A paediatrician who worked in Slovakia while receiving income protection payments for a rare disorder was fraudulently claiming the benefits, according to the Australian Financial Complaints Authority. 

The woman claimed payments for Behcet’s disease when she stopped working as a paediatrician in Australia. She then moved to Slovakia.   

TAL Life paid total disability benefits from January 12 2018 to December 31 2020. In April 2022, it cancelled the policy after it found the woman had been working in Slovakia.  

It alleged the claimant began paid work as a paediatrician in July 2019, with a monthly salary of €2200 ($3566). The woman later reduced her workload to 30 hours per week.  

AFCA says the woman told TAL in regular progress updates that she intended to return to work as soon as her health allowed it.  

The claimant told the insurer in April 2020 that she had started some unpaid work on a part-time basis after being called up to be a healthcare worker during the Covid-19 pandemic.  

In February 2021, she said she had supervised a paediatric clinic one day a week in an effort to “get back into practising paediatrics”. In September of that year, the woman provided the insurer with her tax returns, which showed she had received income from a Slovakian employer. 

In a complaint to AFCA, she said she did not have the “capacity to commit fraud” given the disabling impact of her illness.  

She provided information from a neurophysicist who said Behcet’s disease results in symptoms that mimic bipolar disorder, and that her husband misled her into signing insurance papers in 2019.  

The AFCA panel questions the neurophysicist’s report, noting they were not treating the woman at the time of her false statements and did not provide a complete account of her statements, indicating she had not been truthful to the doctor about her history.   

AFCA also says the woman could not have been so cognitively impaired to be incapable of forming the intention to mislead the insurer while also being fit to be a doctor.

“Even if the panel were inclined to accept that the complainant’s work in Slovakia was less demanding than her work in Australia, the panel is comfortably satisfied that any work as a medical doctor is cognitively demanding, requiring technical expertise, discernment, judgment and with a high level of responsibility,” the authority said.  

AFCA says the woman received payment for her work as a paediatrician between October 2019 and mid-2021 and “repeatedly lied about her work in Slovakia because she was worried it might interfere with her income protection benefits”.  

It has entitled TAL to cancel the policy.  

“The claimant’s lies were not trifling, or of a short duration,” AFCA said. “She was working full-time as a paediatrician for well over a year, and then part-time, and kept telling the insurer she was only doing small amounts of unpaid work.”  

Click here for the ruling.