|Date||29 June 2017|
Charge One – Section 533 Workers' Compensation and Rehabilitation Act 2003 (Qld) (WCRA) – Fraud
Charge Two - Four – Section 534(2) – False or misleading statements
|Court||Proserpine Magistrates Court|
|Case||For exaggeration of symptoms|
On 15 September 2014, the worker filed an application for compensation claiming he had been electrocuted injuring his right hand while at his workplace at a tavern on 14 September 2014. The insurer accepted the claim on 7 October 2014 and made compensation payments from 22 September 2014 until the claim ended 11 May 2015.
Throughout the claim the worker had conversations with the insurer and various medical providers claiming his right hand was a claw and that he was unable to open it normally.
A report of a physiotherapist dated 26 February 2015 stated that in her opinion she has noted 'unusual presentations' and that the worker gave different descriptions of his symptoms over various consultations. The physiotherapist later observed the worker shopping and noticed no restrictions whatsoever and advised the insurer of same.
Surveillance was undertaken and found the worker sailing his yacht and using his right hand in a normal fashion. The footage was shown to one Neurologist who opined that the level of activity was inconsistent with the worker's presentation to him.
The worker attended another Neurologist on 6 May 2015 who opined that the worker's presentation was most unusual and she was of the opinion the worker was deliberately holding his hand in a fixed claw position. He also told the Doctor that he was unable to sail since the injury as he could not pull on the sheets or operate the winch. The Doctor opined that there was no genuine neurological dystonic disorder and the physical signs were 'voluntary, deliberate and not permanent' and the claim was ceased on this basis that the worker was 'over-presenting'.
The worker knowingly and intentionally provided false and misleading information about his injury to the insurer in order to further his claim for compensation. The insurer was therefore deprived of the opportunity to properly assess the worker because of his dishonesty and as a result the claim was accepted and continued for approximately eight months.
A complaint was filed in the Proserpine Magistrates Court on or around 2 March 2016 charging the worker with exaggeration and for providing false and misleading information to the insurer.
|Penalty||The worker was sentenced to 18 months wholly suspended for two years for fraud and six months concurrent for each of the false or misleading charges, also wholly suspended for two years|
|Costs||$20,000.00 - Workers Compensation Regulators Costs|
|Common Law rights extinguished?||Yes|
|Consideration for Prevention|
A worker should be honest about his/her symptoms and capacity to work when speaking to the insurer and/or medical practitioners.