Spotlight on workers’ compensation fraud
Best practice
Understand what workers’ compensation fraud looks like and alert your insurer if you suspect it.
When insurers have evidence that fraud may have occurred, they must report it to Workers’ Compensation Regulatory Services for further investigation and possible prosecution.
Why it's important
Workers’ compensation fraud is a crime.
Fraud means increased costs to the workers’ compensation scheme and premiums for employers.
Understanding workers’ compensation fraud
Fraud is when someone obtains a benefit they’re not entitled to by being dishonest or deceptive.
Fraud can be committed by workers, employers and providers.
| Examples of fraud | ||
|---|---|---|
| Workers | Employers | Service providers |
| Claiming for an injury that didn’t happen at work. | Failing to take out workers’ compensation insurance when they know they need to. | Billing for services that didn’t occur. |
| Working during their claim and hiding it. | Conspiring with a worker to support a false claim. | Providing false or misleading information on medical certificates or other documents. |
| Lying about how serious their injury is. | Lying about a worker’s injury. | Conspiring with a worker to support a false claim. |
| Falsifying medical certificates or other documents. | Falsifying documents such as a certificate of currency. | Purposefully providing services that aren’t required. |
| Hiding relevant and recent pre-existing medical injuries or conditions. | Deliberately under‑reporting wages or worker numbers for a reduced premium. | |
| Failing to pass on compensation payments. | ||
| Working with others to provide false documents. | ||
What actions can I take now?
- Support your worker by making sure they are aware of their obligations. Most workers do the right thing but if you suspect fraud, you must tell your insurer.
- You must have appropriate workers’ compensation insurance.
- Be honest with your insurer, including about the number of workers you employ and the amount of wages you pay.
- Understand your obligations to report suspected fraud.
Your toolkit
- Report suspected fraud
- Learn more about workers’ compensation fraud and other prosecution outcomes.
- Read about the recent prosecution of a Gladstone worker who was sentenced for defrauding WorkCover. He pretended to be a physiotherapist and provided treatment updates to WorkCover to extend his claim.
He also fraudulently claimed reimbursement for travel and other expenses and provided false medical certificates to the insurer.
He will serve three months of his 12-month sentence in custody and was also ordered to pay WorkCover back the $11,410.48 he fraudulently obtained.