Top 7 Fraudulent Injury Claim Warning Signs Every Employer Should Know

Top 7 Fraudulent Injury Claim Warning Signs Every Employer Should Know

Picture this: Your claims experience rating shoots up 200%. WorkSafeBC is breathing down your neck. But those questionable claims driving your soaring premiums? They unravel the second you tug on a loose thread.

We’ve seen it all in over 30 years investigating fraudulent injuries. And I’m here to tell you, sometimes that gut feeling is right on the money.

Fraudulent WorkSafeBC claims cost employers millions each year. They drain benefits from honest workers who need them and jack up your insurance costs. But here’s the thing – you’re not powerless. As an employer, you’re the first line of defense against WCB fraud. The key is knowing how to distinguish the legitimate claims from the questionable ones.

Here are the 7 most telling signs a WCB claim might be suspect, complete with the verification steps you can take today.

Red Flag #1: The “Monday Morning” Limp

It’s a story old as time. John strolls in at 8:05 am, limping from a supposed slip in the parking lot. But something doesn’t add up. No one saw him fall. His limp only appears when the boss is around. And isn’t it odd how these “accidents” spike on Mondays or after long weekends?

The underlying reason is clear: Some employees get injured on their own time —yard work, sports, you name it— but hold off reporting anything until they’re back on the clock to qualify for WCB. That’s the classic “weekend warrior” effect.  One U.S. study found that Monday lost-time injury rates were 27 % higher than the average of other weekday (National Library of Medicine).

Verification Tactic: Check if anyone saw John arrive already in pain. Pull parking lot footage if you have it. Those Monday morning claims may warrant a closer look.

Red Flag #2: The Vanishing Witnesses

Picture a bustling warehouse at noon. Forklifts beeping, machinery humming, workers milling about. Then suddenly – a scream. Jack’s on the floor, clutching his knee. But get this: in a sea of people, not a single soul saw him fall. Or the witnesses’ stories line up a little too perfectly, as if rehearsed from a script.

Legitimate accidents tend to have variability in witness accounts. Details differ as each person recalls their unique vantage point. If you’re hearing verbatim phrases or no one can back the story in a high-traffic area, your spidey senses should tingle.

Verification Tactics:

• Check surveillance video if available. Does it match the story?
• Compare witness statements for discrepancies. Look for unusual consistency.
• Conduct a thorough incident investigation. BC’s OHS regs require a full report (OHS Regulation Part 3).

Red Flag #3: Treatment Dodging and Delayed Reporting

Imagine Jill, an admin assistant, finally reporting a back injury – 3 weeks after it allegedly happened. She claims she thought it would heal on its own. But since reporting, she’s dodged physio, skipped specialist appointments, and flat-out refused an MRI. It doesn’t sit right, does it?

Here’s the deal: Delayed reporting is a hallmark of questionable claims. WorkSafeBC requires injuries to be reported within 3 business days for good reason (How to Report). Prompt reporting means timely treatment and stronger documentation. When a worker postpones that process, it raises eyebrows.

Verification Tactics:

• Compare the incident date to the first medical visit. Big gaps are red flags.
• Note any treatment refusals or no-shows in the claim file.
• Be alert for vague or evolving symptoms with no firm diagnosis.

Red Flag #4: The Layoff “Injury”

Your company is restructuring, and pink slips are flying. As an empathetic employer, you know layoffs breed anxiety. But then Jane, who just received her notice, files a claim for debilitating stress – an hour before her exit interview.

The timing is uncanny and the motive clear: she’s angling for WCB benefits to replace her lost income. Is the stress real? Perhaps. But is it work-related or severe enough to be compensable? That’s the million-dollar question.

Verification Tactics:

• Check disciplinary and layoff notice timelines against the claim date.
• Scrutinize contemporaneous performance reviews. Did Jane only mention stress after job loss loomed?
• But tread carefully. A hasty termination post-injury could trigger a “constructive dismissal” suit.

Red Flag #5: Severe Pain, But Flimsy Proof

Meet Mike, a stoic guy who never complained once in his 5 years on the job. Suddenly, he’s claiming 10/10 back pain and can barely walk. But his imaging scans look clear and his doc can’t pinpoint a smoking gun. So, what gives?

Subjective pain complaints without matching objective evidence are textbook signs of inflated or fabricated injuries. Yes, soft tissue damage is tough to capture on film. And WorkSafeBC fielded over 20,000 strain claims in 2023 alone (WorkSafeBC Facts & Figures). But a complete mismatch between subjective and objective findings should ring the alarm.

Verification Tactic: Request an Independent Medical Exam (IME) to assess those head-scratching soft tissue claims. An impartial expert can spot inconsistencies employees’ own doctors might miss.

Red Flag #6: The Facebook Faux Pas

Social media is a fantastic tool for employers playing claims detective.

Exhibit A: Jessica, who’s been off work for 2 months with a devastating shoulder injury. Her restrictions are a mile long. But wait, what’s this on her public Facebook page? Photos of Jessica pumping iron at the gym and repainting her whole house. Well, isn’t that interesting…

It’s a new era. Claimants are increasingly tripped up by their own digital trails. But employers have to be savvy. In BC, privacy laws prohibit snooping on employees’ purely personal online lives. But public posts relevant to their WCB claim? That’s fair game.

Do’s and Don’ts:

• DO scan public social feeds for mismatched activity levels.
• DO document troubling posts or photos to build your case.
• DON’T “friend” an employee on Facebook to access their private page. That’s a hard no.
• DON’T rifle through DMs without consent. BC’s PIPA law sets firm boundaries (OIPC BC Guidance).

Learn more about using social media intelligence in OSINT investigations.

Red Flag #7: The Compensation Champ

Last but not least, we have the “Frequent Flyer” – the new hire with a suspiciously long history of short-lived jobs and WCB claims. They’re the ones dropping work comp buzzwords only seasoned pros would know. But their resume tells another story: 2 months here, 3 months there, each stint ending in a mysterious “injury.”

Some people, unfortunately, know how to game the system. They’ve figured out the minimum tenure to qualify for benefits, and they bounce from claim to claim. That’s why a thorough background check is your best defense.

Verification Tactics:

• Scrutinize resumes for a pattern of brief employments and compensation claims.
• Listen for WCB jargon that seems out of place for their seniority level.
• But do NOT directly ask about past claims in interviews. That’s illegal discrimination (Gamradt Law).

Your Fraud-Busting Checklist

There you have it – the 7 most glaring signs a WorkSafeBC claim might be fraudulent. But here’s the bottom line: You’re not in this alone. Consider WorkSafeBC your partner in prevention. If you spot these red flags, here are your next steps:

• Document everything. No detail is too small, from witness statements to social media screenshots.
• Report to WorkSafeBC. Their expert team will take it from there. You can report suspected fraud to WorkSafeBC by phone, email, fax – whatever’s fastest. 
• Stay alert. Fraud fighting is a journey, not a destination. Make it a habit to be watchful.

But here’s the real key – Build a culture of safety and honesty from the ground up. Invest in your team’s wellbeing. Make ethical conduct your north star. Train your managers to spot and stop fraud. Because in the end, prevention is the most powerful cure.

When You Need Extra Support -Bring in a Professional Investigator

Some cases are straightforward. Others? Not so much.

When red flags stack up or when evidence becomes murky, bringing in an independent investigator can make all the difference. A licensed investigation firm can discreetly verify facts, conduct interviews, gather evidence, perform lawful surveillance, and help you document findings that hold up with WorkSafeBC.

We have been handling fraudulent injury claim investigations, workplace misconduct, and WCB cases for over 30 years. Our team understands the legal boundaries and evidence standards to uncover the truth without exposing your company to risk.

If you’re facing a questionable claim we’re here to help.

For a complimentary, obligation-free consultation, please get in touch with us at 604-657-4499, info@shadowinvestigationsltd.ca, or fill out our contact form below with your preferred contact method and a brief overview of what you would like assistance with. We keep all information confidential and only use contact information to respond to inquiries.

About the Author

Since 1993, Janet Helm has been a licensed private investigator in British Columbia, with a 30-year financial background in auditing, tax, and accounting. She co-manages Shadow Investigations Ltd., a professional agency in operation since 1990. A member of the Professional Investigator’s Association of BC (PIABC) since 1995, Janet served as its president, initiated the first private investigation course at Douglas College in 1998, and helped develop the Certified Canadian Professional Investigators designation. For her contributions, she received the Taras Hryb Education Builder’s Award. Janet also belongs to various investigator organizations such as the American Society of Industrial Security (ASIS), the World Association of Detectives (WAD), and the Association of Certified Fraud Examiners (ACFE), reflecting her commitment to ongoing education and staying abreast of her field.