Policy
It is an offence under section 149 the Workplace Safety and Insurance Act, 1997 (WSIA) to knowingly make a false or misleading statement or representation to the WSIB in connection with any person’s claim for benefits.
It is also an offence under section 149 of the WSIA for a person to wilfully fail to inform the WSIB of a material change in circumstances in connection with their entitlement to benefits within ten days of the material change.
The WSIB takes all necessary action against a person who commits a claims-related offence, including, for fraudulent acts, referring the case to law enforcement. The WSIB also pursues the recovery of funds, equipment, and the value of services paid to individuals who claim benefits deceptively. Recovery measures used by the WSIB include charges under the WSIA and/or action in civil courts.
NOTE
This policy should be read in conjunction with 22-01-05, Offences and Penalties - General.
To determine if a person has failed to inform the WSIB of a material change in circumstances, the decision-maker refers to 22-01-02, Material Change in Circumstances - Worker.
Purpose
The purpose of this policy is to set out worker offences, the action the WSIB takes when a worker commits or is suspected of committing an offence, and the penalties that may be imposed.
Guidelines
The following guidelines apply to anyone with an interest in a worker’s claim. For the purposes of these guidelines, the term "person" refers to a worker, spouse, or dependant.
Administrative action
Where any new information is obtained by Stakeholder Compliance Services through the review and/or investigation of an allegation against a person, the decision-maker first consults with Stakeholder Compliance Services regarding any conflicts.
After consultation with Stakeholder Compliance Services, the decision-maker may
- review the person’s entitlement to benefits
- confirm, amend, or revoke any previous decision regarding the person’s benefits, and, if appropriate, create a benefit-related debt
- advise Stakeholder Compliance Services of the extent of any benefit-related debt, and/or
- allocate all future benefit entitlement, if any, towards reducing that debt
Recovery of benefits and services
The WSIB takes all necessary action in recovering the equipment it provides, the value of services, and the funds paid to persons who claim benefits or services deceptively. The WSIB has the sole discretion to determine what action it will take in response to an offence or a possibly fraudulent activity.
When a person obtains benefits deceptively, the WSIB pursues recovery of the benefit-related debt, and does not suspend action to recover such amounts because of an appeal, the prosecution of an offence, the passing of a certain period of time, or for any other reason.
Accident costs
If a person is convicted of an offence, the WSIB relieves the employer of the accident costs associated with the improper portions of the claim unless the employer had a role in the offence.
For Schedule 1 employers, these costs are not included in the employer’s claims experience for the purpose of experience rating programs and/or employer level premium rates. Instead, the WSIB transfers these costs from the employer’s claims experience to the employer’s class or subclass.
For Schedule 2 employers, the costs of benefits obtained deceptively are credited to the employer’s account. Any unrecovered costs are charged to all Schedule 2 employers as part of their administrative rate.
Maximum fines imposed upon conviction under the WSIA
See 22-01-05, Offences and Penalties - General.
Time limits
For s.149 offences, there is no time limit for prosecuting an individual or a corporation under the WSIA.
For fraud
An individual or a corporation who commits a fraudulent act may also be charged and prosecuted under the Criminal Code, where no time limit for bringing an action applies.
Application date
This policy applies to all incidents of suspected wrongdoing discovered by the WSIB on or after January 1, 2020, subject to the guidelines for Time limits, for all claims.
Document History
This document replaces 22-01-07 dated January 2, 2018.
This document was previously published as:
22-01-07 dated January 2, 2014
22-01-07 dated March 3, 2008
22-01-07 dated October 12, 2004
11-02-04 dated May 24, 2002.
References
Legislative Authority
Workplace Safety and Insurance Act, 1997, as amended
Sections 149 (1),(2), 157.1(2)
Minute
Administrative
#2, December 17, 2019, Page 571