According to Comcare, employers can decrease their premiums provided they too take measures to “eliminate” (rampant) injured workers’ fraud! These “measures” include checking injured workers’ social media pages!
Comcare is now dangling the carrot on the stick to employers, by promising (a potential for) decreased premiums provided they “eliminate” workers comp faudsters; explaining that he premium that employers pay is based on both their claims experience and the claims experience of all employers in that ‘premium pool. If there is (surely) injured worker fraud, it is adding to workers’ compensation premiums, which are basically funds “that could be better used to meet the employer’s business objectives.”
According to Comcare, injured workers take advantage of the workcover system by, for example, working another job without telling their employer or their workcover insurer, or by pretending to be more incapacitated than they really are. Some are even taking part in sports or even home renovations!
How to detect a workcover fraudster
Comcare states factors that (could) point to injured workers’ compensation fraud, and which should definitely prompt an employer investigation, include the following:
- an injured worker who reports an injury late
- an injured sod, suffering an injury that relates to a pre-existing condition
- an injured worker who suffers an injury just before retirement
- an injured worker who develops secondary conditions
- an injured sod who has more than 1 (active) claim
- an injured worker who has had a previously rejected workcover claim
- an injured sod who changes doctor(s) / treaters regularly
- an injured worker who travels for medical treatment
- an injured worker who suffers from a (more) severe injury after a ‘minor” incident
- an injured sod who engages a lawyer early on in the workcover “process”
And, folks, if that is not enough, Comcare’s own Fraud Guide clarifies “suspicious” behaviour further.
- missing medical or rehabilitation appointments (or frequently being late)
- avoiding calls
- providing false information or becoming aggressive when discussing a claims issue (intimidating case managers)
- lodging partially complete or unsigned forms
- unusual sounds in the background when talking to the worker on the phone (for example, sounds that may indicate working, renovating, looking after children)
- being vague or changing stories when questioned on statements or agreed actions (for example, how and when their injury was sustained)
- their clothing when they are observed (work clothes, sports clothes, overalls)
- discussing activities performed while on holiday, at birthday celebrations and so on, that are inconsistent with their purported level of incapacity (carefully listening to what they say during such conversations)
- changing doctors over the period of incapacity
- not answering calls during the day without explanation
- moving interstate
- using an intermediary to communicate information regarding their condition
- receiving information from work colleagues about the worker’s recent activities which are not consistent with their purported level of incapacity
- their web presence (Facebook, Google+) discussing activities not consistent with their purported level of incapacity or indicating they are earning income from other sources
- the worker is observed with a trailer on their vehicle or bike racks (surfboard!)
- receiving information that the (injured)worker is receiving income from other sources
- long-term mental health claims after previous rejections
- not looking you in the eye when they talk to you.
Worthwhile noting is that while for example employer fraud is the most costly of all types of workers comp fraud, there is not a single word mentioned about it on the Comcare Fraud Guide. But at least they mention 2 little— ridiculous— tips regarding service provider fraud:
Suspicious behaviour may include:
- long-term frequent treatments with no sustained benefit
- avoiding calls to discuss rehabilitation progress.
Whats also interesting is that Comcare warns employers to proceed with caution when acting on (all those) suspicions, as the employer’s “actions” “may impact the ability of future investigations to secure necessary evidence”. It is much better to “talk to a special fraud trained investigator”, who will help the employer to “better target” their “actions”.
“Professional investigators have access to knowledge and equipment that can provide the evidence required for a conviction.”
Comcare also urges employers to encourage their workers “to speak out” when they notice “suspicious behaviour” (of an injured worker). And of course, Comcare urges employers to snoop in their worker’s social media pages as they “”often provide some insight” into their lives and what they might be doing when they are absent with injuries.”
You can report workers’ compensation fraud here: http://www.comcare.gov.au/the_scheme/fraud/reporting_fraud—And we urge you to report suspicious behaviour on the part of Comcare (insurer and their staff), your employer and rehabbers for starters 🙂
[Article dictated by Workcovervictim and manually transcribed on her behalf]