30 Potential Indicators of WSIB/Disability Fraud
1. The alleged injury occurs at the beginning of a shift after being off for the weekend or a period of time off. Be mindful of potential sports injuries.
2. The reported accident occurs immediately before or after an industrial dispute, job termination, lay off, end of a project, at the conclusion of seasonal work, or the injured worker is a short term or contract employee.
3. The alleged injury occurs a day or two before or after a holiday.
4. The accident has no witnesses and the injured worker’s own description does not logically support the cause of the injury. The witness has a poor record with compensable injuries and provides a questionable version of the incident.
5. The injured employee has a history of numerous suspicious claims, or the medical provider or legal consultant has a past history of handling suspect claims.
6. The employee delays reporting the claim without reasonable explanation.
7. The employee’s description of the accident conflicts with the medical history of the employer’s first report of the claim or the circumstances described do not fit the injury or location.
8. Difficulty contacting a claimant at home when they are allegedly disabled. An answering machine is another way of covering the fact that a claimant is continually absent from home.
9. The injured worker refuses a diagnostic procedure to confirm the nature or extent of an injury or travels to seek medical treatment in another area from his home or workplace. Be conscious of the injured worker who has no ongoing treatment.
10. The injured worker is about to be retrenched, demoted or passed over for promotion.
11. Information is received by a co-worker, spouse, friend or any other source.
12. The injured worker has a history of unstable employment or drug and alcohol abuse or has a poor attendance or sick leave record.
13. The employee frequently changes physicians or medical providers.
14. The employee has subjective, soft tissue injuries only. No objective injuries such as broken bones or cuts are present. The disability claimed is beyond normal for the injury claimed, either in rating or length of time.
15. The employee has a long relationship or history with a health care provider other than their family physician.
16. The employee has post-traumatic psychological stress-type claims or complaints.
17. The employee has excessive prescriptions.
18. Employee benefits from WSIB, insurance or disability plans equal or exceed the employee’s regular pay.
19. The employee has a history of self-employment or working for cash.
20. Details of the accident when compared to the initial employee’s report, the employee’s medical history and third-party accident reports are vague or contradictory.
21. After the accident, the employee moves away.
22. The employee receives mail at a post office when it is not warranted.
23. The employee seeks treatment from a chiropractor only and is never examined by a medical doctor.
24. Several different doctors are involved and no one doctor is coordinating the medical treatment.
25. The physician or chiropractor will not consider the employee returning to work at any level as part of the rehabilitation or treatment program.
26. There are substantial gaps in treatment.
27. The treatment or diagnosis is inconsistent with the employee’s injuries.
28. Rehabilitation reports that the employee is tanned, muscular, has callused hands or grease under the fingernails inconsistent with the disabilities claimed.
29. The employee is nearing the retirement years and may decide that he / she just does not want to work anymore.
30. When a claimant utilizes extensive, detailed medical terminology when discussing their injury.