SIRA secures first CTP fraud prosecution in landmark case
SIRA secures first CTP fraud prosecution in landmark case | Insurance Business Australia
Motor & Fleet
SIRA secures first CTP fraud prosecution in landmark case
Magistrate highlighted extensive planning involved in the scheme
Motor & Fleet
By
Roxanne Libatique
The State Insurance Regulatory Authority (SIRA) has successfully prosecuted a claimant for fraud under the Compulsory Third Party (CTP) scheme, following violations of the Motor Accident Injuries Act 2017.
On May 30, 2022, SIRA was alerted to a case involving Tina Pour-Zahrouni, who submitted a fraudulent CTP claim.
Fraudulent Compulsory Third Party claim
According to SIRA, Pour-Zahrouni falsely asserted she was unable to work due to a car accident, despite maintaining full-time employment. As a result, she received $55,698.06 in benefits from GIO, the insurer, by submitting fraudulent medical certificates and employer documentation.
GIO uncovered the fraud after directly contacting her employer, who confirmed that Pour-Zahrouni had been working full-time during the period she claimed to be incapacitated. She later admitted to working while collecting benefits and agreed to repay $40,457.06.
CTP fraudster prosecuted
SIRA investigated the case further, resulting in Pour-Zahrouni being charged under section 6.41 of the Motor Accident Injuries Act 2017 for defrauding the CTP scheme.
Pour-Zahrouni pled guilty, and on Oct. 4 was sentenced to 12 months’ imprisonment to be served under an Intensive Correction Order. In addition to a $1,100 fine, she was ordered to pay $6,203.03 in prosecution costs.
During sentencing, the magistrate noted the level of planning involved in the fraud and emphasised the need for a strong deterrent against compensation fraud.
This case marks the first CTP fraud prosecution pursued by SIRA, with more cases expected to follow.
Independent inquiry into SIRA’s complaints handling
SIRA reported the successful prosecution amid an independent investigation into how it manages complaints.
The investigation has commenced under the direction of the Hon Alan Robertson SC, a former judge of the Federal Court. It was launched under Section 82 of the Government Sector Employment Act 2013 and initiated by the Hon Jihad Dib.
The independent inquiry will focus on SIRA’s response to three longstanding workers’ compensation complaints, aiming to:
clarify the circumstances of each complaint
assess the legitimacy of the allegations
evaluate the adequacy of SIRA’s responses
Recommendations may be issued to either SIRA or the Department of Customer Service based on the findings.
Beyond these three cases, the inquiry will also consider 12 other complex complaints, many of which were addressed in a 2022 review of SIRA’s complaint-handling framework.
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