Engaging in a calling fraud
Engaging in a calling fraud (EIC fraud) is when a worker receiving workers’ compensation returns to work or engages in a ‘calling’ and doesn’t tell the insurer (WorkCover Queensland or a self-insured employer) who is managing their claim about it.
A ‘calling’ includes any paid work (including employment and self-employment), unpaid work and even volunteering. It includes any activity which ordinarily results in remuneration, even if remuneration isn’t received. Examples include employment for an employer, “helping out a mate” on a jobsite, food delivery work via an app, contract or casual work or setting up a small business.
This behaviour is deemed to be fraudulent under section 535 of theWorkers’ Compensation and Rehabilitation Act 2003(the Act) because it can involve the worker "double-dipping" and/or depriving the insurer of the ability to properly manage the worker's claim, which could lead to the claim being open for longer than it would otherwise be, and/or the claimant receiving compensation they wouldn’t otherwise be entitled to.
It is not EIC fraud if a worker notifies the insurer about engaging in a calling in compliance with the Act, or where they have a reasonable excuse for not notifying the insurer about the calling.
People convicted of EIC fraud face imprisonment. They will also be ordered to repay the insurer all the compensation that was paid out during the time they were engaging in a calling, which can be thousands of dollars.
Engaging in a calling fraud in practice
In practice, engaging in a calling looks like this:
A worker is on a claim and is receiving compensation. The worker visits their doctor and they discuss whether the worker could return to work on light duties. The worker says he couldn’t possibly return to work, even on light duties, as he is still in so much pain. The doctor gives the worker a work capacity certificate which certifies the worker as unfit for all work for the next two weeks. The worker gives the certificate to the insurer so he can get paid and his claim can stay open. Secretly, the worker has actually been working full time for another employer for the past month. The worker doesn’t want to tell the doctor or insurer about that because he wants to continue to receive compensation from the insurer as well as his full time wage from his secret employment.
EIC fraud is a high-risk fraud type that represents around 60 per cent of the fraud reports received by the Workers’ Compensation Regulator.
EIC fraud costs the scheme money; over the past 5 years, almost $1.2 million has been defrauded from the scheme by workers who been convicted of EIC fraud.
What are we doing?
A joint targeted compliance program has been launched to target EIC fraud.
The Workers’ Compensation Regulator, WorkCover Queensland and Association of Self-Insured Employers Queensland are taking action to prevent, detect and respond to engaging in a calling fraud, including:
- providing strong warnings about EIC fraud and its consequence
- detecting more EIC fraud by carrying out a range of targeted detection activities
- prosecuting EIC fraud and publicising the outcomes to deter others.
What can you do?
- Understand what EIC fraud is
- Educate yourself about EIC fraud, what it is and how to avoid it
- Report EIC fraud.