Nurse injury smelled fishy to workcover – workcover surveillance smells fishy to us

something-fishy-workocver

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-

workcover spent more than $3800 on hiring a private investigator to prove the injured worker’s fraud committed of $4018.12.

What’s perhaps more disturbing is how the surveillance was conducted….

” 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”

Nurse injury smelled fishy to workcover – workcover surveillance smells fishy to us

Nurse’s injury smelled fishy to WorkCover

Leah Fineran   |  12:01am October 3, 2013 | Goldcoast news

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.

However, he ordered no convictions be recorded.

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:

  1. The business address is a mail drop or the business is physically located in another part of the state from its mailing address.
  2. A prior workcover insurance carrier has dropped coverage for the business or the business has frequently changed carriers/agents
  3. Reported injuries not consistent with purported job titles or duties.
  4. There is an unusual ratio of clerical to non-clerical staff for the type of business.
  5. The business avoids audits or has never been audited.

Read more: Injured worker fraud least costly of all workers compensation fraud



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7 Responses to “Nurse injury smelled fishy to workcover – workcover surveillance smells fishy to us”

  1. One has to Ask oneself who is actually privileged to get the honours of doing this work- cover surveillance????

    I met a lawyer once who told me that he or she get the surveillance jobs! Suprise Suprise….do the pieces of the puzzle start falling together now???

    Looks like it is just a big circle of friends that have each others hands in each others pockets and if you try to join the circle they will play kick the pebble with you until your out and away again.

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    ........................ October 9, 2013 at 3:29 pm
    • Actually lawyers can’t do surveillance because they are not licensed. The surveillance operator is a trained, professional, impartial observer and recorder. If they are ever found to have entrapped a subject they can lose their license – so they never risk it

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  2. goldie

    “The surveillance operator is a trained, professional, impartial observer and recorder”

    They may have been trained that way but none of them follow the rules.

    Further entrapment laws do not exist in Australia.
    I cant stand PI’s to me they are the lowest form of human. They are licenced peeping toms.
    Who knows what they do with pictures of their targets and targets children.

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  3. the insurers use the same investigation firms for each job and bounce back and forth between one or two. They call them “panel investigators”. It is the investigators job to find you doing anything and everything they can including playing with your kids or having a coffee with fiends. I have caught a surveillance operator once when i was IN CHURCH.

    Let me assure you they may say that they are independent and impartial however as human beings; they are not. No matter what they write, it is THEIR opinion they provide to the insurer along with THEIR choice of footage and photos. Just the same as the independent medical examiners. Almost every Judge in the state of Victoria almost immediatley throws out of Court any surveillance because for most injuries if people are more active it is usually because we have taken pain relief before we have gone out or may have just had treatment and are feeling more mobile. Surveillance cannot prove anything other than you were feeling a little better that day (unless you are pretending to be brain dead and then show up on camera doing cartwheels).

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    • As a side note; most of the surveillance report are always negative towards the injured worker as the insurer pays a minimum of $5000 per investigation and if they don’t get a good report, they wont use the firm again. Given there is a limited number of firms and a limited number of insurers, it is competitive and everyone wants their “piece of the pie”.

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      • backpsych101 well said and so true.
        they are in it to catch you doing something and when they don’t they usually write reports to say that perhaps not this occasion but on another occasion footage may show something else. this way they plant a seed in to the insurer so that they re hire them. it is after the second or third time that the Pi is hired that they get more desperate and will be very selective with their footage and wording in their reports.
        They are scum that prey on the vulnerable and cause even more damage to the injured. Injured become more paranoid distrusting and isolated as a result of surveillance.

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  4. Pray you get the bumbling David M[censored] as your PI

    heard of the keystone cops? or the three stooges?

    lol dave you provided me with hours of amusement and you came up with jack shit

    I,d bet you never told your employer you were compromised so many times

    well doofus they can see it here in perpetuity 🙂

    see you on your next stakeout or on you tube?

    as they say dave ” there is no fool like an old fool”

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