Case Studies no. 3 – Factual Investigation

Virtual intelligence conducted a factual investigation into a worker’s compensation claim a worker had lodged as a result of sustaining an injury to her back. There was suspicions raised as to the legitimacy of this claim as it was considered the claimant may have been exaggerating the extent of her restrictions as being unfit for work and there had been speculation raised as to her working with  a family business. As a result a factual investigation was conducted to include a statement from the worker and after investigating the claimant’s employment history it was established she had in fact continued working whilst certified unfit as a cleaner for a separate company to that of the insured despite signing statutory declarations to the contrary. Utilising legal documentation we had obtained the POI employment records from this company and it confirmed the claimant had consistently worked approximately 12 hours per week over a period of  4 years and had received a total exceeding $40,000.00. As a result of this investigation the matter was referred onto WorkCover’s Fraud Department for investigation and prosecution.