Investigating WSIB Claims

What are the Benefits of Worker’s Safety and Insurance Board Investigations?

Worker’s Safety and Insurance Board (WSIB) is a government body in Canada responsible for compensation to employers. It’s also responsible for overseeing the safety of the workplace. It helps employers with their no-fault insurance claims as well. The Workplace Safety and Insurance Act stipulates and governs all the WSIB operations.

Why would an employer start a WSIB (private) investigation?

If an employee files a claim for compensation as a result of being injured or hurt while at work, the employee can request a WSIB investigation to ensure the claim is accurate.  Claims can be extremely expensive for the employer. Employers often take this step to ensure their insurance premiums stop increasing. The private investigations help to keep their claim rates within reasonable levels. Employers with a higher claim rate are susceptible to paying higher premiums.

In order to minimize these claims, companies often hire private investigators to review the file, put the employee under surveillance, and ensure they are attending the medical appointments they say they are. Employers are also free to ask for or initiate the investigations if they suspect a worker of fraudulent insurance claims, or anyone suspected of playing a part in filing a fraudulent claim. The final decision to either approve or deny a WSIB claim is up to the WSIB board. They interpret the data and research gathered by the investigator, and as a result approve or deny benefits according to whether the person is truly in need of them.

Employees with hidden conditions like chronic pain, depression, brain injuries or psychological conditions are harder to assess and can often be labelled as not injured/suffering by video/camera surveillance so private investigators need to ensure they present an overall picture of the case, not just a portion.

Red flags of WSIB Fraud

Some ‘red’ flags for fraud are:

  • Unsigned forms
  • Claiming excessive distances for medical appointments
  • A worker who is never home (could be working ‘under the table’)
  • A worker who doesn’t answer the phone or who has unusual background noise when contacted (i.e. other workplace noises, or vacation sounds such as ocean waves or roller coasters 🙂

Benefits to Workers, Insurers and Employers

Insurance companies often lose a lot of money to fraudulent claims. Employers also lose a lot of money to this type of fraud. Therefore, it is in everybody’s best interest for the WSIB investigations to proceed to a fair and logical conclusion. Furthermore, the fraudulent claims prevent deserving cases from getting the appropriate compensation. Without the investigations, insurers and employers would be compromised.

Therefore, it is beneficial for employers, workers and insurers to support WSIB investigations. The rewards they get from these investigations are limitless. The deserving cases then receive proper compensation and the rotten apples are removed from the system. In most instances, they are punished according to the Workplace Safety and Insurance Act.