Protecting the Integrity of the System Policy 46-300 | Effective Date: November 28, 2023

Policy

WorkSafeNB is responsible for ensuring funds are used appropriately for providing compensation, rehabilitation, medical aid, and prevention services to workers and employers. In managing these funds responsibly, WorkSafeNB provides education, and proactively detects, prevents, and investigates claims of abuse, or claims of abuse arising to fraud.

If WorkSafeNB determines sufficient evidence of abuse, including fraud, it may take internal and/or external civil action, determined on a case-by-case basis. Abusive cases amounting to fraud may additionally be referred to the appropriate police authority for investigation in consideration of criminal charges.

Interpretation

Fraud 

1. WorkSafeNB may find that abuse rises to the level of fraud in cases where a person knowingly provides false or misleading information, or conceals material information, causing WorkSafeNB to rely upon the representations made, resulting in a loss.  This may include a person failing, without reasonable cause, to report a return to work or to report a material change in circumstances that affects entitlement to compensation or services being provided.

Internal Action 

2. When abuse, including fraud, occurs, WorkSafeNB’s internal actions may include:

• Creating and collecting an overpayment as per Policy 21-290 Recovery of Claim-related Overpayments;
• Imposing an employer administrative penalty;
• Terminating, reducing, or suspending benefits;
• Terminating or suspending a service contract;
• Adjusting assessments; and/or
• Terminating or suspending a WorkSafeNB employee.

These actions are taken during an investigation, when appropriate, or at the conclusion of an investigation.

Civil Action

3. In cases of abuse, including fraud, WorkSafeNB may file a civil suit against the party to recover any losses. WorkSafeNB seeks interest in judgments pursued in court, as per as per Policy 21-040 Interest on Claim-related Benefits and Employer Accounts.

 Criminal Action

4. In cases of fraud, in addition to internal and civil action, WorkSafeNB may also file a criminal complaint. Sanctions and other penalties, such as a restitution order, will be sought as appropriate.

5. If no charge is filed, or if the injured worker or service provider is acquitted of the charges, the suspended benefits or contracts are not automatically reinstated. WorkSafeNB may review the benefits or contracts and take any action it determines appropriate.

6. After a criminal complaint is filed, employer coverage and assessment collection continues. At the conclusion of the criminal proceedings, WorkSafeNB may review the assessments for adjustments as appropriate.

7. After a criminal complaint is filed, employees of WorkSafeNB may be suspended. At the conclusion of the criminal proceedings, WorkSafeNB may review the employee’s status and take any actions it determines appropriate.

Application

This policy applies to any person, injured worker, employer, service provider, employee of WorkSafeNB, or any other individual, corporation or organization.

This policy applies to all decisions made on or after the effective date.

Previous policies

• Policy 46-300 Protecting the Integrity of the System release 4, effective September 13, 2017
• Policy 46-300 Protecting the Integrity of the System release 3, effective December 12, 2013
• Policy 46-300 Fraud and Abuse release 2, effective October 27, 2005