CTP fraud

Magistrates Court: Maroochydore

Charges

1 x attempt to deliberately mislead an insurer.

Facts

Claimant was employed at the time of the motor vehicle accident as an aged care personal carer, and had a pre-existing lower back injury which had previously been the subject of a WorkCover claim. The claimant’s offending was committed over a period of 19 months, with four false representations made on five occasions. These false representations related to the claimant’s injuries (specifically aggravators, assistance required, abilities/capacities and inability to raise their arms above their shoulders). Surveillance and other evidence established that no injuries were sustained from the motor vehicle accident and that any symptoms that the claimant suffered were related to the previous lower back injury.

Sentence

Four months imprisonment (wholly suspended for 12 months) + costs of $12,888. Conviction recorded.

Magistrates Court: Brisbane

Charges

1 x attempt to deliberately mislead an insurer.

Facts

Claimant’s vehicle was involved in a fatal collision with a pedestrian. The claimant made various false representations during the course of their CTP claim that they were the passenger in the vehicle driven by their partner and had themselves suffered injuries during the collision.  During the subsequent investigations, it was established that the claimant was in fact the driver of the vehicle which meant they had no entitlement to compensation under a CTP claim. The basis of the claim was a deliberate attempt to mislead the CTP insurer because, at that time, the claimant knew that they were the responsible driver.

Sentence

240 hours of unpaid community service + costs of $7,750. Conviction recorded.

Magistrates Court: Southport

Charges

1 x attempt to deliberately mislead an insurer.

Facts

Following lodgement of a CTP claim, a self-employed shopkeeper claimed that they were unable to work in their pre-accident role, had reduced work hours and was significantly restricted in their ability to perform manual work. Various false representations were made to that effect during the course of the CTP claim process. Surveillance footage taken over 13 separate occasions established that the claimant had fully recovered from their injuries, had no work restrictions, no need for future treatment and suffered no permanent disability.

Sentence

Four months imprisonment (wholly suspended for 12 months) + costs of $9,837. No conviction recorded.

Magistrates Court: Brisbane

Charges

1 x attempt to deliberately mislead an insurer.

Facts

Claimant was employed as a casual cleaner and made several false/misleading statements (including to medical professionals) during the progress of their CTP claim to the effect that they had not been able to return to work following the motor vehicle accident. With surveillance footage and the assistance of the claimant’s employer, it was established that the claimant had returned to work shortly after the accident and had continued to work since up to 20 hours per week. The claimant had previously asked their employer not to disclose this to the CTP insurer.

Sentence

240 hours of unpaid community service + costs of $8,873. Conviction recorded.

Magistrates Court: Brisbane

Charges

1 x attempt to deliberately mislead an insurer.

Facts

A Brisbane motor vehicle dealer lodged a CTP claim alleging that they were unable to work, or work fulltime and was forced to close their motor vehicle sales business because of a neck and shoulder strain and prolapsed disc injury sustained in a motor vehicle accident. Subsequent surveillance evidence captured the claimant working during the alleged period of incapacity, working more than the claimed number of hours and performing ‘hands on’ duties, all the while lacking any severe restriction associated with their alleged injuries.

Sentence

Four months imprisonment (wholly suspended for 12 months) + costs of $12,258. Conviction recorded.

Magistrates Court: Brisbane

Charges

1 x attempt to defraud an insurer. 2 x attempt to deliberately mislead an insurer.

Facts

The claimant alleged injuries to their right elbow whilst engaged in activities as a repossession/commercial agent. As an amateur weightlifting competitor, they claimed that due to their injuries they were unable to resume competitive weightlifting and was limited to involvement in coaching others at reduced hours. In addition, the claimant stated that they were reliant on their family to help with heavy work around the house and with hanging washing on a clothes line. Surveillance footage captured them competing openly in strongman events which included the claimant dead-lifting weights of up to 260 kilograms and flipping earth-moving tyres likely weighing upwards of 300 kilograms.

Sentence

Four months imprisonment (wholly suspended for 18 months) + costs of $4,992.  Conviction recorded.

Magistrates Court: Townsville

Charges

1 x attempt to defraud an insurer.

Facts

The claimant, who was employed as a masseuse, lodged a CTP claim alleging that they were unable to work due to a spinal injury and a post-traumatic stress disorder sustained as a result of a motor vehicle accident. The basis of their claim was that they had not completed work of any kind since the accident however surveillance evidence confirmed that they had continued to be fully employed in their occupation.

Sentence

Two months imprisonment (wholly suspended for 9 months) + costs of $15,550.  Conviction recorded.

Magistrates Court: Brisbane

Charges

1 x attempt to defraud an insurer. 1 x attempt to deliberately mislead an insurer. 4 x providing false and misleading information.

Facts

A former nurse claimed that they had not been able to work for several years and was unable to return to work in the future, following injuries allegedly sustained in a motor vehicle accident. A substantial claim was lodged for economic loss and personal care and assistance. The claimant used their knowledge as a former nurse to create sophisticated lies to various medical practitioners about the extent of their injuries and symptoms.

Surveillance subsequently revealed that the claimant was engaged in an owner/operated mobile food business which included activities inconsistent with the assertions made in their claim. The claimant had prior fraud convictions and the offending under the CTP claim occurred whilst they was serving an Intensive Corrections Order.

Sentence

Fifteen months imprisonment – to be released on parole after serving 4 months + costs $32,442. Conviction recorded.

Magistrates Court: Brisbane

Charge

1 x attempt to defraud the CTP insurer pursuant to S87T(1)(a) of the Motor Accident Insurance Act 1994.

Facts

The claimant was a self-employed child care worker at the time of the accident. They were a passenger in a motor vehicle when struck from behind by another vehicle whilst stationary at an intersection. The claimant alleged that because of the accident they suffered a whiplash injury to their cervical, thoracic and lumbar spine, dental injuries and a major depressive disorder. During the claimant’s insurance claim, they made various representations to the CTP insurer about the extent of their injuries and impacts of those injuries on their life. The CTP insurer had suspicions about the veracity of the claim and conducted surveillance that showed the defendant performing a variety of physical activities inconsistent with the representations he made to the CTP insurer.

Sentence

12 months imprisonment and ordered that the term be wholly suspended. It was further ordered that the operational period be two years and that the defendant pay the complainant’s costs.

Magistrates Court: Townsville

Charge

1 x attempt to mislead: s87T(1)(b) of the Motor Accident Insurance Act 1994. 1 x giving an insurer a document the person knows is false or misleading in a material particular: s87U(3) of the Motor Accident Insurance Act 1994.  

Facts

The claimant was riding their bicycle when they were struck by a motor vehicle. The claimant lodged a Compulsory Third Party (CTP) insurance claim with the CTP insurer of the motor vehicle. The claimant alleged that because of the accident they suffered soft tissue injuries to their face and wrists, injuries to their thoracic vertebra, right shoulder, right knee, a closed head injury, dental injuries, and shock. They also claimed that because of the physical injuries they suffered an intellectual impairment, anxiety, and depression. The claimant alleged that their employment was affected by the accident. The CTP insurer admitted liability in full for the circumstances of the accident but contested the injuries. The claimant failed to disclose to AAI that they were playing rugby league and gave the impression that they were living a sedentary life. Surveillance captured the claimant engaging in activities that were not consistent with their representations to doctors and in the Statement of Loss and Damage in relation to their playing of sport. Rugby league team sheets showed that they had been a member of the local rugby league team for three years. The claimant had also received a player of the year award from the local sporting club. The claim ultimately settled after the surveillance was shown in the civil trial and the claimant was cross-examined on their representations.

Sentence

The claimant was convicted of the principal charge of attempting to mislead the CTP insurer. However, they were acquitted of providing a document which contained a misleading particular. The claimant was sentenced to six months imprisonment, wholly suspended for 12 months. They were also ordered to pay $12,623.00 which was referred to the State Penalties Enforcement Registry.

Magistrates Court: Brisbane

Charges

2 x attempts to mislead an insurer pursuant to s 87(1)(b) of the Motor Accident Insurance Act 1994.

Facts

The claimant was riding a bicycle which was impacted by a Suncorp-insured truck. The claimant sustained minor and temporary injuries only. The claimant engaged in a prolonged course of conduct by which they deliberately attempted to mislead the insurer during a motor vehicle accident claim. Suncorp admitted liability but did not admit that the claimant suffered any injury, loss or other damage. The claimant failed to disclose to medical practitioners and in claim documents that prior to the accident they suffered serious back and neck injuries with associated headaches. They also made misleading statements to the doctors, and in the claim documents, attributed their pre-existing injuries to the accident. The claimant’s non-disclosures and statements to medical practitioners influenced the opinions in their reports about the level of physical impairment related to the accident. The claim failed to resolve at the compulsory conference. The claim was litigated on the basis that the pre-existing injuries were caused in the accident, but was ultimately discontinued.

Sentence

The claimant participated in a voluntary interview and made admissions, thereby demonstrating remorse. They pleaded guilty to the charges and was sentenced on each charge to imprisonment of 6 months, suspended for an operational period of 18 months.

Magistrates Court: Brisbane

Charges

Defendant 1: 2 x charges of attempting to mislead an insurer pursuant to s 87(1)(b) of the Motor Accident Insurance Act 1994. The claimant (the first Defendant) attempted to mislead the Nominal Defendant by nominating in the Notice of Accident Claim Form (NOAC) that a work colleague (the second Defendant) witnessed the accident and by making a false representation in a statutory declaration about the involvement of the witness.

Defendant 2: 1 x charge of attempting to mislead an insurer pursuant to s 87(1)(b) of the Motor Accident Insurance Act 1994. The second Defendant provided a false witness statement to support the CTP insurance claim of a work colleague (the first Defendant).

Facts

The first Defendant alleged that an unidentified vehicle allegedly swerved from the right-hand lane into the left-hand lane in which they were travelling. The first Defendant then swerved to the left to avoid a collision, lost control of their vehicle, and collided with trees on the side of the road. The first Defendant recorded in the NOAC that the collision was witnessed by the second Defendant. The second Defendant provided a signed witness statement to confirm the involvement of an unidentified vehicle as alleged by the first Defendant in the Notice of Accident Claim Form. The second Defendant confirmed that an unidentified vehicle caused the first Defendant’s vehicle to lose control and collide with trees on the side of the road. The Nominal Defendant accepted liability for the collision. The claim progressed with the first Defendant attending various independent medical examinations and providing documentation in support of the claim. Further investigations conducted by the Nominal Defendant however revealed that the witness nominated by the first Defendant could not have possibly witnessed the accident. The claim did not settle at the compulsory conference and mandatory final offers were exchanged.  District Court Proceedings were commenced by the first Defendant. The matter eventually settled with both parties agreeing to bear their own costs, and with no payment of damages to the first Defendant.

Sentence

Defendant 1: The first Defendant pleaded guilty and received a sentence of six months imprisonment wholly suspended for an operational period of 18 months (for each offence and to be served concurrently).

Defendant 2: The second Defendant pleaded guilty to both charges and received a sentence of one-month imprisonment wholly suspended for an operational period of four months.

Magistrates Court: Brisbane

Charge

1 x charge for attempting to mislead an insurer pursuant to s 87(1)(b) of the Motor Accident Insurance Act 1994. The Defendant (claimant) attempted to mislead the insurer when lodging a CTP claim by falsely stating being the driver of a vehicle involved in a motor vehicle accident.

Facts

The accident occurred when a car belonging to the claimant’s spouse was driven by a friend. This vehicle collided with the rear of the insured’s vehicle. The claimant later discovered that the friend was an unlicensed driver at the time of the accident. This led to concerns about the impact on comprehensive insurance held on the vehicle. It was at that time that the claimant decided to falsely state being the driver of the vehicle that was involved in the subject accident. It appears that the claimant wanted to avoid potential issues with insurance to repair the damage to the vehicle. The claimant was not involved or injured in the subject accident but regardless continued with the claim. The claimant made further representations to a medical specialist who assessed injuries for the purposes of a medico-legal examination. The claimant ultimately withdrew the claim when the insurer fully investigated liability.

Sentence

The defendant pleaded guilty to the charge and was sentenced six months imprisonment wholly suspended for an operational period of 24 months. The magistrate recorded a conviction. The defendant was also ordered to pay costs in the sum of $7,000.

Magistrates Court: Brisbane

Charge

1 x charge for an offence under section 87U (3) of the Motor Accident Insurance Act 1994 for providing a misleading or false document to the insurer.

Facts

The claimant, employed in the retail sector,  was injured in a collision between a motorcycle and another vehicle that failed to give way. The medical certificate alleged injuries to the shoulder and wrist.  The claimant had some time off work before returning to work. The matter proceeded through the usual pre-court procedures but was unable to be resolved. The claimant sought a significant amount of damages in the claim documents that included a claim for past economic loss as well as loss of future earning capacity.

The insurer requested a statutory declaration from the claimant, detailing certain matters surrounding the claimant’s injuries. It was in the signed statutory declaration that the claimant made representations of not being able to perform a list of physical activities. The claimant declared not being able to, for example, lift certain items using the right arm above chest height. The insurer then conducted surveillance of the claimant who was then observed reaching above shoulder height and using both hands to hold boxes and reaching above shoulder height with the right hand. The claimant was also seen lifting and carrying heavy items with just the right arm. The footage demonstrated that the claimant had made false misrepresentations in the statutory declaration regarding level of mobility and accordingly swore a false statutory declaration.

Sentence

The claimant pleaded guilty and was fined $1,200. Costs were agreed in the sum of $8,000. A conviction was not recorded given the potential impact on the claimant’s current and future employment prospects

Magistrate Court: Brisbane

Charge

1 x charge for an offence contrary to s87T(1)(a) of the Motor Accident Insurance Act 1994 for an attempt to deliberately defraud an insurer.

Facts

The claimant alleged personal injury following involvement in a motor vehicle accident. A compulsory third-party claim was submitted to the relevant insurer. During the normal course of investigations, the insurer discovered that the claimant was not in the parked vehicle when another vehicle on reversing collided with it. The evidence proved that the claimant could not have been injured as a result of the collision and therefore had no legal basis for making a compulsory third-party claim.  The claimant ultimately withdrew the claim given the evidence.

Sentence

The defendant pleaded guilty for an attempt to deliberately defraud an insurer, contrary to s87T(1)(a) of the Act, and was sentenced to the maximum 240 hours of community service to be undertaken over 12 months. The Magistrate accepted the defence’s submission about the impact of a recorded conviction on the Defendant’s ability to retain and gain employment and therefore decided not to record a conviction. The Defendant’s cooperation and considering that the claim was never going to proceed due to the lack of the required medical certificate were some of the mitigating factors. The Defendant was also ordered to pay an amount of costs to MAIC.

Magistrate Court: Southport

Charge

1 x charge for an offence under s87T(1)(b) of the Motor Accident Insurance Act 1994 for attempting to deliberately mislead an insurer.

Facts

The claimant falsely claimed to be a passenger in a vehicle involved in an accident and suffering injury as result of the collision. The claimant allegedly lost wages, salary, business, or other income because of the accident and was awaiting medical evidence and therefore not able to yet accept payment for the claim.  The insurer on speaking with their insured driver determined that there were no passengers in the vehicle at the time of the accident. This information was disclosed to the claimant’s solicitors who subsequently advised that they no longer acted on behalf of the claimant and the claim ultimately lapsed.

Sentence

The defence in mitigation relied upon the early plea and youth of the defendant. The prosecution emphasised the need for general deterrence and that false CTP claims increase the cost of the scheme, which effects all drivers. It was further noted that the defendant had a criminal history and the offending was serious. The claim was entirely false. The Magistrate during sentencing noted the defendant’s significant criminal history, but no previous dishonesty offences. However, the defendant knew that the representations were false.  The defendant was sentenced to three months imprisonment wholly suspended for an operational period of 12 months.  The defendant was ordered to pay all costs sought by MAIC.

Magistrates Court:  Richlands

Charge

1 x charge for an offence contrary to s87U(2) of the Motor Accident Insurance Act 1994 for providing information to the insurer that was false or misleading in a material particular.

Facts

The claimant stepped onto the road at a pedestrian crossing when a vehicle passed through a red traffic light. The vehicle passed close to the claimant. The claimant served a claim form on the relevant CTP insurer. It is alleged in the claim form that the vehicle ran over the claimant’s foot at the time of the vehicle passing causing a fall to the roadway and injuring the claimant’s back. The insurer investigated the claim and obtained video footage of the accident recorded by a nearby red-light camera. The footage however showed the alleged ‘at fault’ vehicle did in fact not make contact with the claimant at the time of passing. Furthermore, the claimant was not seen falling to the roadway as represented in the claim form. Liability was denied for the accident. The claimant became aware of the existence of the video footage and ultimately withdrew from the claim.

Sentence

The Magistrate noted the calculated and brazen deceit of the defendant and considered that a mere fine was not appropriate. The defendant was sentenced to three months imprisonment suspended for an operational period of two years. A conviction was recorded.

Magistrates Court: Bundaberg 

Charge

1 x charge for an offence under s87T(1)(b) of the Motor Accident Insurance Act 1994 for an attempt to deliberately mislead an insurer.

Facts

The claimant, who was legally represented, pursued a CTP claim with an insurer for injuries sustained in a single motor vehicle accident. The claimant later submitted a medical certificate to the insurer and also declared having directly obtained the medical certificate from a General Practitioner (GP). The insurer admitted liability for the claim. During the course of the claim, the insurer conducted enquiries with the medical practice where the GP was based to obtain a copy of the claimant’s medical records. The medical practice then informed the insurer that the GP had in fact not completed or signed the relevant medical certificate that was submitted by the claimant. The GP, in a signed a statutory declaration, confirmed not having consulted the claimant for the purposes of issuing a medical certificate. When the claimant’s solicitors requested an extension of the limitation period, the insurer informed them that they had reason to believe that the medical certificate submitted was not completed by the relevant GP and not agreeable to extend the limitation period. The limitation period passed without the claimant having commenced proceedings in court.

Sentence

The defence conceded during sentencing that it was incumbent on the claimant to know the veracity of the documents filed in the claim. Whilst the dishonesty involved the falsifying of a medical certificate and is not an entirely fabricated claim, the medical certificate is an important safe-guard in the CTP scheme. The Court noted that the claimant had some difficulty in obtaining the required medical certificate for the CTP claim and was frustrated by lawyers who had cold-called the claimant whilst in hospital. It was during this time that someone unspecified indicated that they could be of assistance to the claimant and a medical certificate has been produced and provided. The Magistrate considered that the dishonesty was exacerbated by a signed statement from the claimant confirming attendance upon the doctor with a copy of the hospital clinical notes to have the medical certificate completed, which in itself is a complete fabrication that occurred. The offending is serious as the medical certificate is a very important part of the statutory insurance scheme to eliminate undeserving claims. The defendant was sentenced to two months wholly suspended imprisonment, for an operational period of six months. A conviction was recorded.

Magistrates Court: Holland Park

Charge

1 x charge for an offence under s87T(1)(b) of the Motor Accident Insurance Act 1994 for an attempt to deliberately mislead an insurer.  The charge relates to the claimant’s false and misleading representations in the notice of accident claim form (NOAC) and to a medico-legal specialist about pre-accident employment.

Facts

The claimant falsely declared in the NOAC not having any pre-accident medical condition , having never suffered a disability and having never made a claim or received compensation for a disability. The claimant furthermore declared a loss of income because of the accident and provided an incorrect date of birth on the claim form. The insurer on making enquiries discovered that claimant was casually employed from time to time and paid cash in hand. No records of income were recorded. The description of work was on a lower scale than indicated by the claimant. ATO payment summaries showed that the claimant was in fact on a disability support pension in previous years, confirmed by records from Centrelink. The insurer on searching the claimant’s claims history, using the correct date of birth, found that the claimant previously had a personal injury claim with another insurer. In that claim the claimant declared significant previous disabilities (example: lower back pain and shoulder pain) that were not included in the notice of accident claim form submitted in the subject claim. The claimant also failed to disclose a significant Workcover claims history.

Sentence

The defendant entered a plea of guilty to the above charge. After hearing submissions from the legal representatives, the Magistrate sentenced the defendant to three months imprisonment, wholly suspended, for an operational period of 12 months. A conviction was automatically recorded. Costs were agreed in advance.

Magistrates Court: Brisbane

Charge

1 x charge for an offence under s87U(3) for providing false and misleading information and 2 x charges for offences under s87U(2) for making false or misleading statements or giving false or misleading documents to the insurer pursuant to the Motor Accident Insurance Act 1994.

Facts

The defendant was allegedly injured in a motor vehicle accident. The accident occurred when another vehicle at speed reversed into the defendant’s parked vehicle. When the ‘at fault’ vehicle sped off, the defendant followed. Both vehicles ultimately ended up at a no-through road where a further collision occurred. The driver of the ‘at fault’ vehicle before leaving the scene, approached the still seated defendant on foot and hit the defendant with a metal pole.

The defendant submitted a personal injury claim with the relevant CTP insurer. During the claim, the defendant made statements to medical specialists in relation to the impact of injuries and not having returned to gym exercises since the accident. The defendant also when providing a signed statement in response to the insurer’s questions again falsely declared not having attended the gym since the accident. These statements were false or misleading in circumstances because at the time of making the statements the defendant had in fact attended gym at various times since the accident. The matter proceeded to a compulsory conference where mandatory final offers were exchanged. The matter remained unresolved and the defendant then filed a Claim and Statement of Claim in the Brisbane District Court. The insurer maintained a denial of liability, denied that the injuries were sustained as pleaded and that the claims were excessive and exaggerated. Following the exchange of further disclosure (including Statements of Loss and Damage and Statutory Declarations) as well as investigations undertaken by the insurer, the matter finally resolved on the basis that the parties walk away with each bearing their own costs.

Sentence

The defendant pleaded guilty to the above offences and was sentenced to complete 240 hours of community service. No convictions were recorded. The Magistrate considered that the defendant’s offending was serious and protracted, the defendant’s cooperation and the impacts that recorded convictions would have on economic and social well-being. The Court took into account the defendant’s early plea of guilty, cooperation in facilitating the course of justice, the circumstances where criminal matters occurred, that impact on the defendant but also the defendant having pursued personal gain out of something known to be wrong. The Court found it irrelevant to consider immigration issues because employers and the Department of Immigration would likely in any event become aware of the offences simply from the fact that the defendant has been charged and pleaded guilty. The Magistrate decided that a fine could not adequately reflect the criminality involved and therefore it was appropriate that the defendant be considered for a period of community service and that the maximum is considered.

Magistrates Court: Brisbane

Charges

The defendant was charged with 2 x charges for an attempt to defraud an insurer pursuant to s87T(1)(a) of the MAI Act 1994 and 2 x charges for an attempt to deliberately mislead an insurer pursuant to s87T(1)(b) of the Motor Accident Insurance Act 1994.

Facts

The claimant sought compensation from the insurer for injuries sustained in two motor vehicle accidents in 2016 and 2017. During the course of the claim the claimant made false and misleading representations to the insurer about income from personal training, cleaning businesses and particularly failed to disclose income from paid English tutoring work. The claim did not settle and proceeded to a four-day trial. The claimant maintained that falsehood during evidence at the civil trial and it was only when confronted with the contradictory evidence that the claimant accepted receipt of tutoring income. The claimant furthermore made false and misleading representations to doctors engaged by both parties when reporting injuries in statutory declarations and in filed court documents about the physical impact of the accidents. The representations about the extent of injuries formed the basis of the claimant’s claims for past and future economic loss in circumstances where it was relied on the represented injuries to claim a reduced capacity to perform personal training. The claimant under oath maintained these representations at trial. The insurer’s pre-trial investigations into the claimant’s representations resulted in obtaining and relying on CCTV footage from a fitness gym and Instagram posts which evidenced the claimant performing activities inconsistent with representations. The insurer’s investigations also revealed that for a period between 2016 and 2018 the claimant was in fact attending a gym on many occasions, that was not disclosed to the insurer. The claimant further represented on two occasions (in a statutory declaration and to a doctor) having recovered from prior injuries in other motor vehicle accidents (and therefore asserted that the subject accidents were causative of the claimed pain, suffering and loss of amenities). The insurer obtained records which revealed that for a period before the first accident in 2016 the claimant repeatedly attended upon a physiotherapist and general practitioner for treatment for neck and back pain, including just five days before the first subject accident. In dismissing the claim, the Magistrate found that the claimant was ‘without credit’ and ‘exaggerated the claims of symptoms. The arbitrary reporting of income and attempted altering and withholding of evidence made it impossible for the Court to be satisfied that injuries were sustained that caused any pain, suffering or loss of amenity. Costs were ordered against the claimant in the civil matter.

Sentence

The defendant pleaded guilty to the charges under s87T and s87U of the MAI Act 1994. The defendant was sentenced to 3 months imprisonment under each charge for attempting to deliberately to mislead an insurer and respectively 3 months and 9 months imprisonment for attempts to defraud an insurer. The terms of imprisonment were wholly suspended for an operational period of 18 months and to be served concurrently.

Magistrates Court: Cairns

Charges

The defendant was charged with 1 x attempt to deliberately mislead an insurer pursuant to s 87T(1)(b) of the Motor Accident Insurance Act 1994.

Facts

The claimant commenced a claim for damages following a motor vehicle accident that allegedly caused injuries to their back and neck. In the notice of accident claim, the claimant denied any relevant medical history and maintained similar representations to medico-legal specialists. The insurer, on investigating the claim, discovered that the claimant had previously sought regular chiropractic treatment for neck and back complaints. The claimant also provided a statutory declaration and formal statements in support of the false and misleading representations

Sentence

The Court accepted that the offending was not sophisticated but occurred over a significant period. The claimant does not have prior criminal history and did not make a pecuniary gain. The defendant was sentenced to 9 months imprisonment wholly suspended with an operational period of 2 years.

Magistrates Court: Brisbane

Charges

The defendant was charged with various offences under S87T(1) of the Motor Accident Insurance Act 1994, for an attempt to defraud an insurer, for making false or misleading statements to an insurer and for attempts to deliberately mislead an insurer during a claim.

Facts

The defendant (‘claimant’) was injured in a motor vehicle accident whilst cycling and as result of the impact sustained injuries to left knee and rib. A Notice of Accident Claim Form was subsequently lodged with the CTP insurer. The claim failed to settle at the compulsory conference and the matter ultimately proceeded to trial in the Supreme Court of Queensland.

The claimant reported to medical practitioners of being unable to perform certain activities due to the impact of the accident-related injuries. The claimant also adopted the same representations in statements of loss and damage, in circumstances where the claimant could perform the activities without significant restriction. The reports to medical practitioners were made with the intent and purpose of inducing the insurer to rely on their reports when assessing the claim for damages.

The insurer undertook extensive investigations during the claim that included obtaining surveillance material, records, social media posts and supplementary reports from health practitioners. When giving evidence at trial in the civil matter, the claimant effectively maintained the extent and severity of the impact of injuries as outlined to the various medical and allied health practitioners during the claim. The claimant was shown parts of the surveillance footage that suggested an ability to do more than what was advised to the health practitioners. The parties during trial resolved the matter by consent and the Court ordered judgment in favour of the insurer.

Sentence following a plea of guilty

The defendant (‘claimant’) pleaded guilty to 1x attempt to defraud an insurer and 1x attempt deliberately to mislead an insurer pursuant to s87T(1)(a) of the Motor Accident Insurance Act 1994. The defendant was sentenced to nine months’ imprisonment for the attempt to defraud and six months’ imprisonment for the attempt to deliberately mislead. Both terms of imprisonment are to be served concurrently and were wholly suspended for an operational period of 18 months. Convictions were recorded.

The Court considered that the defendant was involved in a protracted period of offending which continued up to trial in the civil matter. A term of imprisonment was necessary to serve as a general deterrent. However, given that the defendant did not receive any money and having regard to his limited criminal history, actual time in custody was not warranted.

Magistrates Court: Richlands

Charges

The defendant was charged with offences pursuant to s 87T (1)(a) of the Motor Accident Insurance Act 1994 for attempting to defraud an insurer; s 87U(2) for making statements to an insurer, knowing it is false or misleading in a material particular and s 87U(3) for giving the insurer a document knowing it is false or misleading in a material particular.

Facts

The defendant commenced a claim under the MAI Act 1994 following a motor vehicle accident that allegedly caused upper back and neck injuries. The defendant denied any relevant medical history in the Notice of Accident Claim form. The defendant claimed a significant sum in damages.

The insurer’s investigations ultimately revealed the defendant’s pre-existing injuries found in the medical records and WorkCover files obtained by the insurer. It was discovered that the defendant had sought regular treatment for neck and back complaints for more than a decade including a prior WorkCover claim for similar injuries. The defendant on two occasions made false or misleading representations to medical practitioners who were assessing the alleged injuries for Medico-Legal opinions. The defendant also submitted false and / or misleading claim documents to the insurer in furtherance of the claim for damages. The claim was discontinued shortly before commencement of trial.

Sentence

The defendant was sentenced to 12 months’ imprisonment, wholly suspended, with an operational period of 2 years for the s 87T(1)(a) charge; 9 months imprisonment, wholly suspended, with an operational period of 2 years for the s 87U (2) charge and 9 months imprisonment, wholly suspended, with an operational period of 2 years for the s 87U (3) charge. The Magistrate had regard to the defendant’s timely plea and the consequential loss of employment in sentencing the defendant but nevertheless considered that the offending was a substantial offence of dishonesty with dire consequences for the public purse. The conduct occurred over a sustained period and the defendant maintained the deception when attending several conferences leading into the trial.

Magistrates Court: Toowoomba

Date: June 2023

Charges

The Defendant (‘claimant’) was charged with five offences under the Motor Accident Insurance Act, 1994 (‘the Act’). One charge of deliberately misleading or attempting to deliberately mislead the insurer under section 87T(1)(b) and four charges of giving the insurer a document knowing it was false or misleading in a material particular under section 87U(3) of the Act.

Facts

The claimant sustained soft tissue injuries in a motor vehicle accident while on a journey from home to work. The claimant thereafter lodged a claim for compensation on the relevant CTP insurer who admitted liability. The claim parties were unable to informally resolve the claim and the matter progressed to litigation. The insurer at this time discovered that the claimant has been running an online business, offering makeup and beauty services on Facebook which had not previously been disclosed in the claim form or statement of loss and damage or any other document. The insurer at a pre-trial conference confronted the defendant about the business and the income derived from this self-employment, not previously disclosed. The claim then settled but at a reduced amount.

Sentence

The matter progressed to a contested hearing. The Magistrate when deciding the case commented that the defendant’s claims and evidence were unconvincing and rejected that the failure to disclose the ‘makeup business’ was an ‘honest mistake’. The defendant regularly referred to the make-up service as a business. The ‘makeup business’ should have been disclosed from the outset when the claim was made to the insurer. The defendant also misled the judicial system in addition to the insurer and the continued conduct is an aggravating feature of the matter. The defendant was found guilty on all charges and sentenced to a head sentence of nine months’ imprisonment (wholly suspended) for charge 1 and sentenced to three months’ imprisonment (wholly suspended) for charges 2 to 5, to be concurrently served. A conviction was recorded for each charge.

Magistrates Court: Brisbane

Date: April 2024

Charges: Attempted fraud and for giving a document to the insurer the person knows is false or misleading in a material particular.

Facts

The claimant suffered lower back and neck injuries as result of a motor vehicle accident. In the Notice of Accident Claim form, the claimant denied any relevant medical history. It was later discovered that before the accident the claimant had sought regular chiropractic treatments for neck and back complaints. There were also several instances during the claim where the claimant provided information to medical practitioners and in filed documents that was false or misleading in a material particular.

Sentence

The defendant initially defended the criminal charges but just before trial pleaded guilty to the head charge under s87T of the MAI Act 1994. The claimant had no prior criminal history and was sentenced to 12 months imprisonment wholly suspended for an operational period of two years.

Magistrates Court: Brisbane

Date: June 2024

Charges: Attempt deliberately to mislead an insurer

Facts

The claimant sustained injuries to the neck and back following a motor vehicle accident. The claimant worked as a delivery driver at the time of the accident. However, in the Notice of Accident Claim Form, the claimant omitted to disclose being the sole director and shareholder of a company, incorporated prior to the accident with the intention of commencing a delivery service. The claimant also made false and misleading representations to medical practitioners during medico-legal examinations about a limited ability to work. Additionally, in the litigated civil matter the claimant filed documents in the District Court claiming an inability to commence operation of the business due to the exacerbation of the injuries suffered in the accident. Although the claimant’s personal injury claim settled, the misleading conduct was identified following investigations undertaken by the insurer and MAIC. The claimant’s former solicitor was summonsed during the criminal trial to give evidence for the prosecution. A pre-trial application was made seeking that legal professional privilege be waived. The prosecution’s application was successful. When the claimant was made aware that the former solicitor’s evidence would be detrimental to the defence, the claimant pleaded guilty.

Sentence

The defendant was sentenced to 6 months imprisonment wholly suspended for an operational period of 18 months. A conviction was recorded.