5 Reasons you may Face WSIB Fraud and here is the Solution
March 2, 2020 /

5 Reasons you may Face WSIB Fraud and here is the Solution

What is WSIB?

The Workplace Safety and Insurance Board (WSIB) is the authorized body that controls remuneration and insurance to Ontario workers. In other words, it supervises workplace safety & insurance claims. Its operation agrees with the Workplace Safety and Insurance Act.

Interestingly, WSIB reports that most claims-related fraud by injured workers is falsehood. And so, as an employer, that’s how serious you should investigate a WSIB claim of your employees.

But as an employer, what are possible reasons you might decide to object to an employee’s WSIB claim? Here are 5 possible reasons:

5 Reasons You May Face a WSIB Fraud

As expected, when a worker is hired to work in a firm, he/she enters into a written agreement with their employer, which indicates relevant items such as start date, benefits, work time, and duties.

However, employees arrange falsehood WSIB claims to get benefits to which they do not qualify. This will be accounted for them as an action to defraud WSIB.

For example, if your worker submits an insurance premium claim. That is a WSIB fraud under your nose!

While it’s true that employees do this, what are the common reasons employers face WSIB frauds?

  1. Injury Happens Away from Work

While you might not want to dispute the claim of an employee that there is an authentic injury or illness, it’s a decent thing to question whether or not it’s work-related. Things can get a little complicated when an injury occurs during the workdays, but it’s not in any way work-related.

For example, you may have an employee claiming he/she sustained an injury during the workday, but in the real sense, it’s not related to work in any way. How then can you know this? Hiring a PI is your sure bet! Just because an injury occurred during the workdays doesn’t automatically mark it as authentic or related to their work duties.

  1. Not Medically Justifiable

If a worker with an accident claim looks very healthy or doesn’t have matching medical reports, there’s every possibility this is a WSIB fraud. Sometimes, it can be difficult to prove this is a falsehood as these kinds of claimants will have subjective claimants. Only via surveillance and investigation for a few days will the truth be unveiled.

  1. Failing to inform the WSIB of changes around a circumstance

If your worker appears too familiar with WSIB rules, claims-handling, or fails to inform WSIB of changes around an accident, then this might be as a result of previous claims. This type of employee will have fears that he/she will be placed under surveillance. Hiring a professional is your best option in handling this kind of case.

  1. Insufficient Documentation

As an employer, you should raise your eyebrows if the witnesses and your worker (victim) are providing contradicting or insufficient shreds of evidence and documentation. Plus, if it looks like the statements were rehearsed rather than being authentic, you should be suspicious.


  1. Pre-existing Conditions or Re-occurring Injury?

Several provinces in Canada, including Toronto, will not approve the WSIB claim of a worker with a pre-existing condition. For example, an employee with a cardiovascular problem and is to stay away from lifting heavy objects. He then goes about the normal activities at his workplace that aggravate the cardiovascular problem causing a slight heart problem and further health issues. If there is no specific event, which contributes to the existing cardiovascular problem when a worker submits a WSIB claim, it is denied and counted as a fraud.


Want to learn more? Talk to an expert now on 416-912-7755. Alternatively, send an email at info@pipro.ca