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Criminal Law » Fraud / Dishonesty Offences » Workers Compensation Fraud

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Workers Compensation Fraud

In NSW, employers have an obligation to obtain insurance to cover injured workers. In turn, employees may receive financial support if they are eligible for compensation. If, however, a person is fraudulent or falsifies a claim they may be held criminally responsible.

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Fraud on Workers Compensation Scheme

Under section 235A of the Workplace Injury Management and Workers Compensation Act 1998 (NSW), a person may be committing an offence if they obtain or attempt to obtain a financial advantage under the workers compensation scheme, by deception. This may be for the benefit of themselves or someone else.

What is deception?

Deception can be any words or other conduct including making a statement or producing a document, whether in relation to a matter of fact or law, that is false or misleading.

Penalties

This offence can be dealt with summarily in the Local Court or the District Court.

If the matter is dealt with in the Local Court, the maximum fine is $22,000 and/or 2 years imprisonment. If the matter is dealt with in the District Court, the fine can be up to $55,000 and/or 2 years imprisonment.

False Claims 

Under section 235C of the Workplace Injury Management and Workers Compensation Act 1998 (NSW), a person must not make a statement knowing that it is false or misleading in:

  1. a claim, or
  2. a medical certificate or other document relating to a claim; or
  3. furnishing information related to a claim.

This includes statements verified by a statutory declaration. Making a false statutory declaration can lead to further charges.

Penalties

The penalty for this offence can be a fine of up $55,000 and/or 2 years imprisonment.

Investigating fraudulent or false claims

The State Insurance Regulatory Authority has a number of investigative powers that may affect employees, employers and insurers.

Powers of Entry

An inspector of the State Insurance Regulatory Authority may:

  • Enter any premises, at any reasonable hour, if they know or suspect it to be used by an employer or insurer including for storage or custody of records;
  • Require an employer, insurer or any other person on the premises to produce any records in their possession or within their control to produce; and
  • Require an employer or insurer to answer questions in relation to an injury or incapacity of a worker, business or financial position of an insurer or the observance of the legislative requirements.

A person must not:

  • Refuse or fail to allow an inspector to enter premises;
  • Wilfully obstruct or delay an inspector when exercising any powers; or
  • Unreasonably refuse or fail to produce a record or statement or answer a question asked by an inspector.

Doing so can result in a fine of $11,000.

An inspector can also apply for a search warrant.

Power to obtain information

An inspector also has the power to issue a notice on a person they believe to be capable of giving information, producing documents or giving evidence in relation to a contravention of the legislative requirements. An inspector may require a person to:

  • Give an inspector, in writing, any information of which they have knowledge;
  • Produce any documents; or
  • Appear before an inspector to give evidence orally or in writing.

Failing to comply without reasonable excuse or providing false or misleading material can result in a fine of $11,000.