Workers Compensation Fraud

It is estimated that workers compensation fraud is one of the fastest growing types of insurance fraud crime.

Dishonest claimants may:

  • fake their injuries
  • exaggerate legitimate injuries, or
  • claim for injuries that are pre-existing, or happened outside the workplace


In doing so, they might receive monetary benefits and/or time off work to which they are not actually entitled.


More complex cases

Workers compensation fraud can be complex; involving conspiracies where healthcare providers, lawyers and patients make fraudulent claims, or 'pad' legitimate claims. Supposed back injuries, soft tissue injuries, muscle strains, headaches and workplace-induced stress are popular types of claims.

Many workers compensation cheats are caught out doing second jobs, heavy home repairs, gardening or other tasks that their claimed injury would normally be expected to prevent. Other fraudsters are revealed because they can't resist boasting about "putting one over the boss" or the insurer.

However, many of these fraudulent workers compensation claims remain undetected. They continue costing us all a fortune in lost production, payments to replacement staff and other expenses. They also push up workers compensation premiums and the price of goods and services produced.

As with all insurance fraud, the pocket it ultimately hits is yours .

If you have information that you believe in good faith is insurance fraud, report it NOW!

Types of Fraud

Workers Comp

This can include employees falsely receiving benefits such as time off work, by faking injuries, exaggerating legitimate ones, claiming for pre-existing injuries or those sustained that have no relation to the workplace.

Motor Vehicle

This type of fraud takes many forms, including claiming theft in order to obtain money for an unsaleable car, or to cover up 'drink driving' accidents; staging car accidents; or vehicle arson.

Property

Goods that are unsaleable due to their poor condition, quality or lack of market demand, may also be fraudulently 'lost' or 'destroyed'. In the case of buildings and plant equipment, arson is often involved.

Arson

Insurance arson typically involves the intentional burning of insured property in order to destroy it and claim its insured value, especially when this is greater than the item's saleable value.

Life

A typical example of life insurance fraud might be a person claiming a monthly benefit - while working another job on the quiet. More extreme examples include elaborately faking deaths and disappearances for the fraudster and any accomplices to secure the payout.

Health

Fraudulent acts include healthcare or medical professionals billing for services not performed, claiming higher than actual costs, participating in the treatment of 'patients' brought in as a result of staged accidents, or carrying out unnecessary procedures.

Other

People might claim falsely for injuries relating to falls (called 'slip and fall' accidents) or other incidents where the consequences can be exaggerated.