1. Assuming You Will be Forgiven by Apologizing
One of the most common mistakes people make when dealing with an insurance benefit fraud investigation is immediately admitting to everything. Many people have the misconception that if they are honest and tell the truth, they will be given leniency. Others think that because they were a good employee, were well respected or had been with the company for a long time, they will be given a second chance.
This is almost never the case. When dealing with insurance benefit fraud investigations, even the most trusted, well respected, long time employee may face termination, criminal charges or be sued in civil court by their employer or the insurance company.
In many cases, especially in larger companies, reporting policies and shareholder duties are triggered once an employee admits to engaging in fraud related to their employee benefits. In companies with shareholders, there is often a duty that must be discharged, which in many cases may mean pressing charges against an employee who commits fraud.
In many cases, immediately admitting to the fraud and apologizing will do more harm than good for the benefit holder. Firstly, it is unlikely that the apology will hold any weight at all. Just as you cannot apologize your way out of criminal court, you cannot apologize your way out of defrauding your employer or insurance benefit plan provider. Secondly, once you have admitted and apologized for the alleged fraud, it is very easy for your employer or the insurance company to have you charged and convicted and/or sue you in civil court. Finally, if the fraud is reported to law enforcement and charges are laid, the Crown attorney may use any admissions to the employer or insurance company as evidence in the criminal case. This is discussed more in detail below.
2. Running Away Won’t Save You
Insurance fraud investigations take a long time. In some cases, the long periods between contact from the insurance company can lull people into a false sense of security. Many individuals believe that if the insurance company has not reached out for several months the matter must have resolved itself and gone away. This is almost never the case. The insurance company will never just “go away” when it comes to potentially fraudulent behaviour. While they may not contact you for several months at a time, this does not mean they are not still investigating.
Similarly, running away from the insurance company will not stop an investigation. Some individuals believe that if they leave their job the insurance company will not be able to find them or won’t bother going after them. This is untrue. It is not relevant whether you are still working for that employer, the insurance company will still attempt to collect on their losses.
Furthermore, for professionals such as nurses, doctors and teachers who are regulated by a College, being accused of defrauding your employee benefit plan may also trigger an investigation from the appropriate College. This, in turn, can impact an individual’s ability to practice in their given profession. In situations where an employee refuses to participate in the investigation in any way, the insurer will proceed without evidence from the accused individual, deciding in their absence.