Complete Corporate Services (CCS) have conducted thousands of Workcover and workers compensation investigations, developing a large skill base and experience in this area, including specialist factual, intelligence and surveillance skills.
Many workers necessarily are forced onto Workcover payments after they are injured during the course of their work, and or during journeys to and from work. The Workcover mandatory insurance scheme protects workers from losing income whilst they recuperate and are fit for work again.
All claims are carefully assessed by claims managers as to their validity. In some instances, investigators are appointed either by Workcover itself or by Employers to investigate the validity of claims or extent of injury.
WorkCover is a term used in Australia to refer to a system of laws, policies, and procedures that provide financial and other support to workers who are injured on the job or become ill as a result of their work. WorkCover typically includes provisions for workers' compensation insurance, which provides financial benefits to workers who are unable to work due to a workplace injury or illness. WorkCover may also include provisions for rehabilitation and return to work support, as well as support for workers who are permanently disabled due to a workplace injury or illness. The specific details of WorkCover vary from state to state within Australia.WorkCover is a government owned statutory body, providing workers' compensation insurance to employers. It is mandatory for all employers to hold a workers' compensation accident insurance policy. If you are an employee, you are covered by your employers' workers' compensation insurance policy.
In Australia, WorkCover and workers' compensation are similar in that they both provide financial and other support to workers who are injured on the job or become ill as a result of their work. However, the specific terms and details of these programs can vary from one jurisdiction to another within Australia.
In general, WorkCover refers to the system of laws, policies, and procedures that provide support to workers who are injured or become ill due to their work, and this system may include provisions for workers' compensation insurance. Workers' compensation, on the other hand, refers specifically to the financial benefits provided to workers who are unable to work due to a workplace injury or illness.
It is important to note that the specific details of WorkCover and workers' compensation programs can vary depending on the state or territory in which a worker is located. It is recommended that workers consult the WorkCover or workers' compensation program in their specific jurisdiction for more information on the specific terms and benefits available to them.
WorkCover fraud refers to the act of intentionally providing false or misleading information in order to obtain WorkCover benefits or to avoid paying WorkCover premiums. WorkCover fraud can be committed by workers who claim to have suffered a workplace injury or illness when they have not, or by employers who fail to report workplace injuries or illnesses or who provide false information in order to avoid paying WorkCover premiums. WorkCover fraud is a serious offense and can result in criminal charges and fines, as well as the loss of WorkCover benefits.
Unfortunately, a small number of employees take advantage of the Workcover insurance scheme by making claims for injury that are not legitimate. Some examples include:
This could be an injury that occurred during exercise or other activity during private time and not related to work.Of concern is the increase in the number of work-related psychological injury claims that are not work related by have been sustained as a result of events in a worker's private life.For example, a marriage breakdown, poor finances, and or drug and alcohol abuse.
In jobs that involve manual labor, for example concreating, bricklaying, and tiling it is common for workers to carry old work or non-work-related injury or degenerative illnesses.Such injury may make it difficult for the worker to perform his or her duties and subsequently they unlawfully claim that these injuries have occurred during their current working environments.
Examples can be a sore back or neck with a representation that these injuries occurred during work activity, when they did not.There has been a growth in psychological injury claims that are without foundation.
Probably one of the largest areas of Workcover fraud occurs when workers extend the time that they are on Workcover and are paid benefits when they are fit to return to work.The worker will convince medical practitioners that they are still carrying an injury, are not fit for work and continue to avoid work, whilst on full pay.In some instances, workers have managed to stay on Workcover leave for years longer than required, until exposed through investigation.The instance of this type of fraud is prevalent in psychological injury claims.
A large area of Workcover fraud occurs when either a worker forges and produces a medical certificate that is in fact false, or alternatively obtains a certificate from a medical practitioner who is prepared to support a claim by the worker, without real medical evidence of injury.This certificate is then relied upon by Workcover to continue to provide benefits to the worker, who is not entitled to such.
A number of employers will hear on the grape vines that an injured worker is performing work whilst on sick leave.Often those employers will want investigation undertaken into this.This is often common amongst trades persons, who have the ability to gain referral work through their own networks or social media.
This is common. An example may be an injured mechanic on Workcover leave is serving vehicles for payment in his home garage.
Private investigators (PIs) are used to carry out WorkCover investigations. Investigations are one of the tools that may be used in the claims management process.
They assist to:
WorkCover authorises a number of investigator providers as the only firms who can carry out WorkCover investigations.
Employers must not exert influence in the claim's investigation process.
Employers are entitled to instruct their own investigators.
Registered PIs must comply with WorkCover's Code of Practice for Private Investigators as a condition of their registration.The Code introduces a common set of high conduct and quality standards that have to be accepted and adhered to by any existing or new registered investigator before they are eligible to be allocated WorkCover work.
WorkCover and Employers request circumstance investigations to determine the facts surrounding an injury for which a workers' compensation claim has been made. These investigations are also referred to as ‘factual investigations.
Circumstance or factual investigations are often arranged to:
Factual investigations assist in the determination of liability and contribution.
The report could include the following:
Surveillance investigations are a claims management tool used by Agents to discreetly determine a worker's activities and capabilities.
Surveillance should only be used if:
In performing surveillance activities, Private Investigators are bound by the Information Privacy Principles set out in the Information Privacy Act 2000.
In Australia, the laws governing workers' compensation, also known as work cover, vary by state and territory. However, the general principles of the laws are similar.
In general, workers' compensation laws require employers to have insurance to cover the costs of workers who are injured on the job or develop a work-related illness. These laws also provide benefits to workers and their families in the event of a work-related injury or illness, including medical treatment, lost wages, and other types of financial assistance.
Each state and territory in Australia has its own workers' compensation authority, which is responsible for administering the laws and providing assistance to workers and employers. The specific benefits and coverage provided under the laws can vary by state or territory, so it is important to check the laws in your specific location.
Here is a summary of the main points of the workers' compensation laws in each state and territory in Australia:
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Complete Corporate Services (CCS) is an Australian-based company which specialises in a range of business support services.
CCS is directed and managed by Scott Sattler, who has over a decade of Risk Management, Investigation, and other business related experience. With over three (3) decades of other experience, our management team has more years of experience than any other known competitor.