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Workers compensation fraud

There are different types of workers compensation fraud and different ways you can report it. Once we have become aware of fraud we can and do carry out investigations, and prosecute in some situations.

Workers compensation fraud can include:

Employer fraud

Employers can be investigated and prosecuted for workers compensation fraud.

Some examples of employer fraud include:

  • failing to take out workers compensation insurance and then lying about it
  • conspiring with a worker to support a false claim
  • supplying false information to obtain or renew a policy
  • falsifying documents like a certificate of currency
  • deliberate underestimation of wages or worker numbers
  • failure to pass on workers compensation benefits, and
  • working with others to supply false documents to support any aspect of a claim.

It may indicate fraud if an employer supplies, or asks a worker or health practitioner to supply, false or misleading information in relation to their business or any aspect of a claim.

This might include things such as:

  • overstating wages
  • advising a place of injury different from the actual place of injury.

Fraud indicators may not conclusively establish the existence of fraud. Further investigation may be required to determine if fraud exists.

Worker fraud

Workers can be investigated and prosecuted for fraud.

There are different types of worker fraud. Examples may  include:

  • claiming for an injury that didn't occur at work
  • failure to notify of return to work or change in income
  • non-disclosure of multiple claims relating to the same injury
  • false or overstated travel and/or expense claims
  • falsifying medical certificates
  • supplying false or misleading information in relation to a claim.

It may indicate fraud if:

  • the worker's descriptions of the incident conflicts with medical findings or the circumstances described do not fit the type of injury received
  • the worker delays reporting the claim without reasonable explanation.

Fraud indicators may not conclusively establish the existence of fraud. Further investigation may be required to determine if fraud has occurred.

Health professional fraud

Health professionals (and other service providers) in the workers compensation industry may commit fraud.

Examples include:

  • knowingly billing for consultations that didn't occur
  • billing for services that weren’t provided
  • providing false or misleading information on a medical certificate or other documents
  • providing receipts for individual consultations when group rehabilitation has occurred
  • requesting a worker to sign more than one certificate of capacity for one consultation.

Fraud indicators may not conclusively establish the existence of fraud. Further investigation may be required to determine if fraud has occurred.

Other fraud

Fraud is not always restricted to people directly involved in a claim or policy.

Fraud could be committed against the workers compensation system by someone indirectly involved in the claim.

Examples can include:

  • spouse or friend of a worker or employer (e.g. a spouse or partner) knowingly submits a false document on behalf of a worker,
  • a witness to an alleged work related injury (e.g. a co-worker) makes a false statement supporting a fraudulent claim,
  • staff involved in administering the system (e.g. internal fraud).

These indicators of fraud are investigated and prosecuted in the same manner as any other fraud allegation.

How we investigate

We investigate allegations of workers compensation fraud by:

  • gathering additional facts and background information
  • conducting an investigation where there is evidence that an offence may have been committed.

Penalties

Fraud on the workers compensation scheme may be prosecuted as an offence under a number of laws including:

Report workers compensation fraud

Workers compensation fraud can be reported by:

  • calling our Customer Service Centre on 13 10 50
  • sending an email to contact@sira.nsw.gov.au
  • writing to Compliance, Investigations & Prosecutions, Locked Bag 2906, Lisarow NSW 2252