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Brisbane, 19 December 2016

Date

19 December 2016

Charges

One charge of fraud

One charge of failing to notify the insurer of engagement in a calling

Three charges of false or misleading information or documents

Court

Brisbane

Magistrate

Terry Gardiner

Plea

Guilty (to all charges)

Case

For returning to work and failing to notify the insurer and making false and misleading statements to the insurer

Facts

On 17 July 2012 the worker lodged an application for compensation with the insurer for a stress related injury which he allegedly sustained on 16 July 2012. The claim was accepted on 17 August 2012 and compensation was paid from 17 July 2012 until 18 May 2015, with benefits totalling $241,608.00. The worker was diagnosed with a major depressive disorder and was certified totally unfit for any work during the entire claim.

Towards the end of the claim period, the employer advised they had information the worker was working as a chaplain at a State High School. Records were then obtained from the employer showing the worker had in fact returned to work over two periods of work the first commencing 7 July 2014 to 12 December 2014 at a state high school and the second between 18 October 2014 and 24 June 2015 another state high school.

Additional investigations revealed the worker also had been working as a casual bus driver from 19 October 2012 to 12 September 2014. The worker also failed to disclose this work to the insurer.

Penalty

15 months imprisonment, wholly suspended after serving 2 months in custody and 3 months each wholly suspended for the false and misleading charges, to be served concurrently

Restitution

$223,006.26

Costs

$8,575.68

Conviction

Recorded

Consideration for Prevention

A worker should notify the insurer if they engage in a calling. That is, they should notify the insurer if they perform any activity giving rise to the receipt of remuneration or reward including self-employment or the performance of an occupation, trade, profession, or carrying on of a business, whether or not the person performing the activity received remuneration.

A worker should be honest about his/her symptoms and capacity to work when speaking to the insurer and/or medical practitioners. This includes the worker's capacity to perform work which is different to the work they were performing when they injured themselves.

If the worker believes they are able to engage in another calling (i.e. not the employment at which they injured themselves) then the worker should notify the insurer. If the insurer has a true understanding of the worker's capacity then they can properly manage the worker's claim.

It may be possible to arrange for the worker to engage in the alternate calling under a host employment arrangement. This allows the worker to perform the alternate calling while still receiving weekly benefits.

Alternatively, if the worker notifies the insurer that they intend to engage in an alternate calling then they may not be entitled to receive weekly benefits, but they might be entitled to receive compensation for medical and rehabilitation expenses.

Last updated
07 March 2017

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