Fraud Surveillance in Ontario: The WSIB’s Relationship with Private Investigators

Fraud Surveillance in Ontario: The WSIB’s Relationship with Private Investigators

If you live in Ontario, Canada, you’re likely familiar with the Workplace and Safety Insurance Board (WSIB). This organization is responsible for providing employees throughout the province with workers compensation as well as no-fault insurance. The WSIB also works very closely with private investigators that provide surveillance in situations where they believe an employee is lying about the severity of their injuries.

What is Workers Compensation?

Workers compensation is provided by the WSIB to employees injured on the job. It provides employees with a replacement salary and for costs related to health care provided to treat the injury. Workers compensation also covers rehabilitation costs and training where required.

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,

  • Photographers
  • Taxidermists
  • Travel Agencies
  • Private Day Cares
  • Trade Unions
  • Doctors (which includes all private healthcare practices)
  • Banks
  • Insurance Companies
  • Hair Salons
  • Shoe-Shine Stands
  • Barbers
  • Embalming and Funeral Directing

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 that they register before they even think about hiring their first employee.

WSIB Benefits

Before we can move onto the relationship between private investigators and the WSIB, let’s take a look at the WSIB’s benefits. The overall goal of the WSIB 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 does protect companies by taking care of health care costs related to on the job injuries. The WSIB also replaces employees lost earnings.

If a company requires safety training, the WSIB can also help. Through its comprehensive training programs, the WSIB trains employees to reduce workplace injury and illness that can reduce staff and overall productivity.

The bottom line? No one wants his or her friends and family to get hurt while on the job. The problem is, it’s not a perfect world and workplace injury does happen. It’s the WSIB’s job to ensure that these people are taken care of fairly and responsibly so that these people can return to work as soon as possible.

The WSIB 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. 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 has no choice but to turn to a private investigator or private investigation company. A licensed private investigator is properly trained and knows how to uncover any shady behavior from these types of individuals.

It is important that the WSIB 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. In fact, if they even attempted to catch a liar in the act, they would likely get caught themselves and end up being the ones in trouble instead.

Private Investigator Services

When a private investigator is called in to work on a WSIB case, there are a few types of services they will 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 with the WSIB.

Private Investigators and Surveillance

Private investigators in Ontario primarily use surveillance techniques to determine whether or not an individual is lying to the WSIB. In most situations, the individual claims that they are unable to return to work due to their injury. In other situations, an employee might claim that their injuries are actually 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 hires a private investigator. The private investigator sets up surveillance outside the employees home. It takes two days, but the private investigator eventually sees the employee lifting their children into the car to take them to school. The same afternoon the employee takes out the trash, using their injured hand without any trouble.

The theme here is that the individual is lying about their injury to avoid going back to work. Using surveillance to watch that individual carefully, a licensed private investigator can inform the WSIB.

What Happens Now?

The WSIB can then take action against the individual. In most situations, this means that the individual will need 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 claiming this type of benefits only raises the cost for those paying for them.

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

It’s important to note that the WSIB does not hire a private investigator to look into every single employee. So, there’s no need to panic or worry. If you’ve put in an honest claim, there’s no reason your file will send up any red flags. The WSIB is looking for individuals with inconstancies in their story. In some occasions, they also receive tips, which they take very seriously.

 

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