Insurance fraud is often a difficult topic to discuss. The reason why is because many people all across Ontario require insurance payouts to help in cases of injury or illness. If a person can’t work, they still need a way to make ends meet. It is for this reason that anyone who decides to engage in fraud is met with swift action and punishment. It is also for this reason that the WSIB in Ontario is stepping up its surveillance game.
Want to know more? Well, first things first. Let’s take a look at what the WSIB is and does, and who they hire to help.
What is WSIB?
WSIB stands for the Workplace Safety Insurance Board. The WSIB is the organization in Ontario that takes care of paying out injured or ill employees. By law, many organizations and companies throughout the province must provide this insurance for their workers.
If someone is injured on the job or falls ill, he or she will need to file a claim with the WSIB. Depending on the claim, the injury, or the illness, the WSIB will require information from a doctor or specialist to confirm the fact that the employee cannot work. In general, this is enough proof to demonstrate that the employee isn’t faking their injury or illness.
Once the WSIB has all the information and approves the claim, the employee can expect to receive their payment or benefits. In Ontario, these benefits are called, Loss of Earnings benefits. Depending on the claim, the benefits generally cover up to 85% of the employees’ pay (pre-injury). In addition, the employee is typically entitled to 12 weeks of full pay starting from the injury date. Factors that impact payout length and percentage include, whether or not the employee hold a permanent or part-time position.
As you can see, if the WSIB didn’t have rules or regulations, many employees could just make a claim and not continue to work. It is for this reason that making a false claim is illegal.
It’s Not Worth the Trouble!
If an employee decides to make a false insurance claim, this is considered fraud. Getting caught just isn’t worth the trouble. Why? Well, anyone who makes a fraudulent insurance claim is subject to paying hefty fines. Depending on the results of the trial, the employee could also face jail time.
Despite fines and jail time, we know that there are still people out there who try to game the system. So, how does the WSIB handle these situations?
Hire a Private Investigator
In many situations, the WSIB will turn to a private investigator or private investigator agency for help. The main reason why the WSIB hires private investigators is that private investigators have the right training to uncover the truth.
It’s important to note that the WSIB does not hire private investigators for every single employee making a claim. If however, a WSIB employee notices discrepancies or gets a tip, it is in their best interest to follow up on the individual. In general, if the WSIB hires a private investigator to look into a case, it’s because it’s pretty serious and outside help is required.
A private investigator or private investigation team will use a variety of different techniques to uncover the truth. When it comes to fraud, private investigators often use surveillance to get the job done.
What is Surveillance?
Surveillance is a technique that private investigators use to observe an individual as they go about their regular, daily activities. For example, let’s say that an employee claims that he suffered a neck injury. However, some questions about the claim come up. A private investigator or several private investigators will set up surveillance. They will watch the employee, and record what he or she does all day.
If, for example, the employee remains at home, wearing a neck brace and goes for a slow walk around the block, the private investigator will report this back to the WSIB. But let’s say that the employee leaves the house without a neck brace to start building a huge deck in his backyard. The private investigator will also report this back to the WSIB.
When it comes to surveillance, a private investigator won’t have an opinion. He or she will simply present the facts to the WSIB. The WSIB then reviews the facts to determine whether or not they need to take action.
Methods of Surveillance
Most private investigators will do surveillance in one of two ways, or a combination of both. Depending on how much ground the private investigator needs to cover, he or she will bring in more private investigators to help.
In many cases, a private investigator will sit in a parked vehicle to watch the employee. This is extremely useful in situations where the employee is at home. If the employee leaves the home via car, the private investigator can tail the employee to see where they go and what they do. It is important for a private investigator to drive a car that doesn’t draw any attention. It is also important for the employee not to figure out that he or she is being followed. A private investigator must use their vehicle as a tool to help them get the job done right.
Of course, there are also situations where the employee might leave home. In these cases, the private investigator must be prepared to move. The employee might drive to their destination, but they could also walk on foot. Once the employee reaches their destination, they will also likely step out of their vehicle and go about their business. A private investigator needs to use his or her training to make sure they follow at a discreet distance. They must make sure the employee does not see them. They must also be in contact with any other private investigators in their team.
The most critical part of any surveillance investigation is that the subject must not know a private investigator is observing him or her. The moment anyone realizes they might get caught, they change their behavior. A private investigator wants the truth, so anything that could disturb that must be avoided at all costs.
Why did the WSIB Increase Surveillance?
Again, it is very important to note that the WSIB does not run surveillance on all individuals making claims. The majority of people don’t lie about their injuries or illness, and the WSIB isn’t trying to make anyone uncomfortable. However, the WSIB does need to take action on individuals looking to scam the system. It isn’t right or fair for these individuals to get financial compensation when there are others who legitimately need it more.
According to the Toronto Star, in 2014, the WSIB increased the amount of surveillance conducted on claimants. There is one major reason why the WSIB is stepping up its surveillance game.
The Unseen Illness – Mental Health
Every year, the WSIB receives approximately 250,000 claims and pays out benefits of around $2.5 billion. In more recent years, the WSIB has seen a shift in the type of claims an employee files. Depression, anxiety, and stress-related issues are closely linked to disability, illness, and injury. What this means is, people more often require more time to heal over the long-term. Unfortunately, this can lead to people contacting the WSIB with ‘tips’.
Getting Some Fresh Air – An Example
For example, let’s say that a woman is recovering from a nasty fall. She uses a cane and receives benefits. The problem is, sitting around at home isn’t good for her mental health. The woman gets encouragement from her doctors to try and get outdoors as much as possible. So, she goes to the mall and buys a few things to brighten her day.
Let’s say that someone she knows, one of her colleagues, sees her out and about. Let’s say that the colleague determines that she looks fine! There’s no way she shouldn’t be at work. She’s walking around and shopping! That colleague then decides to call the WSIB with a ‘tip’.
The WSIB then needs to decide whether or not to follow up on the woman. Unfortunately, in most ‘tip’ cases, following up on the individual is a requirement.
WSIB and Private Investigators—Erasing Fraud
As you can see, the unseen illness that is mental health means that the WSIB has to step up its surveillance game. The challenges this presents is something both the WSIB and private investigators must acknowledge. Accusing an employee of fraud is a serious offense, and so it is critical that a good private investigator get all the facts.
By stepping up their game, the WSIB ensures that the payouts they provide go to the right employees. After all, fraud is illegal any way you look at it. Hiring a private investigator to gather surveillance only helps to ensure the future of benefits for employees that need them.