Today’s employers are willing to take a stand against workplace benefit fraud but may lack the internal resources to deal with these sensitive issues. At CIS we focus our expertise to include all areas of health benefit fraud including WSIB fraud, long and short term disability claims and chronic absenteeism investigations.
INDICATORS OR RED FLAGS OF POTENTIAL FRAUDULENT WSIB CLAIMS
The mitigation of risk through effective management of WSIB claims is important because mishandling a claim can be very costly. For the Risk Manager, Safety Director and Human Resource Manager this spells challenge and the potential for liability and loss. Employers often see “Red Flags” arising and may become aware of suspicious claims in a number of ways. These are some of the most common ones we at CIS have seen over the years.
- The injury occurs on a Friday but is not reported until the following Monday, or the injury happens early Monday morning or at the beginning of a weekly shift.
- A workplace accident has no witnesses and the injured worker’s own description does not logically support the cause of the injury. The witness has a poor record with compensable injuries and provides a questionable version of the incident.
- The injured employee has a history of discipline issues. Along with absentee problems, employees who have discipline problems can become disgruntled and be motivated to fabricate a claim. You may see employees moving from one disability insurance to another.
- The accident occurs immediately before or after a vacation. If time off or requested vacation time is denied.
- Prior disciplinary actions or other work related issues that pre date the onset of the disability.
- The employer has difficulty contacting an injured worker at home when they are allegedly disabled. An answering machine is another way of covering the fact that a claimant is continually absent from home. Conversely, many employees across Canada now only have a mobile phone allowing them to be anywhere when a call is taken and may claim they are at home resting.
- The injured employee has a history of claims, generally at specific times of the year such as the warm summer months.
- The employee delays reporting the claim without reasonable explanation.
If you are concerned about the possibility of a fraudulent WSIB claim, looking for information on our WSIB fraud investigations, or wish to discuss your options, contact us today for a complimentary consultation.