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In today’s landscape where insurance crime has never been more complex, Canadian P&C insurers are doing morethan ever to protect consumers through their strategic partnership with Équité.Accident benefits fraud is known as a ‘gateway fraud’; it is an entry point fordeeply complex and sophisticated organized crime networks, including healthcarefraud, synthetic identify fraud, and more.
In Équité Association’s experience, these organized crime networks are often made up of dishonest individuals whounderstand how to take advantage of the system. Unfortunately, this includes thosewith a duty to act with integrity, such as healthcare clinic owners, registeredhealthcare practitioners, lawyers and more.
This tip sheet is designed to help brokers and agents talk to clients about how to spot potentially fraudulent scenarios and avoid becoming a victim of insurance crime. Ensure to speak toyour clients about the importance of taking the below steps to avoid becoming a victim of insurance crime:
Understand before signing forms
- Criminals will try to use a collision for financial gain, without considering the healthcare needs or injuries sustained to the honest people involved. This may result in delayed access to healthcare through unnecessary assessments or billing for treatments not provided, often draining a policy, impacting thetotal amount an injured person has to support their healthcare. Once a policy is drained, the individual will no longer have ongoing financial support for their healthcare and may be left without the care they need. Help your client understand what the forms are for, and ensure what they are signing aligns with the services/goods received.
Research and ask for recommendations from trusted sources
- Équité investigators often see organized crime networks that work across multiple auto-related industries. For example, the driver of a premeditated staged collision may be connected to a tow truck company, who will collude with a healthcare clinic to bill for unnecessary care costs. This leaves the victim without anyone prioritizing their care and healing. Brokers and agents can help drivers avoid these fraudulent business practices by providing a list of trusted businesses including auto-repair shops and tow companies.
Document and take photos
- Photos of collisions or paperwork can help prove fraud especially when it comes to altering documents or falsifying staged collision events.
Be aware of cash-only requests
- Staged collision criminals may try to make the collision look like the other drivers fault, and then demand cash to keep from reporting it. This is dishonest behavior, and clients should contact their insurance agents/brokers who can offer support on how to submit a claim.
Report suspected fraud
- 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.
Équité Association is working collaboratively with the insurance industry to educate and build awareness of the true cost of insurance crime in order to put an end to insurance crime and fraud.
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