September 12, 2012

Investigators can look into alleged fraud

View from the Board | Grant McMillan

WorkSafeBC has a Field Investigation Section that looks into alleged fraud, misrepresentation, suspicious situations and similar concerns. The section is staffed mostly by former police officers, who are trained in investigative techniques.

On occasion, a WorkSafeBC claim will present a special challenge.

You may learn that the worker, who is off on compensation, is working at another job or is building a garage on his property.

You may be told that the worker suffered the injury in a softball game or helping a friend move.

There may be a series of events that leads you to believe that the claim is fraudulent.

When this happens, you should ask WorkSafeBC to conduct an investigation using a field officer.

Gather all of the information and evidence that you have and present the need for an investigation to the case manager.

The field officers have been very successful in detecting fraud.

Ask your case manager to involve a field officer where appropriate.

You can also report suspected fraud anonymously by calling the Fraud Hot Line at 1-877-523-3315 or send an e-mail to fraudinfo@worksafebc.com.

Now, lets take a look at proactive claims management.

When a worker with a disability does not return to work of any kind, the worker may receive a substantial WorkSafeBC pension – up to $1.5 million or more!

In order to help prevent major claims and costs, it is important to understand what factors can trigger a long-term absence from work or a lifetime pension.

A worker with limited skills will be difficult to place in an alternative job if the injury prevents returning to the same job.

If a worker is not able to return to the same employer because of the physical disability, WorkSafeBC tries to place the worker with another employer or in a different occupation.

The workers, who are most likely to have difficulty in getting another job are those with: low levels of education; language or literacy problems; or a lack of transferable skills.

As with any other business situation, it is best to avoid difficulty by planning ahead.

It is better to hire workers, who have the capacity to succeed in other work should this become necessary because of injury.

This means hiring workers with adequate education, good language and literacy levels with transferable skills.

It is also reasonable to set a test for basic competence and capacity to do the job.

These tests must be directly related to the requirements of the job. The evaluation of the tests must be objective and consistent.

You may wish to check: education/technical training; English comprehension (verbal); English comprehension (written); trade tickets; and other qualifications. Verbal comprehension means the ability to understand shop instructions clearly and communicate with fellow workers.

Written communication means the ability to understand shop manuals and other relevant written materials within the worksite.

These additional skills could form the basis for setting up a Return to Work program for the individual worker.

For help with Return to Work, disability management and claim updates, you can contact the WorkSafeBC Construction Nurse Line at 1-877-633-6233.

They provide excellent assistance and the service is done at no charge.

Grant McMillan is the president of the Council of Construction Associations (COCA), which represents the interests of 16 construction associations in B.C. on WorkSafeBC matters. Grant is also a member of the Journal of Commerce Editorial Advisory Board. Send comments or questions to editor@journalofcommerce.com.

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