Insurance fraud is everyone’s business!
In the insurance industry, there are varying degrees of fraud, but they all make an impact. The consequences are felt by all: you, other insured people, groups that place their trust in us, and us, too.
Let’s make the most of Fraud Prevention Month and try to find some common solutions.
In group insurance
Our goal is not to list every possible case or point fingers at the culprits. Instead, we’d like to inform you so that you can be on the lookout for fraud.
In most cases, fraud occurs during a claim, when rules are exploited or deliberate acts are committed to falsify documents and the claims themselves.
An obvious example? When filing a disability insurance claim, an insured person exaggerates or claims to have symptoms to take a leave from work. Some people can go as far as receiving a second income without informing their insurer.
Sometimes, healthcare professionals commit fraud, too. For example, if your dentist submits a claim for a nighttime mouth guard when in fact you only went for a cleaning. That’s fraud!
In other cases, the professional and the insured person team up to commit fraud. It’s called collusion. Some examples?
- You reach the maximum amount for naturopathic treatments. At your request, your healthcare professional makes out a receipt in your spouse’s name instead of yours, even though you received the treatment.
- Your optometrist clinic gives you an invoice for expensive prescription contact lenses when in fact you bought new sunglasses, without a prescription.
The goal remains the same, to get reimbursed for an unjustified amount.
What you can do
This is where you play an important part in preventing group insurance fraud.
It all starts with the details of your group insurance plan. It’s always good to know what’s covered, what’s not covered and the maximum amounts you’re granted for healthcare treatments. However, you should keep this information to yourself.
Exercise the same caution with your personal information: PINs, insurance cards (use the one provided in the Client Centre or the Beneva mobile app) and all your group insurance documents, etc. Once they’re in the wrong hands, the information can be used to submit a false claim.
Fraud does not strictly consist of an amount to be reimbursed and maximum amounts. Your insurance covers all required healthcare and medical equipment. Fake invoices and exaggerated services are also considered fraud. You should accept only invoices that reflect reality.
Do business with healthcare professionals who are members of a recognized association or order. How can you find out? Contact the professional organizations in your province. That’s how you can be sure that there were never any complaints filed against your healthcare professional. Also visit the Client Centre to see which associations, establishments and healthcare professionals we’ve excluded. Otherwise, your claim may be denied.
Check whether the description of the treatment you received is accurate.
Lastly, store all important information such as:
- Dates of medical appointments
- Names of healthcare professionals
- Diagnoses
- Treatments received
- Prescription drugs and medical supplies you purchased
What we do
We don’t take group insurance fraud lightly. The proof? We have a team dedicated to combatting it full-time.
The team has implemented several measures to prevent fraud, including:
- Checking past claims
- Requesting reimbursement of overpaid amounts
- Terminating or cancelling insurance contracts
- Filing complaints with professional orders and associations
- Taking legal measures
We use artificial intelligence to help us detect fraud, and pool our claims data with other insurance companies.
Car insurance
In car insurance, the story is often the same as group insurance. Claims are exaggerated or fabricated.
Usually, the claim is legitimate, but the damage is overstated. How? Either it was caused before the accident, or they perform more repairs than required.
Ever hear of staged car accidents? Some scammers stage collisions, then submit claims to several different insurers. They exaggerate the damage or injuries in order to turn a profit.
And if everyone piles on, the bill keeps climbing. Who pays for this abuse? By increasing the expenses insurers need to reimburse, the pressure is felt by everyone and car insurance premium rates are likely to go up.
What you can do
Be extremely cautious.
For example, a car accident can be a stressful experience, so why not turn to your insurer for guidance? They can tell you which steps to take, whether injuries were involved or not. They’ll also help you avoid fraud pitfalls.
Ask your insurer to recommend body shops, towing companies (This hyperlink will open in a new tab) and healthcare professionals if you sustained any injuries. You can count on your insurer!
If you pick a body shop on your own, make sure the price they charge for the work they do aligns with the estimate provided by your insurer.
Then, compare the documents provided by your insurer with the repair bills. Everything should match, with nothing extra appearing on the bill!
Are you getting the feeling it might be fraud? You can report anything you deem suspicious anonymously. To do so, write to the Insurance Bureau of Canada (This hyperlink will open in a new tab) (IBC) or call 1 877 422-8477.
What we do
Fraud is serious business! We have a team dedicated to preventing and detecting fraud.
We also carefully select the service providers that we recommend to customers: garages, body shops, towing companies, healthcare professionals, etc. They all must be reliable.
We also participated in the National Summit on Combatting Auto Theft (This hyperlink will open in a new tab). The event is organized by the federal government and brings together all stakeholders who are looking for solutions to combat the influx of car theft, including the police, car manufacturers and insurance companies, among others.
Why is fraud prevention important?
Did you know that, according to the IBC, everyone pays approximately 15% more for their insurance due to fraud?
For insurers, it represents losses that can add up to 5% of their annual sales. It includes any investments made to combat fraud.
But insurance fraud is not just about the money!
Increasing premium rates puts more pressure on everyone. And it jeopardizes the viability of insurance plans.
How to report fraud
Suspect fraud? You can let us know anonymously:
- online (This hyperlink will open in a new tab)
- 1 866 777-3694
- [email protected]
Everyone wins when we prevent fraud!
