Donich Law has been capable of not only defeating but concealing insurance fraud investigations. These investigations typically commence with audits aimed at reconciling claims with practitioners or billing providers. While many investigations originate in Ontario, the insurance providers’ location, they often span the entire country, involving employees and law enforcement agencies in provinces like British Columbia, Alberta, and Quebec.
The first indications of a suspected insurance fraud investigation will be the suspension of access to claims or benefits coverage. Subsequently, these investigations progress through stages, including workplace inquiries, employee interrogations, and ultimately, criminal charges. Defending against insurance fraud investigations proves exceptionally challenging due to their complexity. Successfully safeguarding the client’s interests demands a comprehensive understanding of insurance, employment, regulatory, and criminal law. The challenge escalates further if the individual under investigation holds a professional license, such as those in accounting, education, nursing, dentistry, or other healthcare fields, as regulatory bodies conduct independent investigations.
Donich Law has successfully defended insurance fraud allegations ranging from as low as $200 to $60,000. The Firm has successfully defended clients against investigations conducted by law enforcement units such as York Region Organized Crime Bureau and Durham Financial and Organized Crime Unit, involving both employees and billing providers like dental clinics.
The Criminal Code states that an individual commits fraud when he or she, by deceit, falsehood or other fraudulent means defrauds any individual or the public of any money, property, belonging, service and/or security. The accused must have intended to defraud the individual or public. Fraud happens in a wide variety of contexts and situations and our office has experience handling a variety of fraud related charges, including insurance fraud. Insurance companies are conducting joint internal investigations with the plan member’s employer and providing evidentiary briefs to law enforcement. In many cases, these offences are treated as internal employee thefts, since the fraudulent payment(s) received were funded by the employer. The Firm has been involved in several insurance benefits fraud investigations, which are referred to police by Sun Life, Canada Life and Manulife.
In the Firm’s Case No. 20*****6 it resolved two insurance fraud allegations where an accountant was alleged to have defrauded two separate large Bay Street accounting Firms in Toronto, after quitting the first job and migrating to new employment. We were also able to broker a resolution where the employer would not report to law enforcement, ultimately avoiding a criminal investigation.
In September 2022, Jordan Donich defended at $21,000.00 Sun Life benefits fraud investigation with a large Canadian Bank in its Case No. 35****0. The employee had allegedly been making false psychology claims and received cash including under her partners benefits plan with Sun Life. This jeopardized the employment, income and liberty of the entire family unit. Both Sun Life and the bank confirmed reporting to law enforcement in British Columbia. The Firm was able to quickly challenge the credibility of the therapist and provided fresh defence evidence. The matter was then discreetly resolved without a termination or criminal charges.