21 April 2017
Charge One – Section 533 Workers' Compensation and Rehabilitation Act 2003 (Qld) (WCRA) – Fraud
The worker was charged for dishonesty describing the cause of the workers' injury to a workers' compensation insurer.
In December 2015 the defendant allegedly sustained injuries which included a black eye, a cut to her head, a sprained right wrist and a concussion. The defendant lodged an Application for Compensation form with the insurer detailing that she was involved in a car accident on her way to work.
The insurer requested documentation from the defendant regarding the road assistance callout on the day of this accident to verify the claim. The next day, the defendant provided a photo of a road assistance document which stated that RACQ responded to a callout regarding the defendant's car.
The day the road assistance document was received from the defendant, the insurer accepted the claim.
As a result the worker knowingly made dishonest representations to the insurer and registered persons during the claim. The insurer was deprived of the opportunity to make a properly informed decision based on all of the relevant information about whether to accept and/or continue to pay the worker compensation.
As a result, the worker obtained a benefit from the insurer (by way of compensation paid to her or on her behalf) that she was not entitled to.
The total amount of compensation paid during the offence period was $3,253.63 (i.e. this was the “amount of the fraud”).
$6,000.00 (Workers Compensation Regulator's costs)
|Consideration for Prevention|
A worker should not provide false and misleading information/documents to claim for compensation for which they may not otherwise be entitled to.