VIC - WorkSafe Stops Frauds Gaming Compensation System

Original article published by WorkSafe Victoria

WorkSafe investigators have prevented almost $37 million being syphoned from Victoria’s workers compensation scheme by fraud in the past four years.

While the vast majority of people use the scheme for legitimate support for themselves and their families as they recover from a workplace injury, a small minority attempt to game the system for their own benefit.

Investigators halted 23 fraudulent claims with a combined projected lifetime cost to the workers compensation scheme of $19.47 million in the 2021-22 financial year.

WorkSafe Director Investigations Peter Collins said computer-based analytics and data matching were playing an increasing role in exposing those lining their pockets at the expense of injured workers.

“Tools for detecting workers compensation fraud are becoming increasingly sophisticated, making it easier to identify suspect patterns of behaviour and claim types,” Mr Collins said.

“Anyone attempting this kind of fraud should know that WorkSafe has developed and deployed new techniques, meaning we will find you, we will catch you and we won’t hesitate to prosecute you.”

WorkSafe investigators using data analytics were able to link one claim with previous fraudulent work injury claims lodged in NSW that had led to an arrest warrant being issued in that state.

As a result the 65-year-old accused was arrested in Victoria, extradited to NSW and sentenced to more than four years prison.

Since 1 July 2018, WorkSafe has completed 65 successful fraud prosecutions, resulting in more than $1.65 million in restitution and repayments.

In the majority of those cases the accused was found to be earning income at the same time as claiming compensation, including one offender who was sentenced to nine months prison after fraudulently obtaining more than $112,000 in payments while working.

Before launching any prosecution, WorkSafe can immediately terminate compensation payments where there is sufficient evidence that they have been obtained fraudulently.

Thirteen fraudulent claims with a combined projected lifetime cost of $3.98 million were terminated in 2020-21; eight, worth $3 million, were halted in 2019-20; and 23 claims, valued at $8.65 million, were terminated in 2018-19.

WorkSafe Executive Director Insurance Roger Arnold said funds that would have been stolen had those frauds gone undetected were now helping genuinely injured workers.

“WorkSafe is here to provide for the lost wages and medical expenses of people who are injured at work and those who defraud the scheme are taking resources intended for some of the most vulnerable people in our community.”

‍