WorkCover Claims Fraud Surveillance

Summary and scope

WorkCover Queensland is committed to advancing the economic, environmental and social objectives of the Queensland Government, including maximising Queensland suppliers' opportunities to participate in government business, supporting regional and remote economies, and doing business with ethically, environmentally and socially responsible suppliers. This requirement is to seek suppliers with expertise in factual and surveillance services utilised by insurance providers to support their claims management process. Surveillance as used by insurers is a tool to prove allegations and identify suspected fraudulent claims or behaviour to reduce financial exposure in claims. Undetected fraudulent claims impact on the overall scheme, and insurers paying out fraudulent claims result in an increase of premiums for policyholders. WorkCover Queensland therefore has an ongoing requirement to facilitate outsourced investigations where there is reasonable belief of fraud on specific claims made by injured workers and/or their employers to determine whether information provided to WorkCover is true and correct. With the varying levels of complexity, geographical spread across the State of Queensland and volume of claims sought – a panel of suppliers is preferred by WorkCover to operationalise this outsourced need.