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 a 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.
