Forging Partnerships with Employers to Prevent Fraud against WCB

Honesty pays, but sometimes not well enough for some…

The WCB knows that most workers, employers and suppliers are honest, but past experience has shown that there is a small percentage who are not, and their actions can be costly.

What is fraud?

Fraud is the act of obtaining anything through lies or any other dishonest means in order to obtain benefits—and it’s against the law! Therefore, making a dishonest claim of any kind is considered fraud.

For example, if a worker has an accident in the workplace and the employer or worker fails to truthfully and accurately report it as such—or if they avoid reporting incidents all together, they are committing fraud.

How does fraud against the WCB affect us?

Abuse of the workers’ compensation system costs us all. The ripple effect can include lost jobs and profits, lower wages and benefits, and higher costs for goods and services (in part because employers such as you are forced to pay higher premium rates to cover increased claims costs). And from the WCB’s perspective, dishonest claims take money away from those injured workers who are truly entitled to compensation. In the end, we all pay.

How can we prevent fraud?

Beyond realizing that fraud is something that affects us both, it is also important to recognize that there are a number of steps you can take to prevent it from occurring in the first place.

1. You can conduct thorough background checks of prospective employees. Devoting some resources to thorough background checks at the beginning can help you lessen the risk of fraudulent claims later on.
2. You may consider installing video equipment in the workplace. The installation of cameras and video surveillance equipment has been proven to deter fraud and other crimes in the workplace in general. It is important that prior to using this method of monitoring your business that you consult with local Human Rights and Privacy Legislation.
3. Develop a rapid and timely workplace injury response plan. Who is in charge when an injury occurs? Your response plan should include the following: immediately recommending a medical facility for treatment; securing the description of accident and injury; reporting the occurrence immediately to an administrator; preserving any workplace evidence; securing the names of any and all witnesses; and, if possible, taking statements from the injured worker and witnesses and securing a photograph of the area. It is important to create accident reporting procedures and to clearly communicate them to all employees ahead of time. This will ensure that timely and proper procedures are followed when an accident might occur.
4. You can implement a comprehensive workplace safety program. Make workplace safety a priority by conducting regular safety awareness seminars. Use posters, flyers and newsletters to stress safety procedures, and reward workers for achieving safety milestones. A truly safe workplace makes it that much harder for fraudulent claims to get by the system.
5. Make use of our fraud fighting toolbox. We encourage you to consult with our Investigations Coordinator with regards to what resources we might be able to provide you with as well as how you can develop your own in-house anti-fraud program.

What does the WCB do to prevent fraud?

The WCB regularly and thoroughly checks its internal files to ensure its claimants and suppliers are dealing honestly with the WCB. The WCB develops partnerships with its various employers and gives them the necessary tools to prevent fraud before it can be committed. And where appropriate, the WCB takes immediate legal action against those who attempt fraud. In 2005, the WCB investigated 71 cases of suspected fraud. And in the same year, the WCB had a cost avoidance and recovery of $1,989,200.00 (cost avoidance is an estimate of the costs the WCB would have continued to pay out for a one year period if the fraudulent activities where not detected).

What are some of the warning signs of fraud?

Please remember these are ONLY warning signs, and they do not mean that fraud is certainly taking place:

• The injury happens at the start or end of the work-week, but is not reported until after the weekend
• The injury happens right before a strike, layoff, termination or end of seasonal work or when some other job change is about to happen
• No one witnesses the accident
• The worker has made a number of suspicious claims
• It is difficult to contact the worker at home during normal working hours
• The worker doesn’t report the injury right away, and there doesn’t seem to be a reasonable explanation
• The injured worker refuses to follow the medical treatment which has been arranged
• There is a consistent circulation of rumours surrounding the legitimacy of a worker’s injury; sometimes rumours are grounded in fact

Again, even if you encounter a number of these warning signs, there is no guarantee that fraud is taking place. However, if a number of them are detected, it would be wise to investigate the matter further.

How can suspected fraud be reported?

If you suspect someone is committing fraud or have questions about it, you can anonymously call the Investigations Coordinator, toll free at: 1-866-286-3338