19-01-2023 Townsville

Charge 1 – s 533 – fraud

Charge 2 – s 533 – attempted fraud

The worker defrauded the insurer by not disclosing that she had sustained similar injuries to her right shoulder prior to the work incident.

The worker attempted to defraud the insurer by providing a Notice of Claim for Damages that did not disclose her relevant medical history.

The worker sustained a right shoulder injury while working as a cook. She made an application for workers’ compensation which was accepted.

The worker spoke with multiple representatives of the insurer and when she was questioned if she had sustained previous injuries to the same area, she said no.

The worker was admitted for surgery to repair her work-related injury.

The worker attended two orthopaedic surgeons to assess her injury. The orthopaedic surgeons opined that the worker had a whole person impairment of 10% and 5% as a result of the work-related injury.

The insurer sent the worker a Notice of Assessment based on the medical opinions of the orthopaedic surgeons and offered the worker $17,392.00 in lump sum compensation. She received $41,724.21 in workers’ compensation during the claim period

The worker signed a Notice of Claim for Damages and served that document on the insurer. In the Notice of Claim for Damages, the worker did not disclose her previous right shoulder injury and the only previous injury the worker said she had sustained prior to her work-related injury was a hip injury.

The insurers solicitors requested the defendant provide further information about her previous medical history after discovering that she had sustained a right shoulder injury in 2015. The worker provided statutory declaration in response which claimed that she was not aware of any pre-existing right shoulder injury and that she only underwent scan of her right shoulder in 2015 due to back pain she was experiencing. She also claimed the results of the scan were never discussed with her.

A Notice to Produce Information/Documents was sent to the worker’s general practitioner who referred her for the right shoulder scan in 2015. The GP stated that his notes indicated that he had discussed the results of the scan with the worker, therefor she was aware of the injury.

A Notice to Produce Information/Documents was sent to both orthopaedic surgeons which enclosed a list of questions to be answered in relation to their assessments with the worker.

Both of the orthopaedic surgeons responded that they were not aware of the worker’s previous right shoulder injury and that their assessment of whole person impairment would have been significantly less.

Charge 1 and 2 – 15 months imprisonment wholly suspended with an operational period of 30 months.