Ever thought: "Maybe I'll get these non-prescription sunglasses and claim them under my benefits?"
That's benefits fraud - and it can have serious consequences.
As an employment and criminal law firm, we frequently receive calls about benefits or insurance fraud. This is most commonly a scenario where you claim a health related item through your benefits that was not justified.
Is benefits fraud a serious problem?
Top benefit providers like SunLife and Manulife use an online system for members to make a claim. These claims submission portals use the “honour system” but are subject to audit either by the insurer asking the member for receipts or comparing the member’s submission and claim to the records of the actual benefits provider. The member is asked to make an acknowledgement before submitting the claim, often called “the legal stuff” and is required to confirm that the details of the claim are true and accurate.
This is legally known as an attestation, which means confirming your knowledge that what you are claiming is true. This is how the insurer confirms you are knowingly making a claim, which makes it hard to argue later that you did not know it was wrong or false.
I’ve been contacted about a claim of benefits fraud, now what?
It’s important to flag that there are resources on the internet with a lot of misinformation. If you are under investigation for potential benefits or insurance fraud, before speaking to your insurer, an investigator, or the police, you should engage with a trusted lawyer for a privileged discussion and to receive confidential legal advice.
You will benefit greatly from knowing your rights before you have any further discussions relating to the investigation. Your rights will differ when you are speaking to your benefits provider or employer versus when you are speaking to the police.
What are the consequences of benefits fraud?
If you are found to have committed fraud, you could be at risk of a variety of life-altering consequences.
- While an innocent mistake can likely be rectified by you on your own, anything outside of that requires advice.
- Benefit or insurance fraud is serious and can trigger an investigation by your employer and cause potential termination.
- There is also the potential for police involvement and criminal consequences.
That seems pretty serious, doesn’t it?
In his article about benefits fraud, Stephen Frank, President and CEO of the Canadian Life and Health Insurance Association (CLHIA), emphasizes that the consequences of benefits fraud extend beyond repaying money and can include job loss, criminal records, and jail time.
A survey conducted by Environics Research for the CLHIA indicated that 75% of Canadians incorrectly believe that the only punishment for benefits fraud is higher premiums or reimbursing incorrect claim payments.
This is not accurate.
Always be weary of the advice you are receiving off the internet, reddit, and from your own employer/colleagues.
Where do I get good advice on benefits fraud?
Individuals seeking guidance on how to respond to benefits providers when an alleged fraud has taken place, or if you have questions about next steps or potential consequences:
