What employers should know about employees abusing workers compensation benefits in Manitoba.

We are receiving an increasing number of cases from agencies and corporations who suspect their employee is abusing the Worker’s Compensation Program in Manitoba.

If you suspect your employee is exaggerating his/her injury and you have video evidence from a third party to support your allegations, you will be required to provide the Special Investigations Unit  of the Workers Compensation Board of Manitoba with a “Third Party Video Questionnaire”.     This questionnaire outlines the process that is required to submit third party video images to the Worker’s Compensation Board (WCB) from an external party.   This source of the video image will have to provide permission for the use of the evidence.   The Special Advisor from “WCB” will review the evidence to ensure it is relevant, accurate, verifiable and credible.   If this evidence is sufficient, then the Special Advisor will forward this material to the manager or adjudicator handling the file.   They may also conduct their own investigation at their discretion.   All investigations carried out by the Special Investigations Unit must be in compliant with their investigation policy.    If they are considering retaining their own investigators, they have policies with respect to how surveillance investigations are carried out.  If their investigation is inconclusive, then the results are not contained in the claimant’s file.   For example, if “WCB” carried out an investigation by one of their own investigators that did not uncover anything relevant, this information would not be permitted in the claimant’s file.   However, if the results were conclusive, the claimant is entitled to review and respond to the outcome of an investigation and view any video footage obtained by the investigators that are hired by “WCB”.

If you suspect an employee is engaging in program abuse by witness accounts,  you can make a complaint to “WCB” by filing an investigation request form to be provided to the manager handling the “WCB” file.   It is important to provide as much information as possible, including the date of the complaint, all identifying characteristics of the party you are complaining about, including your relationship to the subject matter.  If the complaint demonstrates reasonable grounds of program abuse, an investigation may be carried out by “WCB”.   The discretion will depend solely on their decision based upon all the information that was provided in the complaint.   The results of any investigation carried out by “WCB” will only be disclosed to the employer, if the matter is under review or appealed.

If the “WCB” rules in favor of the claimant in a benefits decision, the employer is entitled to make a “Request for Review” of a decision and the adjudicator will advise you of this right in their decision.   If “WCB” rules against the claimant, the claimant is also entitled to the same process.

At this stage in the review, any new evidence will be considered for review. Therefore, if you are an employer and wish to undertake your own investigation, it would not be unreasonable to do so.

As part of our investigation, we will conduct a three day surveillance investigation on the claimant to establish their activities and provide video evidence.   The employer will have thirty (30) days from the date of the review request to provide the new evidence.   The claimant is entitled to review the evidence provided by the employer when the matter is under review.    The claimant will have fifteen (15) days to respond.    The new evidence that we provide the employer can only be used for the Review Office.

The Special Investigations Unit has no jurisdiction to review or obtain a copy of any of our findings that are under review because our investigation is carried out for the sole purposes of the review process.     Special Investigators or Special advisors of “WCB” carry out investigations for offenses under the Worker Compensation Board Act.   They report to the Director of Legal Services in Manitoba but when we carry out the investigation for the Review, acting on behalf of the employer, we are doing so as a civil matter.

The Review Office process is guided by an independent and impartial review of the file.  They will evaluate all the evidence relevant to the issue, including any new evidence and these decisions are based upon the merits of each case.  There are no hearings held at this stage of the review.   It is a very informal process and you can appeal any decision made at this stage.

Please visit our web site at http://www.duncaninvestigations.com.  Any questions, please email duncaninvestigations@mts.net

Private investigations in  Alberta, British Columbia, Manitoba, New Brunswick, Newfoundland and Labrador, Nova Scotia, Ontario, Prince Edward Island, Quebec,  Saskatchewan, the Northwest Territories.

 

 

 

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