Free 30 Minute Consultation 416-923-1900 or click here.
Select Page

EMPLOYMENT BENEFITS INSURANCE FRAUD

Employment Benefits Insurance Fraud

Employees often receive a benefits plan through their employer for health care services such as dental, massage therapy, physiotherapy, optometry, and orthopedics. Issues arise, however, when employees are investigated by the insurance company for unsubstantiated claims.

It may come to your attention that you are being audited or investigated by an insurance company in a number of ways. For example, you may be informed by one of your health practitioners that they have received inquiries about your claims for paramedical, dental, and other services. You may also be contacted by an Investigator from an insurance company by phone, email or in person about your claims. You could also be brought into a HR meeting by your employer and asked to explain the claims in question.

Internal Insurance Company Investigations

Insurance companies often investigate matters of unsubstantiated claims internally. These investigations often commence by way of routine claims audits. The insurance company may contact you requesting additional information or supporting documentation for a number of claims that you previously made. It is important to contact a lawyer early on in this investigation process. A lawyer will provide you with important legal advice before you speak to an insurance investigator or your employer about any health benefits claims issues.

Employment Consequences

Allegations of insurance benefits fraud can have a significant impact on your livelihood, your career, and your family. An allegation of insurance benefits fraud could result in being charged with criminal offences, being terminated from your employment, or being sued by the insurance company. Criminal penalties can result in a criminal record, which can further impact your future career prospects.

Criminal Penalties or Civil Lawsuit for Insurance Fraud

An insurance company or your employer could also commence a civil lawsuit against you for fraud and may seek the recovery of any funds that were lost.

An insurance company can also forward their investigation to police, who may decide to lay charges for fraud. (Link to Fraud Over $5000 page) A conviction arising from insurance fraud charges can also result in a number of penalties, depending on your previous criminal record. If you have previously been involved in fraud, the chances of incarceration increase. If you have no prior convictions or a compelling personal circumstance, a conviction could result in a lesser fine or other penalty.

Contact a Toronto Insurance Fraud defence Lawyer

To arrange a free initial consultation with Damien R. Frost & Associates, call 416-923-1900 or contact the legal defence firm via email today.

Members of The Criminal Lawyers Association, Toronto Lawyers Association, Ontario Bar Association 
and Advocates' Society.

OUR CLIENT
REVIEWS

Very Pleased Working with Rebecca

"I have been very pleased working with Rebecca. She worked very efficiently, professionally and cared for every step, as we went through the process with Ontario College of Pharmacists. Initially I thought I would be going through a nightmare ,when I received my paperwork from Ontario College of Pharmacists, but Rebecca made the process seamless and the outcome was positive. Thank-you Rebecca and I would highly recommend your excellent professional service to others."
- NP

Very Professional and Helpful

I hired Ms Rebecca Young regarding a legal matter in October 2015. I found her and the firm to be very professional and helpful. The whole process took about one year to resolve. I followed her advice and the outcome was in my favour. I would recommend her for her professionalism, knowledge and pleasant attitude. –
I.S.

Pleased with the Outcome

"Daniel, Thank you for your excellent work. I am pleased with the outcome. I didn’t feel ‘prosecuted’ and I believe that is due to your excellent advocacy skills and rapport with the Court."
- AF

Helped a Lot to Calm my Nerves

"I was accused by my former employer of interfering and damaging their computer systems. I was charged under the Criminal Code for mischief, unauthorized access and destruction of data, which was a very scary, stressful, and upsetting experience. I thought that my world was over and all the hard work I had done in my life was coming to an end. Mr. Frost’s initial consultation (which was no obligation and free of charge) helped a lot to calm my nerves and comfort me and my family in trying times. His team was very understanding, sympathetic, concerned and supporting, she always took my frantic phone calls with calmness and assurance and helped me understand the progress of my case clearly. At every step, I received sound professional advice. At the end of the case, the charges were dropped. As a result, I do not have a criminal record, my reputation is intact, and my current job is still secure. Words cannot truly express my gratitude for having such amazing lawyers. From explaining the terminology used in court, to sitting with me outside the court room when I couldn’t hold back my tears, they stood by my side. Thank you for exceeding my expectations, and then some."
– JS

Very Pleased with Mr. Frost’s Representation

"We were very pleased with Mr. Frost’s representation. He provided us with the best possible legal representation. He was dedicated to obtaining a tremendous resolution in what was complex litigation while being always mindful that we required a cost-effective solution."
– BB

I am very Pleased

"I was charged along with nine other physicians with fraud against OHIP. I was also the subject of a complaint before the College of Physicians and Surgeons arising from the same allegations. I was assigned counsel by the Canadian Medical Protective Association (CMPA). On the advice of a friend who was a Crown Counsel I insisted that I be allowed to retain Mr. Frost. I am very pleased that I was allowed to do so. Mr. Frost (together with Ms. Samantha Peeris) provided me with first class representation. He convinced the Crown to drop the charges against me. His office always kept me informed in a timely fashion of any developments. He clearly understood the impact of these allegations on my professional reputation. Mr. Frost always maintained a very low profile. Mr. Frost went on to represent me before the College of Physicians and Surgeons ensuring that no disciplinary was taken. I continue to practice medicine in my area of expertise." –
Dr. C

I was Relieved with his Representation

"I am a healthcare provider with a practice in the Greater Toronto Area, Ontario. I was represented by Mr. Frost before my professional licensing College with respect to a complaint by an insurance company. I was quite concerned that the complaint could affect my professional standing and reputation. Mr. Frost understood what needed to be done. He also understood the impact the complaint was having on me personally. He acted quickly. He was able to convince the College to take no further action. I was relieved that his representation was very low profile and my professional reputation was not undermined with the public or the College. As a result of his representation my status with that particular insurer was regularized."
– CC

Tell Us About Your Legal Issue

  • This field is for validation purposes and should be left unchanged.