Not all claims made to the Workplace Safety & Insurance Board are legitimate, some have a marked presence of questionable signs that employers must watch out for. Fraudulent claims are often ripe with questionable signs that can be easily distinguished. This is not to say that seeing a few questionable signs is a fool-proof indication of fraud, but an alert of the possibility of fraud won’t hurt anyone.
The following are a dozen top red flags for fraudulent WSIB claims:
When witnesses are often only close friends of the claimant and there are no security cameras in the workplace, things may not as they seem and may need further investigation.
Raise your eyebrows if the witnesses and the victim are offering conflicting statements or if the statements seem too rehearsed and too identical.
Perpetrators of false claims often do not plan out all details of the accident and when asked about an unplanned detail, they would feign not being able to remember what occurred. This also happens when inconsistencies are pointed out, with the claimant often blaming shock as a reason for their varying statements.
If the employee is very new to the job, has very poor work attendance, has a history of very short jobs, or has a history of discipline issues, then there is a real possibility that the claim may be fraudulent.
Accidents that happen right after or before a vacation can be an employee’s attempt to prolong a vacation or forcibly get their way. If the injury happens just prior to a company layoff, possible termination, disciplinary action and demotion, or a strike, then the injury can be a ploy by the employee to keep his/her job.
Injured people would logically want to get better soon, but those who are faking their injury/injuries are likely to avoid recommended medical attention. The fraudster will attempt to delay treatment, refuse to seek treatment, not show up for medical appointments, miss therapy sessions, or would wait a few days after the injury has transpired before reporting it. All of these are questionable actions because they defy logic.
Questionable Claimant Whereabouts
Fraudulent claimants often give another address so they can hide their fake injuries in case someone decides to check up on them. It is either that or they are never home or simply not available when needed to be spoken to via phone because guess what, they are actually on vacation!
The claimant’s lifestyle is grossly incompatible with his/her income. They appear to be making top-level pay on social media although they only hold a starting or low position with no other source of income.
The claimant looks very healthy, recently tanned, and appears to be very well. These types of claimants often have subjective complaints so it would be very difficult to prove they are indeed injured except via surveillance and monitoring for a few days.
Questionable WSIB Knowledge
If the claimant appears to be too familiar with claims-handling or WSIB rules, then this might be because of previous claims. This type of claimant may be expecting that he/she will be investigated and placed under surveillance too so a professional team may be best to handle this case.
Questionable Service Provider
If claimants from the same employer are using the same clinic, chiropractor, doctor, therapist, or lawyer, then this could be a sign that something is amiss.
If the injuries are very inconsistent with what happened or if the complaints are subjective (like phantom pain, emotional trauma) and the claimant appears too healthy and well, then it might be time to place the claimant under surveillance, more so if the complainant has more than one claim at present time.
Need help to investigate a false WSIB claim? Fake WSIB claims cost everyone money and must be investigated before a claim pushes through. Hire the best private investigators in Toronto to help you uncover the truth behind a WSIB claim. Contact us so we can help you with surveillance and consult with you regarding the actions you should take.