Private Investigators & Fraud Prevention with the WSIB

Private Investigators & Fraud Prevention with the WSIB

Private investigators often take on many different types of clients with many different types of cases. What you might not know is that good private investigators in Ontario develop relationships with different organizations. Some of these private investigators work very closely with an organization called, the Workplace Safety and Inspection Board (WSIB).

The WSIB

In Ontario, the WSIB is a government-run organization. The WSIB is the organization looks after workers compensation and no-fault insurance throughout the province.

Workplace safety is incredibly important in North America. All employees have rights, which include, the right to work in a safe environment. Therefore, if or when an employee gets injured on the job, they have the right to claim worker’s compensation.

WSIB Benefits

Worker’s compensation allows an employee to contact the WSIB and claim several different benefits. Some of these benefits include things like providing money for, medical bills, medicine, and recovery time.

If an employee is injured on the job, it is sometimes difficult for the employee to return to work right away. Here’s an example. Let’s say that an employee slips on ice walking into the office and they break their hip. After seeing a doctor, they learn that they cannot return to work for 6 to 8 weeks.

The employee’s company will not want to pay for an employee who isn’t actually working. As a result, it turns into a problem for the employee who needs to pay their bills. In some cases, the company might allow the employee to use vacation or sick days as part of their recovery time. However, different companies have different policies when it comes to workplace injuries. The best thing an injured Ontario employee can do is to make a claim with the WSIB.

Benefits to the Company

The WSIB helps company’s deal with workplace injuries in a similar way to an insurance or other benefits company.

Two Ontario Firefighter’s Charged with Fraud

In February of this year, police officially charged two Ontario firefighters with fraud and money laundering. These two men dedicated time to helping families of injured or deceased firefighters across the province apply for WSIB benefits. After the men helped these families with their WSIB application, they would ask for donations to the Ontario Professional Firefighter Association (OPFFA).

The police launched an investigation after a complaint revealed that several large donations went missing. These donations were directly linked to the two men.

Unfortunately, this isn’t great publicity for the WSIB. With such a close connection to fraudulent activity, the organization might need to look a little closer at the claims they received.

Fraud and The WSIB

As you can imagine, lying on a WSIB claim is completely illegal. However, there are plenty of people out there who can’t work because of something that happened on the job. These people must live with the pain and after effects of their injury. In some cases, they have to live with the injury for the rest of their lives. These people truly need the help and benefit that the WSIB.

This is why all employees must tell the truth and provide authentic details about the extent of their injuries.

If an employee lies on their WSIB claim, it is considered fraud. Fraud is a punishable offence, and if proven in court will require the convicted individual to pay back—at a minimum—the amount they received.

The WSIB puts several measures in place to try and deter both employers and employees from making fraudulent claims. Some of these measures include,

Audits

The WSIB audits employers for a variety of reasons including, to share information with the Canadian Revenue Agency (CRA) and random spot checks. These types of audits will likely request information for up to two years prior to the current date. Therefore, if you received or processed any claims with the WSIB, you need to keep those records for a minimum of two years.

Information that the WSIB might request from an employer include,

  • Payroll and financial records
  • All information related to filing with the CRA
  • WSIB files
  • General ledger
  • Cancelled cheques

Penalties

The WSIB can penalize both employee and employer should he or she not comply with the rules and regulations laid out by the organization. Other individuals related to the employer or employee can also face related penalties. These individuals include,

  • WSIB staff
  • Spouses and/or dependents
  • External suppliers

The WSIB’s primary concern is with individuals who “knowingly make a false or misleading statement or representation to the WSIB,” or “willfully fail to inform the WSIB of a material change in circumstances when required to do so.”

Convictions

If convicted, the WSIB can fine an individual up to $25,000 CAD. The court system can also require the individual to spend up to 6 months in jail. Convicted employers must pay a fine of up to $500,000 CAD. To serve as a warning, the WSIB provides a list of employer convictions in Ontario. An employer conviction will remain on the WSIB website for two years.

No one wants to end up paying hefty fines or spend any time behind bars. This is why it’s in the public’s best interest to only make truthful claims with the WSIB.

Private Investigators & Working for the WSIB

It is extremely difficult for the WSIB to prove a claim is fraudulent. This is why the organization encourages those who suspect or know of an individual or employer making false claims to come forward and make a complaint. The WSIB takes these complaints very seriously and will do everything in their power to protect the identity or origin of the complaint.

Once the WSIB receives a complaint, they will begin an investigation. In many complaint cases, the WSIB will turn to private investigators in Ontario or a private investigation company in Ontario for assistance.

Private investigators work closely with the WSIB to find concrete proof related to the fraudulent claim. This relationship is quite important, as most WSIB employees don’t have the skills or know-how to catch a criminal. A good private investigator will know the letter of the law in Ontario. They will not engage in criminal activity themselves just to find proof of insurance fraud. A private investigator hired by the WSIB will know different surveillance, interview and research techniques.

How Does it Work?

Let’s go back to the example where an employee breaks their hip slipping on ice on company property. As a result of the fall, his or her doctor might recommend they be off work for 6 to 8 weeks. However, the employee decides to change the number. Instead, they claim the doctor actually recommends they stay home for 10 to 12 weeks.

Maybe a neighbour overhears the employee talking on the phone in their backyard. The employee brags about the fact that they are feeling much better but still won’t return to work for another 6 weeks. Suspicious, the neighbour files a complaint with the WSIB.

The WSIB turns the case over to a licensed private investigator or private investigator company. The private investigator will take the information that they have and form a plan. In this case, let’s say that the private investigator decides to conduct surveillance. He or she will park in a car outside the employee’s home and watch them for a few days. Sure enough, on day three, the employee is seen walking to their car without any assistance. Maybe on day four, the private investigator catches the employee taking waterskiing lessons.

The private investigator provides this information to the WSIB. The WSIB can then inform the employer and take legal action against the employee.

Don’t Lie. Tell the Truth.

In general, most people in Ontario make valid claims, and the WSIB is happy to provide assistance in these situations. So, it is really a small number of people who take advantage of the system that end up raising insurance premiums for those who actually need WSIB related services.

As a result, it is in your best interest to remain as truthful as possible when making a claim. If you don’t, a private investigator working for the WSIB will likely tell the truth for you.

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