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17-08-2017-Brisbane

Date 7 June 2017
Charges Charge One – Section 533 Workers' Compensation and Rehabilitation Act 2003 (Qld) (WCRA) – Fraud
Court Brisbane Magistrates Court
Plea Guilty
Case For failing to disclose significant pre existing conditions
Facts

On 11 June 2014 the worker allegedly sustained a back injury at work when he slipped as he walked while working as a camp manager for a mining company. The worker also claimed he suffered secondary urological and psychological injuries as a consequence of the injury. The claim was accepted on 24 June 2014 and compensation was paid to the worker for the period 12 June 2014 to 29 January 2016 in the amount of $119,347.

During the claim the worker made representations, to the insurer and various medical providers, to the effect that his previous back injuries were limited to a single back injury about 30 years ago and/or any back pain he suffered prior to the injury was not significant. Medical records revealed these representation were false because he had suffered and been treated for multiple injuries to his back and suffered significant back pain between 2006 and 2014.

The worker also made representations to the insurer and medical providers to the affect that his urological condition started after the injury. Medical records revealed the worker had been treated for a urological condition prior to the injury.

The worker also made representations to the insurer that he had never been treated for any psychological or psychiatric or mental health condition. The medical records obtained revealed the worker had been treated for mental health issues prior to the injury.

It was considered that the worker knowingly made false and misleading representations about previous health issues and/or did not disclose previous health issues where disclosure was clearly required and therefore received compensation to which he was not entitled.

A complaint and summons was filed on 28 November 2016 with three charges for each fraud however later combined as one charge only.

Penalty 18 months whole suspended for an operational period of 3 years.
Restitution $98,818.87 (less $70,000.00 paid on the day, leaves balance $28,818.87)
Costs $7,500.00 - Workers Compensation Regulators Costs
Common Law rights extinguished? Yes
Conviction Recorded
Consideration for Prevention A worker should not provide false and misleading information to an insurer and/or medical practitioners about any relevant pre existing condition they may have so a reasonable assessment can be made on the claim and benefits can be paid for the work related injury only.