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Fraud Surveillance: The WSIB’s/WCB Relationship with Private Investigators

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If you live in Ontario, Canada, you’re likely familiar with the Workplace and Safety Insurance Board (WSIB), also known as the Worker’s Compensation Board (WCB) in provinces like Alberta, British Columbia and Nova Scotia. This organization provides employees throughout the province with workers’ compensation and no-fault insurance. The WSIB/WCB also works very closely with private investigators that provide surveillance in situations where they believe an employee is abusing the system or being fraudulent regarding the severity of their injuries.

What is Workers Compensation?

Workers’ compensation is provided by the WSIB/WCB to employees injured on the job. It provides employees with a replacement salary and costs related to health care provided to treat the injury. Workers’ compensation also covers rehabilitation costs, training as required, and other benefits.

What is No-Fault Insurance?

No-fault insurance means that it doesn’t matter who caused or was at fault for the workplace injury. The individual must deal with his or her own insurance company to settle the insurance claim.

Companies Exempt from Registering with the WSIB in Ontario

If you own a company in Ontario and plan on hiring an employee or contractor, you likely need to register with the WSIB. The only companies exempt from this law include the following:

  • bank, trust and insurance company
  • trade unions
  • private daycare
  • private investigators
  • travel agency
  • photography business
  • barber shop and many hair salons (with exceptions)
  • funeral or embalming establishment

If an employee is injured on the job and the company is not registered with the WSIB, there is a good chance that the employee can sue. Any company that wants to stay in business will ensure they register before they even consider hiring their first employee.

WSIB/WCB Benefits

Before we can move on to the relationship between private investigators and the WSIB or WCB, let’s take a look at the WSIB’s benefits. The overall goal of the WSIB/WCB is to get injured employees back to work as soon as possible. This means ensuring that the employee is provided with the proper care they need. While this certainly doesn’t come without cost, the WSIB/WCB does protect companies by taking care of health care costs related to on-the-job injuries, including replacing employees’ lost earnings.

The WSIB/WCB also provides comprehensive training programs, including training for employees to help reduce workplace injury and illness that can reduce staff and overall productivity. If a workplace injury does occur, the employer must try to find suitable work for the employee within their functional ability. WSIB/WCB benefits also place a responsibility on employees, such as notifying them of any changes in their income or their medical condition.

The bottom line? It is in both the employer’s and employees’ best interest to ensure a safe work environment to prevent injury on the job. The problem is, it’s not a perfect world and workplace injury does happen. It’s the WSIB/WCB’s job to ensure that workers are taken care of fairly and responsibly so that they can return to work as soon as possible.

The WSIB/WCB and Private Investigators

Unfortunately, there are situations where an individual, or group of individuals, try to get more benefits and time off than they really need or qualify for with WSIB/WCB. This is called insurance or disability fraud. Both are illegal, and if caught, the individual will find himself or herself in a lot of trouble.

In these situations, the WSIB/WCB has no choice but to turn to a private investigator or a private investigation company. A licensed private investigator is properly trained and knows how to uncover fraudulent behaviour from these individuals.

It is important that the WSIB/WCB use or work closely with a private investigator to work on these cases. Their own employees are only trained in how to put together an insurance claim and provide insurance-related help. They don’t have the training required to catch an individual in a lie, nor are they legally licensed to conduct surveillance and other related services that a PI is licensed to conduct.

Private Investigator Services

When a private investigator is called into work on a WSIB/WCB case, there are a few types of services they can provide, including,

  • Interviews
  • Insurance Fraud Investigation
  • Disability Claims Investigation
  • Long-Term Disability Investigation
  • Activity Checks
  • Witness Locates
  • Background Checks

The purpose of conducting an investigation is to discover whether or not an individual is lying about their injuries or claims, or participating in fraudulent behaviour, with the WSIB.

Private Investigators and Surveillance

Private investigators in Toronto, Ontario or Vancouver, British Columbia, primarily use surveillance techniques to determine whether or not an individual is lying to the WSIB/WCB. In many situations, the individual claims they cannot return to work due to their injury. In other situations, an employee might claim that their injuries are worse than they actually are.

For example, let’s say that an employee cuts his or her hand while on the job. While the cut was bad, it required a few stitches and two weeks off work to recuperate. However, the employee lies on their claim, stating that the injury has prevented him or her from returning to work for at least 12 weeks.

The WSIB/WCB hires a private investigator to conduct surveillance. The private investigator sees the employee out with their dog, using the injured hand to play fetch with their dog, and lifting the dog into their vehicle. The same afternoon the employee takes out the trash, using their injured hand without any trouble.

The behaviour confirms that the individual is lying about the extent of their injury to avoid going back to work or to receive more WSIB/WCB benefits than they are entitled to. Using surveillance to watch that individual carefully, a licensed private investigator can inform the WSIB/WCB.

What Happens If Fraud Is Detected?

The WSIB can then take action against the individual. In most situations, this means that the individual will have to pay a fine. This often includes any money that was provided past the defined period of the actual injury. The employee is often fired from their job, as this behaviour is fraudulent and ultimately comes at a cost to the company.

In more severe cases, the individual can face jail time.

It’s important to note that the WSIB/WCB does not hire a private investigator to look into every single employee. So, there’s no need to worry if you’ve put in an honest claim. Your WSIB claim will not be automatically flagged. WSIB and WCB are ultimately there to help workers receive the coverage they need to recover from workplace injury and return to work. However, in order to ensure the system is not abused, WSIB/WCB is looking for individuals with inconsistencies in their stories. In some situations, they also receive tips, which they take very seriously.

Looking for licensed private investigation services? Our team is here to help.

About the Author

Whitney Joy Smith

Whitney Joy Smith is a prominent figure in the field of private investigation and security, serving as the founder and CEO of The Smith Investigation Agency Inc., Smith Security Inc., and Training Centre Canada, as well as a sitting politician.

With a remarkable journey that began in the early 2000s, Whitney's professional background as a private investigator is underscored by her unwavering dedication to the role. Born in Canada and having spent her early years between Canada and the United States, Whitney possesses a unique perspective shaped by her experiences in both countries. This background equips her with an in-depth understanding of the intricacies of private investigative laws, regulations, and operational standards in North America.

Throughout her career, Whitney has garnered numerous industry awards and accolades. She takes great pride in working closely with her continually expanding agency, striving to elevate industry standards, maintain compliance, and effectively meet the diverse investigative needs of clients.

Whitney actively engages in various membership, committee, board and support roles, demonstrating her commitment to the industry and professional community. She is affiliated with all local chambers, associations and more.

Whitney's wealth of experience is not limited to her professional achievements; her thought-provoking articles have been featured in publications ranging from Readers Digest, Cosmopolitan, Huffington Post, and Mens Health to Business News Daily. She constantly seeks to redefine standards and push the boundaries of excellence within the private investigative and security fields.

To discover more about Whitney Joy Smith and the dedicated team at The Smith Investigation Agency Inc., visit our website to learn more.

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