2.8.4 Potential scheme abuse and non-compliance
2.8.4.1 Identifying potential scheme abuses | 2.8.4.2 Reporting allegations of suspected offence or non-compliance | 2.8.4.3 Termination of benefits for fraud | 2.8.4.4 Recovery of payments | 2.8.4.5 Impact of fraud on premiums
Agents are responsible for notifying WorkSafe's Enforcement Group of suspected scheme abuse or non-compliance with the legislation. WorkSafe's Enforcement Group monitors and investigates offences and breaches of the legislation by all scheme stakeholders including workers, employers and service providers.
A potential offence is identified by one of the following three main sources:
- Agents - through claim alert indicators and information gained in the management of claims.
- the Enforcement Group - through trend and data analysis and reviewing individual claims.
- allegations obtained from any other source, including employers and the public in general.
For a comprehensive list of offences, see: Offences under the Victorian workers compensation legislation.
2.8.4.1 Identifying potential scheme abuses
Agents are required to check claims for potential scheme abuse at specific times through the life of the claim.
2.8.4.2 Reporting allegations of suspected offence or non-compliance
Allegations received by Agents of suspected offences or non-compliance must be promptly reported to the Enforcement Group. The Enforcement Group will advise the Agent as to the appropriate actions. In undertaking those actions Agents must ensure that they do not hinder any possible future investigation.
For example if an allegation is received that:
- a worker is working while receiving weekly payments (based on an anonymous call), the Agent must arrange a period of surveillance to determine whether there is any foundation to the allegation, see: Allocate investigations.
Note: The Private Investigator must be instructed not to approach the worker or employer.
- an employer is failing to make weekly compensation payments in accordance with the legislation, the Agent should contact the worker and employer to ascertain if there is a genuine reason for non-payment. Detailed file notes should be made by the Agent.
Enforcement group provides advice
If there are any doubts as to what action is required, advice should be sought from the Enforcement Group.
Reasonable evidence of a suspected offence
When the Agent believes that a possible offence exists, the details regarding the circumstances which establish the suspicion of an offence must be referred by the Agent Enforcement SME to the Enforcement Group. It would assist if copies of relevant documents are attached to the referral.
A referral to the Enforcement Group is made via three main sources:
- the Enforcement Group allegations hotline on 03 4243 7132
- email to: enforcement_compensation@worksafe.vic.gov.au
- post to Compliance Investigations, Enforcement Group, DX 216086
If Agents receive direct evidence of scheme abuse or non-compliance (e.g. through a surveillance report), the Agent Enforcement SME must immediately refer the matter to WorkSafe’s Enforcement Group, ensuring all relevant documentation is included via one of the three methods listed above.
The Enforcement Group assesses the allegation and liaises with the Agent Enforcement SME about the future management of the claim.
The Agent is still responsible for managing the claim. However, ongoing consultation with the Enforcement Group is crucial.
If WorkSafe determines that an offence has been committed it may take prosecution action against the offender and seek recovery of monies obtained fraudulently.
Penalty units
Various sections of the legislation include penalties for offences for non-compliance. These penalties are specified as a number of penalty units.
The value of a penalty unit for a financial year is fixed by the Treasurer under the Monetary Units Act 2004 and published in the Government Gazette.
| Year | Value of penalty unit |
|---|---|
| 2021/22 | $181.74 |
| 2020/21 | $165.22 |
| 2019/20 | $165.22 |
| 2018/19 | $161.19 |
| 2017/18 | $158.57 |
| 2016/17 | $155.46 |
| 2015/16 | $151.67 |
| 2014/15 | $147.61 |
| 2013/14 | $144.36 |
| 2012/13 | $140.84 |
| 2011/12 | $122.14 |
| 2010/11 | $119.45 |
| 2009/10 | $116.82 |
| 2008/09 | $113.42 |
| 2007/08 | $110.12 |
| 2006/07 | $107.43 |
| 2005/06 | $104.81 |
| 2004/05 | $102.25 |
2.8.4.3 Termination of benefits for fraud
Agents can only terminate weekly payments and medical services on fraud grounds by the worker if they have authorisation from the Enforcement Group at WorkSafe.
If an Agent believes there are additional grounds for termination they must include these on the termination notice to the worker.
See: Terminating weekly payments
WorkSafe’s Enforcement Group will advise the Agent Enforcement SME in writing of any decisions to terminate for fraud.
2.8.4.4 Recovery of payments
If a person is convicted of an offence for fraud or for providing false or misleading information, payments made as a result of the offence may be recovered from the person, together with an additional sum equal to half the amount of the payments made, together with interest at the prescribed rate Interest at the prescribed rate means interest at the rate fixed for the time being under section 2 of the Penalty Interest Rates Act 1983.
When a prosecution is successful, the Court would normally order that the offender make restitution. Monies recovered by the Courts are forwarded to WorkSafe.
2.8.4.5 Impact of fraud on premiums
Employers can seek a recalculation of their premium for that part of the claim costs that was obtained fraudulently.