-treated family!
        I don’t know in which state you reside, but remember that you can and should appeal any decision taken by the workcover insurer. I.e in Vic you simply lodge a conciliation. Many injured workers have successfully won their cases at conciliation (or appeal in other states). If you have evidence of your injury (as seems the case) and your treating doctors support that (in writing) you will have a very good chance at winning, and have your workcover benefits reinstated.
        However whilst this gets sorted (may take months) you may need to push for centrelink benefits, or get access to your superannuation (on grounds of hardship).
        I hope you have a lawyer! If not, now is the time to get one – start by getting a free 1st consultation with a reputable no win no fee law firm!
        Stay in touch!

    • Where these insurance companies get the gall to use some of these IME reports and label them as gospel is beyond me. Only this week I saw an IME that stated the inured worker didn’t have disc bulges on their MRI and yet the the MRI clearly stated two disc buldges. Then he proceeded to claim the Worker showed no evidence of a chronic pain condition. Well a specialist report was suck under his nose and ignored. Not even mentioned in the reports received list. Then he claimed there was no oblivious evidence of that condition. Well when you sit on you fat backside and don’t examine the patient there isn’t any evidence. Hey bozo! You didn’t look! Yet oh so clever was the wording of this report. As a nurse I felt this IME was having a lend of this worker. So now this worker is going to see another IME at the cost of Workcover. Now who screwed the corporation in this scenario. The worker or the IME? Who playing the elitist games? Protecting each other’s backsides then heading off of a victim blaming party? Guessed it people. Those who are screwing the system and the injured worker.

      • @Trinny – this is insane indeed! I would write a complaint to the medical board and submit the biased IME’s report together with the hard medical evidence (i.e. MRI, CT, etc) of that poor injured worker! This is really unacceptable and nothing short of malpractice, negligence and endangering the life of that injured person. Eough is enough and such illegal practices MUST be reported to the Board for the sake to protect other (future) patients/injured workers.

        This story makes me SICK.

  4. yes they have committed murder, we have had a person here who hung him self off the work cover building.

    christine mckenzie September 20, 2013 at 6:42 pm