Tackling Claims Fraud

Fraud in the NSW CTP scheme has been reported as adding $75 to the cost of each CTP policy. MAIC is committed to deterring fraud in Queensland to keep CTP premiums affordable.

Prosecuting Claims Fraud

MAIC is committed to proactively responding to reports of claims fraud and prosecuting where appropriate.

A person must not in any way:

  • defraud; or
  • attempt to defraud; or
  • deliberately mislead; or
  • attempt deliberately to mislead

MAIC, the Nominal Defendant or any of the licenced insurers. The Motor Accident Insurance Act 1994 prescribes a maximum penalty of 400 penalty units ($50,460 as at 1 July 2017) or 18 months imprisonment.

Additionally, a person must not:

  • state anything the person knows is false or misleading in a material particular; or
  • give a document the person knows is false or misleading in a material particular

to MAIC, the Nominal Defendant or any of the licenced insurers. The Motor Accident Insurance Act 1994 prescribes a maximum penalty of 150 penalty units ($18,922.50 as at 1 July 2017) or 12 months imprisonment.

Claims fraud affects all motorists. When individuals lodge disingenuous or fraudulent claims, this puts pressure on CTP premiums and takes focus away from those who are genuinely entitled. If you are aware of a person who may be committing claims fraud, please report it to maic@maic.qld.gov.au or call 1300 302 568.

Recent Prosecutions

8 November 2017

The Defendant was involved in a motor vehicle accident in 2012 where he was rear-ended by another vehicle in inclement weather. Inconsistent versions of the accident were provided to the insurer by the vehicles involved. As such, liability was admitted to the extent of 50%. The Defendant alleged both physical and psychiatric injury and loss of their employment as an aged care worker. The Defendant was later found to have mislead the insurer about their ability to partake in employment, social and domestic activities.  The Defendant entered a guilty plea to the charge of ‘attempt to deliberately mislead the insurer’ and was sentenced to four months imprisonment wholly suspended for 12 months. A conviction was recorded and costs of $12,888 to be paid within 6 months were imposed.

27 April 2017

In 2013, the Defendant was the driver of a vehicle involved in a motor vehicle accident where a pedestrian suffered fatal injuries. The Defendant subsequently made a CTP claim where he represented to the insurer of his vehicle that he was a passenger. The insurer admitted liability but litigation which followed revealed the Defendant was in fact the driver of the vehicle and therefore ineligible to claim. The Defendant made a plea of guilty. In sentencing,  the Magistrate commented on the seriousness of the dishonesty and attempting to profit from the tragic death of a pedestrian. The Defendant was sentenced to 240 hours of unpaid community service to be completed within 12 months, parole conditions and costs of $7,750 to be paid within 12 months.

21 November 2016

In 2013, the Defendant was involved in a motor vehicle accident where he was not at-fault. The Defendant lodged a CTP claim where he made numerous and repeated representations to an insurer that he was unable to work, had reduced work hours and was significantly restricted in his ability at work.  This was revealed not to be the case and the Defendant had in fact returned to work and wholly recovered from all injuries sustained in the accident. The Defendant entered a guilty plea. A sentence of 4 months imprisonment (wholly suspended) for 12 months with no conviction recorded was imposed.

14 October 2016

The Defendant was involved in a motor vehicle accident in August 2014 where he was not at-fault. The insurer admitted liability. The Defendant made misleading statements to the effect that she had not worked since shortly after the accident to both medical professionals and on numerous sworn documents. The Defendant had, in fact, been working up to 20 hours a week for a year after the accident and requested her employer not advise the insurer that she had been working. The Defendant entered a plea of guilty for attempting to deliberately mislead. A sentence of 240 hours community service and costs of $8,873.40 was imposed. No conviction was recorded.

16 September 2016

In 2008, the Defendant was involved in a motor vehicle accident where he was not at-fault. He lodged a CTP claim and represented to the insurer that he was required to close his business due to injuries suffered in the accident. Instead, the Defendant was regularly performing work and had misrepresented his hours and the nature of his duties. The Defendant entered a plea of guilty. A sentence of 4 months imprisonment (wholly suspended for 12 months) and costs totaling $12,258.40 was imposed.

3 December 2015

In 2009, the Defendant was involved in an accident where he was not at-fault. The Defendant lodged a CTP claim. The defendant reported to the insurer and medico-legal specialists that he was unable to work, compete in his chosen sport and had suffered a significant detriment to his day-to-day life due. The insurer’s subsequent investigations revealed that the Defendant had continued to compete and was functioning largely without difficulty. The Defendant entered a guilty plea. A conviction was recorded, a sentence of 4 months imprisonment (suspended for 1.5 years) imposed and costs of $4,992.56 were ordered to be paid.

 

Last modified 17 November 2017