WSIB (Fraud in Workplace Safety and Insurance Board) Fraud Investigations

Fraud in Workplace Safety and Insurance Board WSIB costs business a lot of money and affects its functioning. Whether you are an employer, insurer or a legal officer, fighting fraudulent insurance claims involve specialization and accuracy. This is where a PI for Insurance Claims comes handy. Just like a doctor prescribes a drug and if his patient is in Toronto, he would know how to use it, similarly if you are located in Toronto, you should know how a private investigator works in Fraud WSIB cases with regards to your business.

What is meant by an insurance investigator?

Insurance investigator is another official position which refers to an employee whose main function is to check the truthful nature of insurance claims. Employment is given to them with the responsibilities of investigating the intrinsic nature of a claim and gathering sufficient facts that will either support or deny the claim. Insurance investigators also have close working relationships with business organizations, insurance firms and legal departments whereby they are required to investigate such frauds as those presented under WSIB.

When it comes to WSIB cases, fraud can take many forms, including:

• Mention should also be made of inflating or feigning an injury.
• Workers doing other things while receiving such privileges.
• Falsified medical documents.
• Employers have been known to provide information that makes the premium as low as possible.

To deal with these cases insurance investigators use techniques such as follow-up, reference checks, and interviews to gather evidence that will be admissible in court or when making a case with the WSIB.

WSIB Fraud a rising issue of concern for employers:

It must, however, be pointed out that WSIB fraud is not only wrong from an ethical perspective but also from companies” point of view as it is expensive. Misrepresentation of facts, dishonest reports make an insurance cover expensive or even result in embezzlement of the company’s resources or even sullying its image in the market. WSIB fraud statistics show that every year, Canadian businesses lose millions of dollars to fraudsters.

Common types of WSIB fraud include:

• Claimant Fraud:

In the circumstances whereby an employee seeks compensation for an injury that never happened at a workplace. Other realm of scams involve exaggeration in the extent of injuries and may also involve acting on the occurrence of an incident. This could result in increased unproductive time off, avoidable costs in terms of medical expenses, and bait and switch of resources. Surveillance and interviews are usually the main means of identifying this type of fraud.

• Employer Fraud: 

When for instance an employer pays less than the actual payroll or otherwise groups workers so as not to be charged higher WSIB premiums. Managers and employers may harbor unfavourable intentions of providing erroneous data concerning the characteristics of positions or the number of staff. Committing this type of fraud results in audits, penalties and legal troubles in case the company is caught.

• Healthcare Provider Fraud: 

When health care providers exaggerate their charges or even doctor their injuries. It may be practiced where some healthcare providers may forward a false or exaggerated demand for a certain service or a service that was never provided in the first place. This not only means that resources are wasted but also attempts of legitimate members to be heard are dismissed.

How can a private investigator help uncover fraud concerning WSIB?

1. Surveillance

Surveillance is one of the most effective means that a private investigator conducts in order to investigate WSIB fraud. Through undercover surveillance, investigators are able to photograph and videotape clients engaging in activities they say they cannot do because of their injuries. 

2. Background Checks

Private investigators work harder in an effort to establish past records in suspicious claims, prior injuries, and other secret employment. Many observers may claim that they have been stiffed by the same scammers, having filed claims from different geographic locations or using inconsistent timelines.

3. Digital Footprint Analysis

But in today’s connected digital world, it could pay to look at social networks for key leads. Professional sleuths will search through the claimant’s any social media accounts to find anything that could disprove their accusations. 

4. Supporting data for litigation

Everything that is gathered by a private investigator is documented to the tiniest detail. Some of such evidence includes CCTV footage, or the statement of a witness or any kind of digital record which can be produced in front of WSIB, insurers or the court in order to challenge fraudulent claims.

Why Toronto Businesses Require the Services of Private Investigators in Cases of WSIB Fraud?

Toronto has a Lot of industries and thus WSIB claims are prevalent in the region. However, the increase in such cases exposes employers to such a situation of putting a lot of money into this since many, most of the claims being fake. A private investigator in Toronto brings several advantages to businesses:

• Knowledge about Local laws and regulations:

It does help that they know all the specifics about the WSIB laws in Ontario and can deal with regional legislation without a hitch. This makes sure that investigations are Acetic as well as efficient.

• Cost Savings for Businesses:

It was stated that those frauds, which are detected at the earliest, prevent organizations to make useless payments and also avoid higher future insurance premium rates. It has been observed that employing services of private investigators is usually a good investment that pays off in terms of tangible dollar returns.

• Protecting Reputation:

As well as using up an organization’s time and money trying to address and attempt to stop such fake claims, it also takes a toll on the overall credibility of an organization. Private investigators also ensure that only genuine claims are awarded thus protects your business reputation.

Private Investigator Insurance Claims: 

That is why hiring a private investigator for insurance claims is not only reactive but also proactive. It is possible for a company to incorporate investigative services as part of general risk management to discourage fraudulence of claims. 

This includes:

• Running background checks when hiring some employees.
• Supervising high risk occupations that make more and frequent claims for compensation for work related injuries.
• Working with investigators in order to quickly and appropriately deal with the complains.
• Taking such a pro-active approach throughout Toronto businesses are in a position to minimize the likelihood of being associated with such fraudulent activities organized by fake workers’ compensation boards.

Conclusion

WSIB fraud is a social problem, which affects businesses, insurers and the economy in general. Getting the services of a private investigator for insurance claims is beneficial since it delineates fraudsters, shields your business funds, and guarantees pleasant claims procedures.

If you’re in Toronto and you believe that your organization is involved in WSIB fraud, it’s time to get professional help from private investigators who deal with insurance fraud. Since obtaining ever the most fundamental services of surveillance, background check, and evidence collection, the PI then gives the means to fighting fraud and injustice. 

Do not allow fraudulent claims to put your business in any compromise. Call us now and get to know how our private investigation services can assist your organization.