Anti-fraud Checklist: How to keep track of your accident benefits

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Accident benefits fraud is known as a ‘gateway fraud’; it is an entry point for deeply complex and sophisticated financial organized crime networks, and includes synthetic identify fraud, healthcare fraud, and more. These networks are trying to maximize insurance payouts and drain your policy by fraudulently billing for unnecessary assessments or overbilling for procedures not provided to the injured individual.

In Ontario, Statutory Accident Benefits (SAB) Coverages are provided by law under every auto insurance policy (Accident benefits coverage information for Alberta is available here and Quebec is here). These benefits provide compensation, regardless of fault, if you, your passengers, or pedestrians are injured, or die as the result of your accident. However, it is important to note there is a maximum value that can be billed to insurers against the SAB coverage. Financial organized crime networks will seek to maximized payouts without providing adequate care or ensuring enough funds are left for continued care.  Unfortunately, this includes those with a duty to act with integrity, such as healthcare clinic owners, registered healthcare practitioners, lawyers and more.

In Ontario, when applying for accident benefits, your claims adjuster will provide you with an Accident Benefits Application Package.

Safeguard your accident benefits: This checklist is designed to help you keep track of your accident benefits and protect against fraudulent billing.

☐ Closely review all forms within the Accident Benefits Application Package provided by your agent, broker or insurance company.

☐ Ensure your healthcare practitioner is authorized by law to treat your impairment that they complete the relevant treatment forms provided by the insurance company, and will be responsible for providing all services required.

☐ Ask questions and ensure you fully understand the answers. If you are not sure or don’t feel the answers are complete, reach out to your insurer, agent or broker for clarification and support with next steps.

☐ Closely review all documents before signing them.  Ensure you received all services listed before signing.

☐ Do research when looking for services such as a lawyer, a healthcare clinic, auto repair shop or others. Your insurance provider can often make recommendations of trusted businesses in your area. Check reviews, get referrals from trusted sources and ask questions to ensure all of these services are working in good faith to support you.

Insurance crime is not a victimless crime, and Équité believes it is time we eradicate these crimes from Canada. In 2023, Équité partnered with Crime Stoppers to make it easier for Canadians to report insurance crimes. The Crime Stoppers tip line is available 24-hours a day, seven days a week. For those who prefer to submit tips online, click here. Both options are anonymous and confidential for tipsters.

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