What is fraud?

Page intro

Learn what fraud is and read examples for workers, employers and care providers.

Page content
Text

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 workers’ compensation system.

Workers

  • Falsely claiming that an injury is work related.
  • Exaggerating the work injury or delaying return to work in order to receive WCB benefits.
  • Purposefully withholding information from the WCB regarding working and/or earning an income while receiving WCB benefits.
  • Making false or misleading statements.
  • Purposefully withholding information from the WCB regarding a material change in your situation. A material change is a change to your income, health status, job or any other circumstance that might affect entitlement to WCB benefits.

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 any changes in your income, health status, job or any other circumstance that might affect entitlement to WCB benefits.
  • Report all instances of suspected fraud or abuse on the part of any stakeholder.

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 the WCB.

Tips for employers

  • When a work injury occurs that requires medical attention, always file an Employer’s Report of Injury (E1) form within five 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.

Care providers

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

Tips for care providers

  • 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 the 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.
Contact

Report suspected fraud or abuse

You can report suspected fraud or abuse by phone, email or mail addressed to the attention of Director, Internal Audit.