Fraud & Abuse

 

Fraud and Abuse
Fraudulent activity impacts any organization’s integrity and accountability to its stakeholders. Maintaining equity within the worker’s compensation system demands that trust be placed in employers, workers, health care providers, suppliers / vendors, as well as WCB staff.

When that trust is breached, there is a cost to everyone.

The workers’ compensation system is funded by premiums paid by Saskatchewan employers. Fraud or abuse can have long-term adverse consequences on employer premium rates, plus worker benefits and treatment.

The WCB will not tolerate fraud or abuse from any party. Those who abuse the system with intent face the possibility of criminal fraud – Section 380 of the Criminal Code. WCB continues to identify and eliminate fraudulent activity. You can help by understanding what fraud is and notifying us about suspected fraud/abuse. Keep in mind, you can notify us anonymously.

What is fraud?
In general, fraud involves action with intent, that is dishonest, and results in some type of benefit that one is not entitled to. Simply put, fraud is committed when a person gains something, whether potential or actual, that results from a lie.

The WCB has investigators to pursue reports of fraud and abuse. You can help by notifying the WCB if you suspect that someone is committing fraud.

What are some examples of fraud or abuse?
Here is a brief list of things that may indicate potential fraud. The presence of some or all of these indicators does not automatically prove that fraud / abuse has occurred.

Tips are included to help prevent and stop abuse of the worker’s compensation system.

Employers

  • Unlawfully deducting WCB premiums from a worker’s wages.
  • Intimidating a worker not to report a work-related injury and not file a Worker’s Initial Report of Injury (W1) form with the WCB.
  • Deliberately understating or falsifying insurable earnings.
  • Not registering with the WCB as required for businesses in compulsory industries or registering only when a work injury is filed with WCB.

Tips for Employers

  • When a work injury occurs that requires medical attention, always file an Employer’s Report of Injury (E1) form within 5 days of being notified about the injury.
  • Make sure that the form is completed in full and includes accurate details of the injury.
  • Make sure that you have an effective injury reporting process in place, one that all management and staff follow.
  • Educate your workers about prompt reporting of work-related injuries and the legal consequences of a false injury claim.
  • Report all instances of suspected fraud or abuse on the part of any stakeholder.

Workers

  • Falsely claiming that an injury is work related.
  • Exaggerating the work injury or delaying return to work in order to receive WCB benefits.
  • Working and/or earning an income while receiving WCB benefits.
  • Making false or misleading statements.

Tips for Workers

  • If you’re injured at work and require medical attention, tell your employer what happened as soon as possible.
  • File a Worker’s Initial Report of Injury (W1) form to the WCB as soon as you can.
  • Contact the WCB if your employer tries to intimidate you or persuade you not to file an injury claim.
  • Contact the WCB if workers’ compensation premiums are being deducted from your pay cheque.
  • Keep your case manager informed about your medical treatment and your work activity.
  • Report all instances of suspected fraud or abuse on the part of any stakeholder.

Caregivers

  • Falsifying an invoice.
  • Billing for service that is not actually provided or is medically unnecessary.

Tips for Caregivers

  • Promptly and accurately report the full details of all treatment provided to patients with workplace injuries.
  • Make sure the WCB case manager is aware of the treatment planned and that it is appropriate. Obtain case manager’s approval where necessary.
  • Contact the WCB if the injured worker consistently fails to show up for treatment. Follow up with the case manager.
  • Report all instances of suspected fraud or abuse on the part of any stakeholder.

Reporting Fraud

You can provide details about suspected fraud or abuse anonymously – by phone, fax, mail, or e-mail.

  • Allegations of fraud are taken seriously; your report will be given prompt attention.
  • You can remain anonymous.
  • If you wish, you can provide your name and contact number so our fraud investigators can obtain additional information from you, if necessary.
  • Supply as much detail as possible; clearly state why you think the activity is improper.
  • You should have some factual information to support your suspicions.
  • Continue to pass on relevant information after the initial report.

Read the fraud brochure for more information. (PDF)

Toll-Free Phone: 1.877.595.2541 (direct line to WCB investigators)

E-mail: fraud@wcbsask.com

Fax: 306.787.0380 to Director, Internal Audit

Postal Mail
Director, Internal Audit
Saskatchewan Workers’ Compensation Board
200 – 1881 Scarth Street
Regina, SK S4P 4L1