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Monday Muses~Fraud is Fraud

Rosemary McKenzie-Ferguson

Founder at Craig's Table- Recipient Summa Comp Laude 2021-22 Recipient Bloom Making a Difference Award 2023

发布日期: 2024年10月28日

What I have written will be a matter of public record when the current Inquiry is concluded, thus this evening I thought I would save each of you the wait. The only difference is that I have taken the liberty to include some information regarding fraud. As you can read there are no time limitations regarding fraud. Simply put fraud is fraud.

My intention here is to encourage others who believe they have something of interest or concern to also write to the Independent Inquiry.

The injured worker community has remained quiet on too many things for far too long.

I do not know if I will be called to speak to my submission or not, I will let you know if I am invited to speak.

All I have ever done is stand for the injured worker community. I promised Don Gage I would never be silenced and that I would never stop fighting for his right to be believed. Sadly we lost Don almost 16 years back when he could no longer find the strength or the courage to hold on. For me I will never stop hearing Don's final question to me "why don't they believe me?" I couldn't answer Don's question in 2009; but now I believe I have the beginning of the answer that so many people ask.

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Independent inquiry - State Insurance Regulatory Authority (SIRA)

Dear Sir,

I write regarding the inquiry into SIRA’s complaints handling.

I write in the belief and in the hope that what I have to say will enable you to understand what others have either written to you or spoken with you about.

I have attached documents that I will reference through this submission.

·???????? Document One Hansard Federal Parliamentary Joint Committee Life Insurance Industry Hansard

The reason I have included this Hansard is because the medico-legal process is rarely ever discussed or taken into consideration when attempting to understand/navigate a workers compensation claim.

The information that was relied upon by the joint Committee came from the New South Wales workers compensation process.

I meet with [retired] Senator Nice Person in February 2017 and passed on the information I had including names and contacts of industry people who could provide information regarding tampering/fabrication of IME Reports.

[Retired] Senator Nice Person spoke with medical specialist who said that they had had their IME Report altered after they had authorised the Report.

As you will read [retired] Senator Nice Person questioned the difference between the authorised IME Report and the transmitted IME Report.

It was acknowledged that altering an IME Report would be fraud.

·???????? Document Two Mr Trevor Silversides.

I became aware of Mr Trevor Silversides via the Illawarra Mercury article [attached]

My concerns were raised after reading that Mr Silversides was sent for a medico-legal [IME] assessment and as reported in the news article, the IME assessment lasted 9 minutes. Mr Silversides has physical injuries, yet there was no physical examination.

·???????? Document Three IME Guidelines

I have attached the SIRA guidelines for you to understand the medico-legal process.

·???????? Document Four Letter to New South Wales workers compensation claims agents.

I made several attempts throughout 2023 to raise concerns with icare via minister Cotsis. Nothing I did was in the least bit successful.

In January 2024 after informing minister Cotsis I wrote to each of the New South Wales workers compensation claims agents to inform them that I was deeply concerned that medico-legal Reports were being tampered with.

As a direct result of that letter one of the claims agents informed me that they had sought advice from SIRA.

It took myself reaching out to SIRA to enquire what if anything SIRA was doing or intending to do. I contacted both Sira Manager Number 1 and Sira Manager Number 2 as I have known both of them professionally for several years.

After another delay I was told that SIRA Manager 3 Manager of Investigations SIRA would take the information I had to share and he would investigate and act upon the information from the investigation.

It took several Teams meetings and a great deal of frustration before SIRA Manager 3 finally admitted that while it was acknowledged there were concerns regarding “some” medico-legal Reports; however, due to the lack of either Federal or State Legislation or Regulation that would allow SIRA to actually investigate or audit any stage of the medico-legal process.

SIRA Manager 3 also admitted that SIRA does not have the staff or the Budget to adequately investigate concerns such as the 9-minute medico-legal appointment

·???????? It is important here to understand the medico-legal process as it is currently used within the workers compensation claim process.

·???????? The medico-legal process is used to establish if a workers compensation claim is either accepted or rejected.

·???????? If the workers compensation claim is rejected there is a legal dispute process available for the injured worker to follow.

·???????? The medico-legal process is used throughout the length of workers compensation claim for various reasons; mainly to reduce support for injured workers or remove injured workers from their workers compensation claim.

o?? Workers compensation claims agents are paid bonus payments when an injured worker is removed from the workers compensation system.

·???????? The medico-legal process is used in order to establish compensation payments.

·???????? The medico-legal process is used at the end of the legislated to establish that a member of the injured worker community is under 21% whole of person incapacity requirement so the workers compensation claim is ended.

o?? Once more the workers compensation claims agents are paid a bonus simply by removing an injured worker from income payments.

SIRA Manager 3 went as far as to agree with me that the ONLY way to validate the transmitted IME Report is to compare it to the original draft report.

I provided SIRA Manager 3 with names and contact numbers the same as I had provided to [retired] Senator Nice Person.

SIRA Manager 3 failed to actually investigate. Or if he did, he failed to inform me as to what he had found.

I have had separate conversations with one of the people I provided SIRA Manager 3 with regarding tampering with medico-legal Reports. I was told that SIRA Manager 3 had had a short conversation and that further conversations would be scheduled. At the time of writing this, no further conversations have taken place.

Another name I provided to SIRA Manager 3; SIRA Manager 3 decided that the medico-legal tampering had happened so far back that it was no longer relevant. I pointed out to SIRA Manager 3 that fraud is fraud and that there is no expiration date regarding fraud.

Both the medical specialist and the informer would have provided SIRA Manager 3 with the exact same medico-legal provider name. The informer would have also provided SIRA Manager 3 with the concern that at one stage the CEO of a medico-legal provider sat on the Board of one of the claims agents.

SIRA Manager 3 also would not investigate the issues I had raised regarding the 9-minute medico-legal appointment that Mr Silversides was required to attend.? The surface look that SIRA Manager 3 said he did inform him that there was nothing to be concerned about regarding a short non-physical appointment. As there is neither Federal or State Legislation/Regulation that would enable SIRA to investigate any part of the medico-legal process without first informing Mr Silversides and Mr Silversides legal representative that SIRA held concerns and needed to look at not just the transmitted medico-legal Report, but question the medical specialist, as well as gain a copy of the original draft report as written/recorded by the medical specialist.?

Had SIRA Manager 3 actually investigated it could have resulted in un-precedented compensation being paid to Mr Trevor Silversides as well as re-instatement back onto workers compensation income payments.

I am unclear as to who within SIRA decided that Mr Silversides was not worth the effort, but it was beyond my ability to tolerate the spin that SIRA Manager 3 was putting forward.

领英推荐

ZALMA’S INSURANCE FRAUD LETTER

Barry Zalma, Esq., CFE 4 年前

ZALMA’S INSURANCE FRAUD LETTER December 1, 2020

Barry Zalma, Esq., CFE 3 年前

ZALMA’S INSURANCE FRAUD LETTER

Barry Zalma, Esq., CFE 4 年前

I reached the point where I could no longer trust anything that SIRA Manager 3 was either telling me or informing me that he was doing.

At that point Sira Manager Number 2 stepped back in noting that my concerns had base and needed to be carried forward. Sira Manager Number 2 understood that I had reached the point of “no trust” regarding SIRA Manager 3.

It was Sira Manager Number 2 who decided that fortnightly Teams meetings with myself had to be scheduled in so that Sira Manager Number 2 could update me with what was happening and for me to speak to information I was emailing into SIRA. -Though I did not actually write people of interest via email, I did inform SIRA that further information had become available that I would only speak to,

At some stage SIRA decided that I should be invited to be a part of Workers and Home Building Compensation Regulation Committee.

The first meeting had been scheduled for the 15th October 2024.

Instead of sending information and updates just to Sira Manager Number 2 I sent information to the WHBCR Committee, once more Sira Manager Number 2 decided that the first meeting would move from 15th October 2024 to 26th August 2024.

The minutes were taken of the meeting though to date as yet I have not received a copy of the meeting.

·???????? Document Five email from SIRA Employee 1 Manager Regulatory Liaison and Reporting WHBCR Office of the Executive Director SIRA

However, because I went above SIRA [with concerns that SIRA was either unable or unwilling to act on] directly to minister Dib it was decided within SIRA that my presence with WHBCR Committee or meetings with Sira Manager Number 2 were to cease effective immediately 13th September 2024.

Now I have no contact within SIRA, information and another name of concern regarding tampering/fabrication of medico-legal Reports sits with me as all meetings with Sira Manager Number 2 or WHBCR Committee have been ceased.

SIRA says it wants to know information but in truth SIRA only wants information that fits within its own narrative and does not require any real effort.

Thank you for your time and attention, it is my hope that the information I have provided here is of assistance; I would be happy to discuss any part of this information with you.

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It is good to have Kathie Melocco and Ballina Gee back from their journey to Samoa and the release of Shattered