We’ve said it a million times, the most important thing is to be honest about your injury, condition, restriction(s), to be yourself at all times, to be aware that you will likely be under some form of surveillance at some stage during the life of your claim. We have also pointed out on numerous occasions, that countless (if not – the majority of) genuinely injured workers are “routinely” accused of “fraud” or “exaggeration” of false accusations, leaving these injured workers in utter poverty, bewildered and having to resort to Courts to clear their name(s) and have their weekly payments and other workcover entitlements reinstated.
Whilst the majority of workcover fraud is committed by employers, service providers and, of course workcover itself,millions of dollars are wastefully spent every year by workcover authorities and insurers on injured workers’ fraud, in the hope of hopes to nab the (less than) 1% of employee fraudsters and to slander our injuries all over the media, portraying us all as fraudsters, system milkers and malingerers.
We normally and deliberately never publish the odd case of employee workcover fraud, however a recent case of injured worker’s fraud caught our attention. Not so much because of the fraud committed (and please don’t get us wrong, we condemn all forms of fraud), but because, and perhaps hilariously-
What’s perhaps more disturbing is how the surveillance was conducted….
Nurse injury smelled fishy to workcover – workcover surveillance smells fishy to us
Nurse’s injury smelled fishy to WorkCover
A little lie and an elaborate spy cam investigation have cost a Gold Coast nurse more than $26,000.
M was ruled medically unfit for work in 2011 after injuring her thumb while working as a hospital pathology assistant.
But during her recovery she was secretly filmed serving up fish and chips at a Runaway Bay takeaway shop.
WorkCover claimed M scammed $4018.12 in overpayments and they spent more than $3800 on hiring a private investigator to prove it.
In a two-week undercover operation a private investigator posed as a customer and used a spy camera concealed in a keyless entry remote for a car to film M working at The Funky Fish Inn at Runaway Bay.
When confronted by a WorkCover customer adviser in December 2011 she said the business was bought in her name but was run by her husband.
During a trial in the Southport Magistrates Court, investigator Peter Jennings played hours of covert footage showing M using her injured hand to serve customers from the counter, to hand out parcels of chips and lift heavy grocery bags.
M, also known by (taken out), initially pleaded not guilty to fraud and providing false information to a government body, arguing she had been helping out but not officially working.
But on Monday she pleaded guilty in the Southport Magistrates Court this week to the two charges.
WorkCover barrister Ben McMillan initially called for a hefty fine, restitution and $23,000 in compensation to cover legal and investigation costs.
But barrister Chris Rosser said the penalty could bankrupt or send the mother of four to jail as she was already juggling a business loan and a mortgage on a nurse’s wage.
“For the court to award those costs would put her in a diabolical situation,” he said.
Magistrate John Costanzo exercised his discretion and ordered her to pay a scaled down version of costs.
He fined her $5000, ordered her to repay the $4018.12 and a combined $17,159.94 in investigation and legal costs.
He referred all the penalties to SPER and reminded her she could apply to have her fine converted to community service if needed.
A little more about of Workcover Fraud
Workcover insurance premium fraud (or employer) is a much more serious problem. Not only is it illegal, it adversely affects the bottom lines of producers and carriers, and leads to higher insurance premiums for honest businesses
As we’ve mentioned before, there are three basic types of premium fraud: under-reporting payroll, mis-classification of employees, and experience modification evasion.
Under-reporting of payroll occurs when a policyholder fails to accurately report their entire work staff to the insurance company, often by paying employees off the books or presenting employees as sub-contractors or independent contractors versus actual employees of the company.
The second type is the mis-classification of employees. For example, when a high-risk employee, such as a construction worker, is classified as a person with low-risk clerical duties, a company will pay less in workers’ compensation premiums.
The third type of premium fraud is experience modification evasion. This occurs when a company closes, then attempts to re-emerge as a new company on paper in order to obtain a lower experience modification factor, but the new business is actually unchanged from the original business.
Common warning signs that business owners are attempting to commit workcover fraud:
- The business address is a mail drop or the business is physically located in another part of the state from its mailing address.
- A prior workcover insurance carrier has dropped coverage for the business or the business has frequently changed carriers/agents
- Reported injuries not consistent with purported job titles or duties.
- There is an unusual ratio of clerical to non-clerical staff for the type of business.
- The business avoids audits or has never been audited.
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