Sydney Workers Compensation Fraud Investigator

Phone 1300 966 103, email us at [email protected], or for 24/7 inquiries Contact Us, free quotes. TEXT ONLY number is 0427 703 120, office hours, for a Sydney Workers Compensation claim fraud investigation.

The Workers Compensation system usually works well where the claim has been accepted, and the insurance has moved to their rehabilitation coordinator phase, with the injured worker as the client. This system works well, for the honest injured worker. We don't see those files.

We see the other files, where the initial claim was suspect, or there is evidence of the claimant committing fraud. The employer, the business, must establish that there is a reasonable suspicion of fraud, once the claim is accepted.

Workers Compensation fraud is the receipt of Workers Compensation benefits by deception, the receipt of compensation to which the person is not entitled. It generally involves fraud, deception, by an act or omission. This includes a breach of obligations of an employee, a dishonest intent, as inferred by the surrounding circumstances.

A Sydney Workers Compensation fraud investigator is a NSW licensed private investigator, an employee of the insurance company, or an agent of the insurer; we investigate where the insurer is not willing, or is unable, to do so.

We investigate for both the privately insured, and the Government insured. Our investigations include factual investigations, as well as a Workers Compensation surveillance investigation.

The insurer is often blocked from investigating, by legislation, once a claim is accepted, unless the employer can bring evidence of fraudulent activity. We are the method of gathering that evidence.

Workers Compensation insurance is required, when you have employees, generally. Safework NSW Workers Compensation insurance is required, unless exempt. We investigate where Workers Compensation fraud is suspected, and the insurer will not engage, without evidence.

A licensed private investigator is the way to obtain evidence of Sydney Workers Compensation fraud. Evidence is required to take suspicion to a reasonable suspicion (civil level) of Workers Compensation fraud, to present to the insurance provider.

Workers Compensation fraud, also known as Sydney WorkCover fraud, is both a cost, and a risk, to business. The cost of the fraud is felt in a number of ways. The first is, when the companies claims exceed industry average, they will see a rise in their premiums.

This rise will remain for many years. The second direct cost for an ongoing claim is the cost of the subsequent civil claim/payout. This will also increase insurance costs. Claims can be used as evidence for Union actions. Fraudulent claims risk triggering other claims, as people copy the first claimant.

The signs of fraud of many. They can include the new worker with the mysterious claim. The ever changing claim. The person who gets worse, not better. The person off long term, without improvement, or with information coming to hand of other activities inconsistent with the claim, such as setting up a business, working elsewhere, or working a cash job.

The insurer generally will not accept social media posts, alone, as evidence of fraud; we can use it as the basis of a private investigation. The purpose of an investigation is to confirm or deny the suspicion of fraud, to investigate, and compare, claimed restriction with displayed real world restrictions, and to investigate compliance with medical directions, or restrictions on activity. It is the gathering of evidence.

As a Sydney Workers Compensation fraud investigator, Sydney WorkCover fraud investigator service, we conduct discreet investigations. These are generally of the surveillance type.

For effective surveillance you require a sufficient budget to learn the subject's behaviours, and to work out what is going on. It is not unusual to see long term claimants working for cash, or starting a side business. Recording these, and other, activities is beneficial to the business, in reducing exposure to excessive claims. It is rare to find fraud of such an extent as to remove all liability from the employer. Most investigations are about removing excess liability, and obtaining evidence of deception by a claimant, which may reduce employer liability.

For those on the Government Workers Compensation scheme the general allowance is a week of observation, to gather sufficient evidence to establish deception, fraud. People refer to this as a Workcover investigation, or a Workers Compensation investigation.

More correctly Workcover, Insurance and Care NSW (iCare), the State Insurance Regulatory Authority (SIRA), are names associated with the Government insurance scheme. This is further divided with other insurance companies being authorised iCare service providers. Workers Compensation is the name for the actual insurance payments. All have expanded meaning in general conversation.

This landscape becomes further complicated with the Federal ComCare workers, the privately insured who go through a broker, and those that are self insured. Each is similar, but often with different requirements.

For example a self insured business, generally a large business, of sufficient mass to cover the requirements, may have to conduct multiple periods of surveillance, over an extended period, to adduce the evidence required to protect itself from a deceptive claim, a fraudulent claim. It cannot pass its need for surveillance, for evidence, on to another.

For a business that goes through a broker, their needs fall between the two. This is especially true where the broker gets a declared kickback from a particular insurance group to direct business towards them, and the insurance provider is aiming to keep their costs low, to maximise profits, and win more bidding wars for clients.

Workers Compensation claim fraud suspicion can be met with a refusal to engage by the insurance. The employer needs more than a vague suspicion, once a claim is accepted, generally.

For the self insured it can come up against things like a person not being at their declared residence. This is often especially true of a mobile workforce, a FIFO worker, who can move on to another self insured, or a different State.

Whereas once a back injury was the prolific claim of the scammer, a mental injury has become more prominent. Particular note must be taken of any claimed restrictions related to this claim, as it is not a physical injury.

This has also become the new morphing claim, where a physical injury now becomes a mental one. You have to address evidence of the physical activities the person is capable of, when dealing with this type of claim.

This has become another area of Workers Compensation claim fraud we are now becoming familiar with. It is creeping into more and more claims.

When you suspect Workers Compensation fraud, and require a Sydney Workers Compensation investigator, a Sydney Workers Compensation fraud suspicion investigation, a WorkCover fraud investigator, a Sydney private investigator, call us.