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Inquiry Into Acc Fraud Unit Serious misconduct of the ACC Fraud Unit

#41 Guest_mini_*

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Posted 02 June 2007 - 10:56 AM

Okies huggie & Fairgo

Am thinking would only need a transferrable e-mail copy of the article to get it through.

You know how ITish I am NOT!!!

Cheers Mini
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#42 User is offline   Al9lifes 

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Posted 02 June 2007 - 02:49 PM

Preliminary Independant Report .Anne Scragg DRSL.

On 26/6/02 a non-compliance decision was issued to Mr Langdon declining to provide entitlements from that date.
ACC's decision was upheld at review.
ACC commenced a fraud investigation, which led to charges being laid against Mr Langdon. These charges were withdrawn in March 2004 but ACC insisted that Mr Langdon complete the statutory declaration before it would reinstate his weekly compensation.

He did not do so and it was not until 29/3/05 following the intervention of the Office of the Ombudsmen that all his entitlements were reinstated and he received payment of arrears backdated to 27/6/02. ( But not the time spent on WINZ so only three months worth of arrears out of 21 have been paid so far so 18 months of arrears still coming...... )

Quote

Interest. Anne Scragg. (In the same preliminary report !!)
Mr Langdon applied for interest in respect of the backdated weekly compensation and on
9/3/06 he was paid interest totalling $35,373.96. This covered the period from 1/7/92 to
23/12/05 with the exception of the periods between 30/7/02 and 12/10/02 and 4/2/03
and 16/1/05.
These periods were excluded because the amount due to be reimbursed to
Work and Income had yet to be fixed.


ACC's actions in relation to the fraud investigation were criticised by the Ombudsman
following a lengthy investigation and ACC has accepted the Ombudsman's findings.


Although ACC has paid Mr Langdon arrears for the period during which his compensation
was suspended,( not yet !!) he retains a strong sense of grievance about the fraud investigation.

When he raised the matter with me on the telephone, I had the sense that he felt persecuted and harboured significant fear and suspicion of ACC as a result of the action it had taken
against him.


Another consequence of the fraud investigation is Mr Langdon's insistence that his
transport costs and any other claim expenditure must be attached to the correct claim file.


He maintains that he does not want to be accused of anything which might be found to be fraudulent or to be involved in any way if mistakes of this nature are made.

This presents ACC with a few difficulties because of the large number of Mr Langdon's
claims and the overlapping nature of some of his injuries.

It is quite possible that from time
to time the wrong claim number will be used because it may not be easy to identify the
correct one(s).


My suggestion is that ACC provide Mr Langdon with a written assurance that he will not be held responsible for any errors of this nature as long as he provides ACC with a full and clear description of the treatment or costs he is seeking.

It will then be ACC's responsibility
to allocate the costs to the particular claim(s).

I have given careful consideration to the issue of whether Mr Langdon should receive an ex gratia payment from ACC in relation to the fraud investigation.

I have concluded that this would not be appropriate.

Although ACC's investigation has been the subject of criticism from the Ombudsman and
ACC has accepted the Ombudsman's findings, to some extent I believe Mr Langdon was
responsible for the very unfortunate situation in which he found himself.


He had been given clear notice of ACC's requirements in terms of transport to treatment costs and continued to lodge claim forms which contained inadequate information.

It was very difficult, if not impossible, for ACC to contact him to clarify matters because he would not allow ACC to telephone him.

He refused to complete a statutory declaration when requested to do so.

While all these things are to some extent understandable, in view of Mr Langdon's injuries (and particularly his post-traumatic stress disorder) and itinerant lifestyle, they were nevertheless factors which, in my view, played a part in the events which
followed.


ACC's investigation was clearly flawed and resulted in an unjustifiable suspension of Mr Langdon's weekly compensation.

I believe, however, that reinstatement of compensation and payment of arrears (with interest) has adequately dealt with the matter.( I am still waiting for the bulk of this to be paid)

For these reasons I do not believe an ex gratia payment is appropriate.

Attached File  Part5pdf.PDF (822.58K)
Number of downloads: 9

Attached File  part4pdf.PDF (1.04MB)
Number of downloads: 7
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#43 User is offline   Al9lifes 

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Posted 02 June 2007 - 03:44 PM

Quote

adequately dealt with the matter


yeah right
Attached File  part1pdf.PDF (875.64K)
Number of downloads: 11

Quote

In preparing this report I have had to rely on ACC's file documentation, copies of file documents annotated by Mr Langdon and documentation from the Office of the Ombudsmen.

It is possible I have either misunderstood Mr Langdon's concerns or failed to take relevant matters into consideration


Easy out ?
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#44 User is offline   Al9lifes 

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Posted 02 June 2007 - 04:15 PM

3. Independent review/audit
You have noted your concern that although you received notification of the Corporation's
decision to obtain an independent review/audit of your claims from the Ombudsman and
Ms Scragg, you have not received such advice from the Corporation itself.

Please accept my apologies for the oversight.

I decided to obtain the independent advice because I was concerned that previous attempts to address your complaints had not been fully successful.

You clearly still had concerns about the management of your claims, and that you had not received your rightful entitlements.

In discussion with the Ombudsman, I decided that I needed to seek a fresh and independent view of your concerns.

I decided to appoint Ms Scragg to provide me some advice on the matter, so that I could be informed when I discussed the matter again with the Ombudsman.

I also advised Mrs Scragg that I was prepared to authorise you receiving some independent legal advice. (gee thanks for the permission dude)

Until I have received further advice from Ms Scragg, I cannot comment on your specific concerns about your case, nor can I properly report to the Ombudsman about your
complaints to her office.

I read in one of your emails your concern that you have not received your full
entitlements, and you ask Dr White to look at the level of assistance you have received
from ACC in the years 1990 to 1997.

You have also asked her about the involvement of several individual staff members.

It is for these very reasons that I requested an independent review/audit of your claims, the assistance provided to you so that I can be advised on the appropriateness of.

Should the review also highlight some concerns about the involvement of any staff member, I will also be in a position to make an informed decision about the appropriate action ACC should take.
15 June 2006
Coo Go Hard and Greasy
Attached File  15Jun06GMpdf.PDF (1.08MB)
Number of downloads: 8
Attached File  15Jun06GMpdf.PDF (928K)
Number of downloads: 14
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#45 User is offline   Al9lifes 

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Posted 02 June 2007 - 04:47 PM

Quote

15 June 2006 Gerard Mc Greevy
I decided to obtain the independent advice because I was concerned that previous attempts
to address your complaints had not been fully successful.


Quote

14 June 2006 Paul Miller
In respect to your request for details about Ms Scragg's involvement in your case, my letter
of 12 June 2006 advised you that Ms Scragg's file review/audit was in response to an
Ombudsman's complaint.


Quote

Until I have received further advice from Ms Scragg, I cannot comment on your specific
concerns about your case, nor can I properly report to the Ombudsman about your
complaints to her office.

Attached File  15Jun06GMpdf.PDF (928K)
Number of downloads: 14
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#46 User is offline   Al9lifes 

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Posted 05 June 2007 - 10:51 AM

So the ACC PI's going around to my freinds and family as well as the local policeman and storekeeper stating I was being investigated for fraud when fishing for information to support their hypothesis is not Legal ?
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#47 User is offline   Spacecadet 

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Posted 05 June 2007 - 11:31 AM

View PostAl9lifes, on Jun 5 2007, 10:51 AM, said:

So the ACC PI's going around to my freinds and family as well as the local policeman and storekeeper stating I was being investigated for fraud when fishing for information to support their hypothesis is not Legal ?


I am currently working to put this exact situation before the Human Rights Tribunal. It does indeed breech the Privacy Act, but there are no penalties under this Act.

Also there is the issue that the Privacy Commission is now using the excuse that because the PI's were contracted to ACC, the Privacy Commision does not have to investigate complaints about them. This too is being put to the Human Rights Tribunal, as well as the Ombudsman
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#48 User is offline   Al9lifes 

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Posted 05 June 2007 - 11:40 AM

Good Luck with that.Spacecadet.

My efforts at bringing these and other related matters to the Ombudsmen and the Privacy / Human Rights has been fairly unsucessful thus far.

They duck the issue and weave excuses between Acts and organizations.
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#49 User is offline   Alan Thomas 

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Posted 05 June 2007 - 11:44 AM

In my own case the ACC fraud unit private investigators collected 43 witnesses for a trial. My best estimate is that they contacted well over 100 people all of whom they alleged I was committing fraud which effectively destroyed my reputation.

They even had my doctor and my surgeon trying to turn what they said inside out. For example I asked my doctor if he would have given me medical certificates if he thought I was working. His answer was "of course not". This was taken to mean the ACC believed that my doctor did not know I was no longer incapacitated. After a fraud conviction based on my doctors evidence I was convicted. However my doctor kept on providing medical certificates because I could not work.

They made out that my surgeon had carried out surgery without surgery being necessary. Even though he stated this concept was ridiculous the mud seems to have stuck with the result that no other surgeons in New Zealand want to provide me with surgery as my condition deteriorates.

The ACC fraud unit and the use of PIs appear to be making big headway into overriding medical evidence simply by breaching the privacy act, creating vast quantities of false information which cannot be corrected with assistance of the privacy Commissioner. Spacecadet is correct in as much as the Privacy Commissioner claims they are unable to address the information gathered by Private Investigators and even though the ACC is relying upon this information in order to process our files when the ACC Fraud Unit claim that the file as part of a fraud investigation.

The ACC Fraud Unit are using the Privacy Act to prevent the identification and correction of false information. Hopefully Spacecadet can clarify this attack on the integrity and preservation of our private information.
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#50 User is offline   MG 

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Posted 05 June 2007 - 03:45 PM

Thanks for posting the above - the Americanization of our society continues apace, regardless of the fact that most NZers hate it. ACC does not care how many claimants it alienates because it has no duty of care or contractual liability towards them. ACC's stakeholders are the commercial and bureaucratic elite, who see everyone not engaged in paid employment as useless eaters and a drain on the elite's capacity to maximize their wealth. As fair as ACC's internal "fraud review" is concerned, I confidently predict it will be a crock of shit, principally because of its own bureaucrats is conducting it, with no input whatsoever from the people who have been most harmed by the actions of ACC's fraud squad and its agents. One of the cardinal principles of natural justice is "nemo judex in causa sua", meaning "no one can be a judge in their own case". Yet this is precisely what ACC is doing in its "fraud review". I believe that claimants and their representatives should have nothing to do with ACC's "fraud review" but, instead, apply for judicial review of it once it is published.
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#51 User is offline   Alan Thomas 

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Posted 05 June 2007 - 04:10 PM

MG-I am a little confused when you made references to the Americanisation of New Zealand. The ACC is about as far from capitalism as can be. The ACC Act is in the traditions of communism, whereby the interests of the few are disregarded for the benefit of the many, together with the inherit corruption. The Communists always took the People's money and invested it elsewhere in a way to someone else's benefit. A capitalist would never do this simply because the person doing it would be prosecuted for embezzlement.

America has the best legal system that is ever existed throughout human history. It has a foundation in a truly wonderful constitution from which all other law must conform. The American health system has advanced medicine at an astonishing rate. Most injured people have their injuries settled by insurers promptly at a reasonable reimbursement. Of course there are the extremes either side but in the main a lot better than our ACC injury insurance and judicial protection, which is practically non-existent. In real terms we are not reasonably compensated nor rehabilitated. Recently receive an embarrassing a token gesture with the person who caused the accident get away scot-free.

With regards to the ACC Fraud Unit Review it is irrelevant what the ACC wants to review. In all probability the criteria of the review will be reconfigured or result in at the very least judicial review. Of course I had dipped my ore in the water regarding the ACC fraud unit practices and will press this matter home given the high level of damage these people have caused me and others who are likely to continue to wreak harm if not stopped.

What really counts is that those who produce false documentation for pecuniary advantage shall be put in prison when the sums involved reach the necessary threshold to warrant incarceration. Most false documentation involving a long-term claimant will reach this threshold. Incarceration should act as a deterrent for any ACC employee seeking to illegally steal from an invalid.
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#52 User is offline   Spacecadet 

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Posted 05 June 2007 - 04:13 PM

My sentiments entirely MG.
I have marked in my diary the date to apply for a copy of the findings of the review under the OIA.

Alan
I think you still have a little more to learn about the application of the law in NZ before you can go around stating who should be imprisoned for which offence.
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#53 User is offline   Alan Thomas 

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Posted 05 June 2007 - 04:23 PM

View PostSpacecadet, on Jun 5 2007, 04:13 PM, said:

Alan
I think you still have a little more to learn about the application of the law in NZ before you can go around stating who should be imprisoned for which offence.


Do you mean as the law is written or are you suggesting that ACC employees and its agents are immune from criminal prosecution of falsify documentation. Remember they don't need to obtain a pecuniary advantage for themselves when committing this type of crime. These types of crimes have a maximum penalty of seven years incarceration. As a sample miss-directing $200,000 by the use of a document will generally result in two years incarceration.

Are you suggesting these criminals should not benefit from the application of the law and perhaps should be punished outside of the law?
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#54 User is offline   Spacecadet 

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Posted 05 June 2007 - 04:59 PM

One of the first principles of understanding the legal system as it operates in NZ is: The law "as written" is determined by the learned Judges of the High Court; and not by Alan Thomas.
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#55 User is offline   Alan Thomas 

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Posted 05 June 2007 - 05:05 PM

What are you trying to say Spacecadet?
Are you suggesting that I might be wrong in law?
Are you suggesting the existence of special laws that permit public servants to steal from those who they serve?

What I am am talking about is the difference between a government servant making an honest mistake and a conspiracy to falsify documents. An ACC worker making a mistake is dealt with under civil legislation, Part 5of the ACC Act. The same ACC worker deliberately falsify documentation comes under the Crimes Act which is measured for purposes of incarceration in terms how much money was stolen.

If I am wrong in law please explain it to me.
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#56 User is offline   Spacecadet 

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Posted 05 June 2007 - 05:10 PM

exactly as written
The High Court give out "interpretations" of what is written, and comment on how it should be applied. i.e case law.
What you or I may think the law means is irrellevant unless backed up with case law.
No vebose replies - just do the homework first.
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#57 User is offline   Alan Thomas 

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Posted 05 June 2007 - 05:19 PM

Spacecadet your response is empty yet I'm still intrigued by the viewpoint you are advancing. If you think the High Court has made a new ruling different to what I have described, from the thrust of Adams on Criminal Law, which is the same law for public servants, I would certainly like to have a copy of that ruling as it would override almost 400 years of developed law.

I wonder if we are focusing too much on civil law and in particular Part 5 of the ACC Act?

I wonder if the ACC staff and private investigators think that they might be immune from criminal prosecution. The ACC Act certainly does not give them any immunity from what I can read.
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#58 User is offline   fairgo 

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Posted 06 June 2007 - 06:27 PM

Well well well.....what coincidental timing. Following my request that the fraud review be placed on the COG agenda yesterday and an explaination given as to why COG were not consulted as a stakeholder, Dr White's letter inviting COG to provide a submission to the review arrived....

The upshot being that the review is firmly on the agenda and COG members have been invited to consult with their parent groups and begin to gather any material that members have, that could contribute to providing the reviewer with an overview of claimants' experience of the ACC Fraud team.

This review is not an appropriate forum to advance individual cases.

So over the next two weeks I will be canvasing Acclaim Otago members and preparing information that can be tabled at COG on 19th June.
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#59 User is offline   Alan Thomas 

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Posted 07 June 2007 - 11:42 AM

In order to determine whether or not the ACC Fraud Unit is competent in what it does or has another agenda it is often beneficial to take a 10 year overview. The following is from the INFORME program the acc front-line staff are told to rely upon. This of course was under the 1992 act but fraud of course remains essentially the same as it comes under the Crimes Act.

Fraud

Facts about
1. Facts about suspension or cancellation of payments or services
2. Facts about offences


Procedures
1. Procedure for suspension or cancellation of payments or services
2. Procedure for identifying an alleged offence


Facts about suspension or cancellation of payments or services
Introduction
Section 73 "Suspension, cancellation or refusal of compensation and rehabilitation" allows payments or services to be suspended or cancelled where ACC is not satisfied the claimant continues to be entitled to treatment, service, rehabilitation, related transport, compensation, grant, or allowance.
Indications
The first indication that the claimant may not be entitled to the compensation they receive could be any of the following:
 A phone call or letter from a member of the public who is complaining that the claimant is "ripping off" ACC.
 Staff with local knowledge are aware that the claimant is working.
 Local newspaper featuring the claimant performing activities that suggest they are fit for work.
 Comments from an employer about their employee.
 Inconsistent information on the claimant's various files, such as a claimant in receipt of weekly compensation later lodging a claim for a rugby injury.
 Extended incapacity for a "minor" injury.
Referral to investigators
Where it is felt that there is sufficient reason to suspect that a claimant may not be entitled to the compensation they are receiving, an investigation of the claimant can be initiated.

Facts about offences
Introduction
Section 166 "Offences" outlines fines and terms of imprisonment which may be imposed on a person convicted by a court of an offence against ACC.
False statements and actions
It is regarded as an offence if a person makes a statement knowing it is false. This could be one of the following:
 Wilfully doing or saying anything, or omitting to do or say anything, for the purpose of misleading or attempting to mislead anyone concerned in the administration of this Act.
 Making any statement that is false, with reckless disregard as to whether or not it is true.
A statement or action is an offence if made or done for the purpose of receiving or continuing to receive (or which results in any person continuing to receive) treatment, service, rehabilitation, related transport, compensation, grant or allowance.
Conviction for any of the above offences can result in a term of imprisonment of up to three months, or a fine of up to $5000, or both imprisonment and a fine.
Failure to provide information
Effective from 1 July 1993, it is also an offence if any of the following people fail (without reasonable cause) to provide information requested by ACC that is necessary to administer the Act:
 An employer or former employer of a claimant.
 A provider of treatment services, rehabilitation, related transport or certificates.
 Any person who has received payment in respect of any claimant.
Conviction for any of the above offences can result in a fine of not more than $2,000 and, where the offence is a continuing one, to a further fine not exceeding $50 for every day during which the offence has continued.
Failure to advise
It is also an offence to fail to advise ACC or an accredited employer (or exempt employer) as soon as practicable, that the amount of earnings has increased, where that may reduce the compensation payable to that person, when in receipt of any of the following:
 Compensation for loss of earnings.
 Compensation for loss of potential earning capacity.
 Weekly compensation to other dependants.
 Weekly compensation payable to surviving spouses and dependants.
Conviction for committing this offence can result in a fine of up to $5000.
Penalties
A fine of up to $500 may be imposed on anyone committing an offence under the Act or under the Act Regulations for which no penalty is otherwise defined.
A person may be liable for any offence for a period of up to 5 years after the end of the calendar year in which the offence was committed. They may also be liable for more than one offence that is founded on the same facts.
1 Procedure for suspension or cancellation of payments or services
1.1 Establish whether the claimant continues to be entitled to treatment, service, rehabilitation, related transport, compensation, grant, or allowance. The first indication that the claimant may not be entitled to the compensation they receive could be any of the following:
 A phone call or letter from a member of the public who is complaining that the claimant is "ripping off" ACC.
 Staff with local knowledge are aware that the claimant is working.
 Local newspaper featuring the claimant performing activities that suggest they are fit for work.
 Comments from an employer about their employee.
 Inconsistent information on the claimant's various files, such as a claimant in receipt of weekly compensation later lodging a claim for a rugby injury.
 Extended incapacity for a "minor" injury.
1.2 Where you feel that there is sufficient reason to suspect that a claimant may not be entitled to the compensation they are receiving, an investigation of the claimant can be initiated.
There are new procedures currently being developed for the investigation process. Until these are available continue the current system being used in your Branch Office.
1.3 If the investigation has established that a claimant is not entitled to treatment, service, rehabilitation, related transport, compensation, grant, or allowance they are receiving, payments or services should be suspended or cancelled.


2 Procedure for identifying an alleged offence
2.1 Indications of when a person may have committed an offence could be identified in any of the following circumstances:
 When medical certificates have been altered.
 The employer has refused without reasonable excuse to provide requested information.
 Information provided by the claimant or other person is later found to be false or misleading.
 An "earnings certificate" is unsigned or does not include a business stamp.
 An "earnings certificate" has been altered.
 A treatment provider fails to provide details of treatment provided to a claimant.
2.2 Investigate any refusal or failure of the claimant, employer or treatment provider to comply with ACC requirements. Do both of the following:
 Write to the claimant, employer or treatment provider requesting their written reasons for refusing or failing to comply with ACC's requirements.
 Enter a bring-up for two weeks to follow-up if a reply is not received.
2.3 Consider if any instance of a refusal to provide information or an attempt to mislead ACC was either intentional or unreasonable. It will not be appropriate to assume an offence has been committed on the basis of one instance of failure or refusal to meet any requirements.
2.4 If you consider an offence may have been committed, write a memorandum to the Examining Officer detailing the facts of the case and a recommendation for future action on the file.
2.5 Forward the file to the Team Leader for comment and request further information if necessary.
2.6 If an employer or treatment provider fails to provide information to ACC, it will be necessary to determine whether or not there is a good reason for them not doing so before utilising powers under section 166 "Offences".
 It is ACC's responsibility to make sure that prosecution under this section is not considered without first informing the specified person that it is an offence under this Act not to provide this information.
 It is also essential for ACC to make sure that the claimant has given their written consent to the information being sought from the specified person and that consent has been passed on to the specified person before ACC decides to commence prosecution proceedings.
2.7 Authorisation should be obtained before taking the following action:
 A private investigator's report is to be sought in cases where an alleged offence has or may have taken place.
 The private investigator will be instructed to investigate the alleged offence and make a recommendation on whether or not an offence has taken place.
2.8 If it is established that an offence is likely to have occurred, the claimant may be interviewed by the private investigator. At that stage a decision will be made to determine if an alleged offence has taken place and whether sufficient evidence exists for entitlement to be stopped.
2.9 The Examining Officer will be involved in all aspects of the investigation and will advise the correct procedures until they are available here.




Table of contents for fraud letters and forms

Forms:
Form 1 FRA6 (Informant information)
Form 2 FRA7 (Referral information)
Form 3 FRA8 (Audit checklist)
Form 4 FRA9 (Investigations update)
Form 5 ACC FPMIS worksheet
Form 6 FRA15 (Statement of claimant's rights)


Letters:
Letter 1 FRA1 (Statement in writing)
Letter 2 FRA2 (Referral for investigation)
Letter 3 FRA3 (Introduction and authority for referral)
Letter 4 FRA4 (Notice of interview)
Letter 5 FRA5 (Investigation status report)
Letter 6 FRA14a (Section 166 to employer)
Letter 7 Victim impact statement (to the district court)
Letter 8 Example memorandum to investigators
Letter 9 FRA10 (Activities inconsistent)
Letter 10 General practitioner letter (Activities inconsistent)

What is really quite horrific is the low threshold for the ACC to initiate a criminal investigation. Once this criminal investigation is underway ACC then apply S27 of the Privacy Act.

It would seem that almost everybody would reach the criteria of five tick boxes to initiate a fraud investigation.

Attached File(s)


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#60 User is offline   Medwyn 

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Posted 07 June 2007 - 02:55 PM

Alan, and others,

Correct me if I'm wrong but I believe that front-line ACC no longer use the Informe programme and have not for a while.

I am lead to believe that new policies and procedures (ie Proof of Identity etc.)
are in place or being phased in as part of the major software upgrade to allow more electronic input from staff and contractors.

I suggest you check your source documents as I noted that some of the comments you quote are out of date therefore unintentionally misleading.
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