Beyond Detection: Building Ethical, Data-Driven Fraud Prevention in Workers' Compensation

Aidan Brophy, executive general manager for Victoria, recently spoke at a conference for the Australian Personal Injury and Disability Management sector. Using his 20 years of industry experience — including a managerial position at WorkSafe Victoria — Aidan addressed the latest trends in workers' compensation fraud.

In this article, Aidan shares his thoughts on the prevalence of the issue and the future of fraud management strategy — exploring innovative solutions, technological advancements, and the importance of training and empathy.

Fraud in workers' compensation is a complex issue — one that quietly erodes trust, inflates costs for employers and insurers, and takes vital services away from genuinely injured workers who need them most. But fraud isn't limited to injured workers; it can also involve employers and service providers, making prevention a shared responsibility across the entire ecosystem.

For Aidan, the conversation about fraud must be nuanced.

"It's important to acknowledge a fundamental truth: almost everyone in the system acts with good intentions," Aidan said. "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 aren't proof — they simply highlight patterns that demand judgement, quality data, and an ethical approach to investigation."

He continued, "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."

To lift the blindfold, Gallagher Bassett is investing in advanced data and analytics capabilities that strengthen fraud detection frameworks today and lay the foundations for future AI integration. These tools can help identify anomalies from any source, streamline routine checks, and provide actionable insights — empowering our claims staff to focus on the cases and people who require our support most.

"Our approach is about enhancing human judgement, not replacing it," Adian said.

"Fraud flags can point to wrongdoing — or to nothing at all. That's why every investigation must be rigorous, respectful, and grounded in fairness," Aidan emphasises. "We're dealing with people's livelihoods, and we take that responsibility seriously. Every decision should be centered on the individual, reflecting empathy and integrity."

For organisations working to strengthen their fraud response, Aidan thinks the roadmap is clear: "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."

If you'd like to learn more about Gallagher Bassett's unique approach to fraud prevention in workers' compensation and how we responsibly manage scheme claims, please get in touch.