In last week’s Toronto Injury Lawyer Blog, I briefly shared with you our law firm’s experience seeing and reporting auto/accident benefit fraud.
We had many calls following that blog post wanting to know more, as I didn’t really expand on what had happened.
This week, we will take this opportunity to examine what happened to our clients, and to our law firm when faced with what appeared to be a clear cut case of lies, deception and manipulation amounting to an attempted accident benefit fraud on our clients.
A friend of mine referred me to lovely family who had been involved in a serious car accident. The mom was still in hospital with a broken leg which had been operated on. She remains unable to walk, work, or engage in her normal activities of daily living. She was staying in the Ortho Floor at Credit Valley Hospital in Mississauga.
I made arrangements and eventually met with the entire family at the hospital. This is normal for personal injury lawyers to do. Hospital meetings are sometimes necessary, and at our law firm, they are free of charge.
After hearing more about how the accident happened and about the family, and after sharing how our law firm could help with their car accident claim,the family decided to retain our services. Retainers and authorisations were signed, and just like that, we were their personal injury lawyers of record.
One of the questions I had asked was whether or not somebody from the insurance company had been in contact with them. The family answered “YES“; a woman named “Ivanna” had called on a number of occasions. In fact, Ivanna was scheduled to come to the hospital and visit with the family in order to get them to sign some forms which the insurance company allegedly needed.
When asked which insurer Ivanna worked for, and for what department (accident benefit, tort, property damage), the family didn’t know. This didn’t strike me as unusual at all, because there was so much going on for the family to deal with.
The family provided me with Ivanna’s telephone number, which I decided to call in order to introduce myself. Ivanna didn’t answer the telephone as your typical insurance adjuster would. I asked her which insurer she worked for and she simply told me that she worked for “head office“. I asked for which “head office” did she work for and she failed to answer. I then pressed again and asked her which insurer she worked for. She then admitted that she did NOT work for any insurance company. Rather, she was an agent on behalf of an assessment centre seeking to get my clients to sign a bunch of forms. I asked her which assessment centre she worked for and she refused to answer.
I asked my clients how Ivanna got in touch with them and they didn’t know. I asked my clients if they had ever reached out to an assessment centre, physiotherapist, chiropractor or another health care professional. They told me that they have been stuck at the hospital ever since the car accident, and that there was no way that they had ever reached out to any such person.
I asked my clients if Ivanna had ever told them they she worked for an assessment centre. My clients insisted that Ivanna had lied to them and told them on multiple occasions that she worked for the insurance company and that it was critically important that she come in and meet with them.
I told my clients never to speak with Ivanna again, and told Ivanna never to contact my clients again.
When we found out who the insurer was after the initial meeting, I shared my experience at Credit Valley Hospital with the insurance adjuster. That adjuster advised me that she had never referred anything out of the file to any assessment centre or health care provider. The adjuster told me that the situation seemed very odd. I agreed. This was all very fishy.
My clients and I decided to report this incident to the Financial Services Commission of Ontario (FSCO). They have their own Fraud Tip Hotline at 1-888-5TIP-NOW. This was my first time ever reporting auto fraud/accident benefit fraud and I really didn’t know what to expect. I was passed to four different people at FSCO before I got to somebody who had an idea of what to do. I’m not sure if a formal report or formal investigation was ever completed by FSCO. I’m not sure if they reached out to Ivanna, or to Credit Valley Hospital about this. My clients and are have been kept in the dark. Chances are, nothing ever became of our complaint, and Ivanna continues to call injured accident victims in Credit Valley Hospital misrepresenting that she works for the insurance company.
What this experience highlights is that not every fraud is a staged car accident. Auto fraud comes in many ways, shapes and forms. In this case, it was a clear lie by a non lawyer trying to get innocent unsuspecting accident victims to sign forms so that they can be retained to provide treatment and bill the insurer for their alleged services. It also came in the form of the leaking of private contact information from a source (Hospital, Paramedic, Police, Tow Truck Driver, Somebody Else?) to Ivanna without the client’s permission.
FSCO could get to the bottom of this very easily. They have Ivanna’s contact information. They know the hospital and room # where my clients were staying. Interviewing all of these people to get answers is not outside of their investigatory powers. You would think that with all of the puffery from the Insurance Bureau of Canada regarding car accident and accident benefit fraud that this problem would be taken a bit more seriously. But that doesn’t appear to be the case. Giving the appearance of being tough on fraudsters is more important than actually doing the work to ensure this sort of thing doesn’t happen again.
This sort of accident benefit fraud is likely easier, less risk and more lucrative than stagging an actual car accident. Staging a car accident can hurt and is risky business. This sort of paper fraud just requires a few people on the inside, a few lies and some signatures to get the ball rolling on people who are in a vulnerable state and unfamiliar with Ontario’s complicated system of accident benefits. The fact that accident benefits in Ontario are so complicated allows this sort of fraud to exist. People just don’t know any better because the system is so confusing and constantly changing.