In order to secure a conviction in criminal proceedings such as fraud each element of an offence must be proven to the criminal standard, that being 'beyond reasonable doubt’, as opposed to the lesser civil onus of 'balance of probabilities'. If this standard of proof is not met, the prosecution will fail.

While not all allegations of fraud will reach the required standard of proof for investigation and ultimately criminal prosecution, cautions may be issued and methods of civil debt recovery may be pursued to recoup overpayments and monies received fraudulently.

Examples:

• Allegation that a doctor is charging for consultations that did not take place – must have a statement from a witness to prove that the consultation did not occur.
• Allegation that a worker failing to ‘notify return to work’ – it must be proved beyond reasonable doubt that the worker was aware of his/her obligations to notify.  Eg a signed declaration/notice that they were told of their obligations.
• Allegation that an injured worker was in secondary employment while receiving benefits – it must be proven beyond reasonable doubt that the worker was being paid for work. Eg wage records or pay slips from secondary employment.
  

Determination of liability for each workers compensation claim is the responsibility of the Agent, Self or Specialised Insurer's, and ultimately, in matters of dispute, the Workers Compensation Commission.

A successful criminal prosecution may not necessarily render the claim itself invalid.  A successful prosecution may result in a retrospective amendment of premiums paid.