Gallagher Bassett (GB) is advocating for a shared approach to fraud prevention, recognising that fraudulent activity in workers' compensation can involve not only injured workers but also employers and service providers.
During 2023–24, there were 146,700 serious workers’ compensation claims involving at least one week off work in Australia. Most claims were related to body stressing, falls, slips and trips, being struck by moving objects, or mental stress, accounting for 84% of all serious claims.
Older workers, particularly those aged 55 to 64 and 65 years and over, had the highest rates of serious claims at 9.5 and 10.0 per million hours worked, respectively. Mental health conditions made up 12% of serious claims, a figure that has increased by 14.7% since the previous year and by 161% over the past decade. The median time lost from work for mental health claims was nearly five times longer than for other types of injuries or illnesses.
Aidan Brophy, executive general manager – Victoria at Gallagher Bassett, said the conversation around fraud must be balanced and considerate of the wider system. “It’s important to acknowledge a fundamental truth: almost everyone in the system acts with good intentions. Fraud prevention isn’t about treating all participants as suspects; it’s about using information responsibly to identify anomalies that may require closer review. Even then, fraud indicators are not proof – they simply highlight patterns that demand judgement, quality data, and an ethical approach to investigation,” Brophy said.
Brophy noted that Gallagher Bassett is implementing data and analytics tools in its fraud detection processes for workers’ compensation. He said the company’s goal is to develop systems that can help prevent fraud. “The challenge isn’t just spotting fraud; it’s about building systems resilient enough to prevent it. Without the right tools, we’re asking our people to find a needle in a haystack, blindfolded,” he said.
Brophy explained that the company uses technology to assist with decision-making by claims staff, rather than to automate it entirely. “Our approach is about enhancing human judgement, not replacing it,” he said. He added that while automated tools can identify potential issues, these signals are not conclusive and require further review. “Fraud flags can point to wrongdoing – or to nothing at all. That’s why every investigation must be rigorous, respectful, and grounded in fairness. We’re dealing with people’s livelihoods, and we take that responsibility seriously. Every decision should be centred on the individual, reflecting empathy and integrity,” he said.
Brophy said organisations should consider ethical decision-making and integrity when developing fraud prevention measures. “Start by fostering a culture of integrity and ethical decision-making. Build strong data and analytics foundations, designing systems that are smart, fair, and human-centered, and consider AI as a future enabler – not a replacement for human judgement,” he said.
Gallagher Bassett states that its current strategy involves the use of data systems alongside oversight by claims staff. The company reports that its aim is to support decision-making processes in claims management and maintain consistent standards in fraud prevention.
