How to detect a workcover fraudster according to Comcare

comcare-workers-fraud

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”

workcover-fraud-exaggerated

And, folks, if that is not enough, Comcare’s own Fraud Guide clarifies “suspicious” behaviour further.

If you read the guide, it is no wonder that ALL injured workers are SUSPICIOUS and treated like criminals, before they’ve even started their workcover “process” hell!

  • 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:

SERVICE PROVIDERS

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 🙂

 

We advise all brainwashed employers (and like-minded) to read the workers compensation myths, as to gain a better understanding in the workers comp “process”

 

 

[Article dictated by Workcovervictim and manually transcribed on her behalf]



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2 Responses to “How to detect a workcover fraudster according to Comcare”

  1. So the way I read this, Comcare are advocating for employers to take on the responsibility (and risk) of prying and investigating their injured employees. Perhaps this is something that can be more easily covered up compared to the surveillance and so called “investigation” that is carried out by insurers?

    Somehow I can foresee many more FWA cases appearing if this becomes the normal practice. At what point does “careful investigation” become harrassment? Worse still, could said harrassment be dismissed as reasonable management action to determine veracity of an injury in the workplace? We’ve all seen how underhanded tactics can be used to stress out and further injure those who have already been injured at work.

    I wonder if there are any privacy concerns too, should an employer really know all the personal details of an employee’s life? Is there any guarantee that the employer will keep that information secure and maintain the employee’s privacy? Is there even any guarantee that an employer will use the information collected only for the purpose it was acquired for? (eg. We didn’t confirm that our injured worker is faking it, but we did find out she’s pregnant. Better spin up that departmental redundancy just for her!)

    As for these “special fraud trained investigators”, why does it seem like Comcare are advocating for yet another party to join the gravy-train that is Australia’s workers compensation scheme?

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  2. This is just like McCarthyism in 1950s USA, but instead of Communists, it is Injured Workers who are deemed the threat. What kind of repulsive society are we becoming where workers turn on each other all for the sake of catching the 0.05% of fraudulent injured workers? Governments reflect the people who voted for them and I am so disappointed that some will think these kind of directives are fair. It is blatantly obvious that the persecution of disabled and sick people is being encouraged by the government with support from some sections of this society. Time to make those who agree with this question whether they have any humanity at all or are just money making machines content to enrich themselves on the misery of those less fortunate.

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