Q:

How do you report disability fraud in Canada?

A:

Quick Answer

Canadian disability plan administrators report instances of suspected disability insurance fraud directly to their insurance carrier, according to Sean Maxwell for Benefits Canada. In cases that involve a disability fraud ring, plan administrators also notify law enforcement. Under Canadian law, disability is a prosecutable offense under the Criminal Code of Canada.

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Full Answer

When plan sponsors suspect fraudulent activity, they need to be careful not to publicize the information or confront the suspected fraudster directly, advises Maxwell. These actions alert a perpetrator, which endangers the investigation by allowing the perpetrator to cover up the crime and formulate a defense. If the company carries disability insurance through a carrier, the carrier should conduct the fraud investigation; it is the victim of the crime and has staff with professional expertise in disability fraud investigation.

Administrators of self-insured plans need to consult with an attorney regarding disability fraud cases because the company sponsoring the plan is the victim, explains Maxwell. Administrators of plans insured through a carrier also need to seek legal advice. They must protect the company from potential allegations the company enabled the fraud to occur, which could lead to a denial of benefits. It is also critical for disability plan administrators to retain all records and documentation related to a disability claim in a litigation file in case the matter goes to court.

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