17-04-2023 Caloundra

Charge 1 - Fraud
Charges 2, 3, 4, 6 & 7 – False or misleading statement
Charge 5 – Failure to notify of engagement in a calling

Guilty

The worker signed an employment contract with another employer while certified totally incapacitated for work. Following this, the worker made several false or misleading statements about their search for alternative employment to the insurer.

The worker then commenced this new employment, performing the same hours and duties as their pre-injury employment. The worker failed to notify the insurer of this work within 10 business days (or at all) and made several false or misleading statements to the insurer and a medical practitioner about their capacity for, and engagement in, a return to work.

On 20 July 2021, the worker sustained a psychological injury at their employment after they were threatened by a colleague. The worker was employed as a dump truck driver.

On 5 August 2021, the worker made an application for workers’ compensation. The following day, they withdrew their claim. On 19 August 2021, the worker recommenced the claim. They signed an acknowledgement that they would disclose a return to calling.

On or about 28 October 2021, the claim was accepted by the insurer.

On 4 November 2021, the worker signed an employment contract with a new employer which noted an expected start date of 13 December 2021.

On 15 November 2021, the worker spoke with a representative of the insurer and enquired what would happen if they secured another job. The worker was advised that they could resign from their current job and commence at another job, however, if they were fully cleared for work, their claim would be finalised.

On 25 November 2021, the worker advised the insurer they were looking for alternative employment and would notify the insurer once they do this.

On 7 December 2021, the insurer advised the worker their pre-injury employer was looking to return them to work at an alternative work site. The worker said they were still searching for alternative employment but that this was proving difficult given the time of year.

On 13 December 2021, the worker commenced full-time employment with a new employer as a dump truck and water cart operator.

On 6 January 2022, the worker attended upon a General Practitioner for the purpose of furthering their claim for compensation. During that consultation, the worker said they did not want to continue working for their pre-injury employer and they did not feel comfortable working full hours. As a result a workers’ compensation medical certificate was issued indicating the worker only had capacity to perform half of their usual work hours.

On 7 January 2022, the worker telephoned the insurer and asked, “If I was to get another job, can I just close my claim?”. The worker was advised that medical expenses would continue but their wage payments would likely stop. The worker was instructed to let the insurer know “if you do secure another job so we can advise then”.

On 19 January 2022, a representative of the insurer telephoned the worker to discuss return to work options. The insurer had previously made several unsuccessful attempts to contact the worker. The worker said they had been interstate, leaving on 9 January 2022 and had only just returned. The worker said they had attended a funeral during this time. This is untrue as the payslips from their new employment show that they worked between the pay period of 8 January 2022 to 21 January 2022 in Queensland.

During the same telephone call, the worker said that they didn’t want to participate in host employment and was going to move interstate to be with their family. They said they did not want to participate in the upcoming Medical Assessment Tribunal. They were told that their claim would close. The worker’s claim closed on 19 January 2022.

Payslips obtained from the worker’s new employment reveal that from 13 December 2021 to 21 January 2022, they earned $11,718.03 in gross wages while also in receipt of compensation.

Between the date the worker engaged in the calling on 13 December 2021 and the closure of their claim on 19 January 2022, they dishonestly obtained $11,121.31 in compensation from the insurer.

The worker entered early pleas of guilty to all charges.

Prior to sentencing, the worker repaid the insurer $10,314.91.

A global fine in the amount of $2,500.00

A worker must disclose any work undertaken during their claim and must not make any false or misleading statements about their capacity for, or engagement in, work.