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Workplace insurance fraud a real risk, says expert

June 7th, 2012 Comments off

Article by 20/20 Canadian Manufacturing & Exporters’ Magazine

A worker breaks his back roofing, gets hospitalized for three months, and is off work from his manufacturing job for a year. His neighbour, a long-time acquaintance, lets slip he is working under the table for cash, while at the same time receiving workplace injury benefits.

As his employer – who is obviously concerned about the overall productivity of your operations – what would you do?

Desmond Taljaard makes it his mission to provide companies with the answer. As vice president of corporate investigations and security services with AFI International, Taljaard oversees internal investigations into workers’ compensation issues. Much of his work involves investigating the validity of claims and working with employers to see if there is fraudulent activity or workplace injury fraud.

“I would define it as someone feigning an injury in order to gain benefit when they are not entitled to that benefit,” says Taljaard, who estimates there could be as much as $100 million spent each year investigating potentially fraudulent claims in Ontario.

And while many cases do turn out to be fabricated, Taljaard adds that a high percentage end up being legitimate claims. “Someone will be hit by a forklift. Someone will hurt their back.”

When an incident occurs, certain red flags start to jump out. For example, complaints of pain may not match the case, or colleagues may see a supposedly injured employee out and about. Investigations, however, have made even easier by a growing culture of connectedness and social media. Public profiles like Facebook are much less intrusive than surveillance.

“People freely post ‘broke 90 today on the links’ as their status update,” says Taljaard, a former policeman and detective. “Colleagues know each other better than human resources or employers in most cases, and they’re the ones who feel the pressure of a lost employee.”

And when these cases are caught, there are consequences.

Read more…

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June 7th, 2012 Comments off

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