Law Times

Law TiMes • May 7, 2012 BY JUDY VAN RHIJN For Law Times W Task force identifies ways to stymie insurance scams " aimed at curtailing the industry in the hopes it can contain its im- pact on insurance premiums and dispute-resolution systems. With sophisticated scams now ith fraud on the rise, the govern- ment is unrolling a swath of measures involving paralegals and reha- bilitation and medical clinics, the government is casting a wide net to catch the fraudsters. Over the last few years, in fact, it has be- come clear to investigators that a veritable industry sprung up around making money from in- surance fraud. Initially confined to false re- porting of accidents and injuries, the scams have progressed to staged collisions involving in- nocent parties as well as billing irregularities and identity theſt by treatment providers. From emergency services to claims-res- olution systems, the fake claims have devoured resources and leſt legitimate claimants without the treatment they require. As a result, the government created the auto insurance anti- fraud task force last year. It provid- ed an interim report in December. The steering committee and three working groups include regula- tors, law enforcement, insurers, and whose mandate is to examine the scope of auto insurance fraud in Ontario and make recommenda- tions to address it. In its first report, the task force insurance intermediaries stated that it wasn't prepared to make a quantitative estimate of the extent or distribution of auto insurance fraud in Ontario. How- ever, an examination of trends in claims-costs data and information gathered from industry stake- holders and regulators has con- vinced the task force that fraud is "extensive, increasing, and having a substantial impact on auto in- surance premiums." In particular, it found that auto insurance claims costs, specifical- ly for accidents under the statu- tory accident benefits schedule, have increased dramatically in a very short period of time. Further reports are expected throughout 2012 with final recommendations due in the fall. Rick Dubin, vice president of investigative services at the Insurance Bureau of Canada, is taking part in one of the task force working groups. Some of the key things his working group is pushing for include dedicated prosecutors, regulation of medi- cal clinics, and whistleblower protection, he notes. The government has already tabled bill 41, the reducing au- tomobile insurance premiums by eliminating fraud act, that will provide protection and legal immunity for informants and investigators who disclose ac- tivities that they suspect involve fraud. It will also protect insur- ers from exposure to claims of bad faith where they've brought Untitled-3 1 something to the attention of the police and the charges have later been dropped. "In the United States, insur- ers have been accused of using the disclosure as pressure on in- dividuals to back off their claim," says Dubin. In the push for dedicated pros- the system well and the majority pleaded guilty. The ecutors, Dubin is hopeful that the success of Project 92, which has resulted in 28 convictions, will provide a convincing argument. "The problem we had before- hand was that many cases never reached the courthouse steps. They were dismissed for unrea- sonable delay as they were tasked from one prosecutor to another. Project 92 reached a milestone " on April 17 when the ringleader known as Max pleaded guilty. "That' Dubin. "That's proof of concept s an important one," says for using two dedicated prosecu- tors supported by the Toronto po- lice force and the investigators of IBC. The cases moved through clinics is on the agenda partly because the health claims for auto insurance database shows an unexplained and continu- ing increase in the number of health-care facilities registered to submit invoices to insurers. There has also been a sig- regulation of medical Government ready to tackle fraud FOCUS this information and provide clear and useful resources on the types of treatments they should expect for their specific injury. Other efforts include a free nificant amount of identity theſt uncovered in Project Whiplash, which resulted in 37 arrests in February. Eight physiotherapy clinics were identified as be- ing owned and operated by the accused. Billing irregularities involved identity theſt from medical professionals who didn't work there or didn't provide treatment to the patients named. Dubin believes strict control over the operation and ownership of medical clinics is necessary. The task force is also involved online training program to iden- tify and investigate staged colli- sions. The Insurance Bureau of Canada will soon be posting a video on YouTube aimed at im- proving public awareness and education on how to identify suspected insurance crime and how to report it. For its part, the government PAGE 11 'The problem we had beforehand was that many cases never reached the courthouse steps,' says Rick Dubin. in developing a consumer engage- ment and education strategy to alert people to the dangers posed by the various fraud schemes. In addition, it wants to develop a sin- gle web portal for Ontario auto in- surance claimants that will display tions will be taken up and that there will be considerable reform going forward that will effectively address accident-benefit fraud. " LT used the 2012 budget as a plat- form to endorse the recommen- dations in the interim report. "All we can tell at this point is that the government is determined to ag- gressively address fraud, particu- larly on the accident-benefit side of things," says Dubin. "We hope the recommenda- PAM LeJEAN Graduate Dalhousie University The McKellar Structured Settlement™ Financial security. Guaranteed payments. 100% tax free. Some decisions are easy. www.lawtimesnews.com 12-04-30 4:30 PM

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