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Insurance and Health Benefits Fraud Cases

Insurance fraud, the act of making fraudulent claims for insurance benefits, is an issue that appears in a variety of different forms throughout the Greater Toronto Area and Ontario. These cases can be very complex, making the assistance and counsel of a knowledgeable defence lawyer particularly valuable.

Damien R. Frost, a criminal defence lawyer with more than 30 years of experience, works closely with clients who face accusations of insurance fraud. Before talking to the insurance company about the situation, contact Mr. Frost and his associates to learn about your rights during a free consultation.

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.

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. 

Insurance fraud may relate to Homeowners insurance polices, car insurance policies, medical insurance plans, including OHIP, and the Ontario Drug Plan.

Internal Insurance Company Investigations

Before insurance fraud matters are turned over to the police, they are often investigated internally by the insurance company. When Toronto insurance fraud defence lawyer Damien R. Frost and his associates are involved early on in the process, they are often able to achieve a resolution to the matter before criminal charges are laid. They work hard to save clients from the stress and financial strain of a criminal case as well as the damage that can result to someone’s reputation and standing in the community from these types of allegations. You should not speak with an insurance investigator or your employer about any health benefits claims at issue before speaking with a lawyer.

Criminal Penalties for Insurance Fraud

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.

Businesses, including health clinics, are often investigated for Insurance Fraud.

This can negatively impact the business, the business owner, its employees and customers. Your business may learn that it is being investigated for insurance fraud from clients whose claims have been audited, or your business may be contacted by an insurance investigator directly.

Insurance fraud investigations against businesses can lead to delisting of services, civil suits, criminal charges, and Professional College Complaints.

Being delisted by an insurance company can be devastating for your business, as the insurance company will no longer reimburse claims for services your business or clinic provides. You should not speak with an insurance investigator without first speaking with a lawyer.

Damien Frost & Associates LLP has represented countless individuals and businesses who are being investigated for insurance fraud. Do not wait until you have been sued, charged with criminal offences, or delisted by an insurance company. Click here to contact Damien Frost & Associates LLP. We will work to ensure the best possible resolution with no surprises along the way.

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.

Additional Articles
  • Ten Things to Know About Insurance Benefits Fraud and Misuse
    Ten Things to Know About Insurance Benefits Fraud and Misuse. Both employees and employers pay into private health-benefits plans. Just because part of your pay cheque goes into your plan, that does not mean you are entitled to use the benefits unconditionally. Pay careful attention to your policy’s limits and rules. Some services, such as massage therapy, require a prescription from a physician. Make...
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  • Employers are Cracking Down on Insurance Benefits Fraud Schemes
    There have been several high-profile investigations by Toronto employers revealing wide-spread insurance fraud schemes. In 2017, St. Michael’s Hospital fired 31 employees after $200,000 in false insurance benefit claims were discovered. In 2018, the TTC fired more than 200 employees after a lengthy benefits fraud investigation, which commenced in 2014, identified that millions of dollars were paid for services that were never provided. Most...
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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."
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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. –

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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."
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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

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