CTP 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.

What is CTP fraud?

CTP claims fraud can include a staged motor vehicle accident, the intentional misrepresentation of the facts or manipulation of the claims process to obtain a financial gain where there has been no actual loss.

What are your obligations?

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.

If you make a fraudulent claim, you may be prosecuted. 

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.

Undetected fraudulent claims also add to the cost of CTP insurance paid by all Queensland motorists when renewing their motor vehicle registration. Reporting fraudulent claims can help to reduce these costs.

Report fraud to the CTP Enquiry Line on 1300 302 568.

If you know someone who has a CTP claim and is exaggerating their injuries or being untruthful about their claim, report this information to the CTP Enquiry Line on 1300 302 568 (information can be provided anonymously) or via email at maic@maic.qld.gov.au

Case studies

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.  Claimant 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 his arms above his 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 his CTP claim that he was a passenger in the vehicle driven by his partner, and had himself 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 that he had no entitlement to compensation under a CTP claim. The basic of the claim was a deliberate attempt to mislead the CTP insurer because, at that time, the claimant knew that he was 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 he was unable to work in his pre-accident role, had reduced work hours and was significantly restricted in his 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 he had fully recovered from his 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 her CTP claim to the effect that she 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 she 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 her 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 he was unable to work, or work fulltime and was forced to close his motor vehicle sales business because of a neck and shoulder strain and prolapsed disc injury he 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 his 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 his right elbow whilst engaged in activities as a repossession/commercial agent. As an amateur weightlifting competitor, he claimed that due to his injuries, he was unable to resume competitive weightlifting and was limited to involvement in coaching others at reduced hours. In addition, he stated that he was reliant on his family to help with heavy work around the house and with hanging washing on a clothes line. Surveillance captured him competing openly in strongman events which included the claimant dead-lifting weights of up to 260 kilograms and flipping earth-moving tyres likely weighting 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 she was 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 her claim was that she had not completed work of any kind since the accident however surveillance evidence confirmed that she had continued to be fully employed in her 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 she 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 her knowledge as a former nurse to create sophisticated lies to various medical practitioners about the extent of her injuries and symptoms.

Surveillance subsequently revealed that she was engaged in an owner/operated mobile food business which included activities inconsistent with the assertions made in her claim. The claimant had prior fraud convictions and the offending under the CTP claim occurred whilst she 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. He was 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 he suffered a whiplash injury to his cervical, thoracic and lumbar spine, dental injuries and a major depressive disorder. During the claimant’s insurance claim, he made various representations to the CTP insurer about the extent of his injuries and impacts of those injuries on his 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 his bicycle when he was 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 he suffered soft tissue injuries to his face and wrists, injuries to his thoracic vertebra, right shoulder, right knee, a closed head injury, dental injuries, and shock. He also claimed that because of the physical injuries he suffered an intellectual impairment, anxiety, and depression. The claimant alleged that his 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 he was playing rugby league and gave the impression that he was living a sedentary life. Surveillance captured the claimant engaging in activities that were not consistent with his representations to doctors and in the Statement of Loss and Damage in relation to his playing of sport. Rugby league team sheets showed that he had been a member of the local rugby league team for three years. He 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 cross-examined on his representations.

Sentence: The claimant was convicted of the principal charge of attempting to mislead the CTP insurer. However, he was acquitted of providing a document which contained a misleading particular. The claimant was sentenced to six months imprisonment, wholly suspended for 12 months. He was 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 (the Act).

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 he 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 he suffered serious back and neck injuries with associated headaches. He also made misleading statements to the doctors, and in the claim documents, he attributed his 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. He pleaded guilty to the charges and was sentenced on each charge to imprisonment of 6 months, suspended for an operational period of 18 months.

Last modified 24 April 2019