Programs that provide a hotline or other mechanisms that the public can use to report to cases of suspected fraud involving claimants, employers, insurance company officials, officials of third-party administrators, insurance agents, lawyers, health care providers, and vocational rehabilitation providers who have lied to obtain a benefit through the Workers Compensation program or to prevent a benefit from being awarded. Examples of this type of fraud include employers who have lied about the nature of the work involved, the number of employees or their salaries in order to receive lower Workers Compensation insurance rates; employers who have not obtained Workers Compensation when required to do so; employees who file Workers Compensation claims for injuries that did not occur; employees who obtain benefits as a result of lying about their ability to work or income from other sources; and health care providers or lawyers who inflate their bills or bill for treatment of or services related to nonwork-connected injuries.
Programs that provide assistance for people who are having difficulty understanding and/or obtaining the full benefits to which they are entitled by law under provincial Workers Compensation statutes. The programs may help people understand the eligibility criteria for Workers Compensation benefits, the benefits provided by the program, and the rights of beneficiaries; provide consultation and advice; help them complete Workers Compensation application forms; negotiate on their behalf with Workers Compensation benefits staff; and/or represent them in administrative hearings or judicial litigation. Included are organizations that offer a range of advocacy services as well as legal aid programs which offer more formalized legal assistance. Workers Compensation is a disability insurance program mandated by the province and funded by employer contributions which provides compensation to covered employees for loss of their earnings as a result of an accidental injury or occupational disease sustained during employment, or which compensates dependents in case of a work-related death.
The above terms and definitions are part of the Taxonomy of Human Services, used here by permission of INFO LINE of Los Angeles.