Greg Dalgetty, Editor
How to tackle auto insurance fraud | Canadian Insurance

How to tackle auto insurance fraud

We talked to Gordon Rasbach, Aviva Canada’s VP of fraud management

Battling auto insurance fraud is on the minds of many in Ontario following the release of the province’s Fair Auto Insurance Plan earlier this week.

Among other measures, the government plans to standardize treatment for common auto collision injuries and establish a Serious Fraud Office to investigate suspected cases of fraud.

Gordon Rasbach, Aviva Canada’s vice-president of fraud management, is well versed in the common types of auto insurance fraud that translate to higher premiums for policyholders.

Related: Canadians blame insurance fraud for high auto premiums: Aviva Report

“The most typical one would be fictitious or exaggerated injuries arising from auto accidents,” he says. “There’s fraud committed by collision repair shops and sometimes auto thefts that are staged. Those are the big ones, but the auto injury side is the most expensive.”

Aviva recently issued a report estimating that auto insurance fraud costs Canadian policyholders $2 billion a year.

Rasbach, a former Toronto Police detective, says that one of the biggest obstacles to tackling fraud is that most cases go unreported.

“It’s not hard to detect from a burden of proof perspective. In other words, if you go out and investigate it, you’ll generally prove it,” he notes. “It’s more an issue of it being an unreported crime or an unreported incident to an insurance company than anything else.”

Related: Reactions to Ontario’s Fair Auto Insurance Plan

Further complicating matters, not everyone who is complicit in insurance fraud is necessarily aware of it. For instance, a rehabilitation clinic might bill an insurance company for services that weren’t provided, unbeknownst to the person being treated.

“The typical case would be I go [into a clinic], I’ve got some soft tissue injuries, I get four treatments and then I go home and I’m better—but the insurance company gets a bill for 20 treatments” Rasbach says. “Most people wouldn’t even know that they’re involved in a case of fraud.”

To illustrate the extent of the problem, in 2014, Aviva sent two undercover investigators with hidden cameras to a healthcare clinic and law office in Toronto. Both places were alleged to have committed insurance fraud.

“The idea behind the footage was to take everybody into a day in the life of a typical injury claim,” Rasbach says.

The footage, which aired on W5, showed employees at the clinic and legal firm coaching the undercover operatives—who explicitly stated that they were not injured—on how to maximize their insurance payouts.

“Just to highlight the issue, those people that were put in undercover were told that no matter what you get asked, you tell them, ‘I’m not injured. There’s nothing wrong with me.’ And yet, it still all happened.”

When charged with fraud-related offences, the parties shown in the video pleaded guilty and were convicted.

From the archives: A Nose for Fraud

“Even after that case was on W5, we went after everybody civilly to recover all of our costs, and we’ll do that on every case,” Rasbach says. “The cost that it takes to prove the fraud—if you don’t recover that cost, it ends up being a cost of doing business in and of itself. So we have to pursue it that way, and we do. We don’t let go of it—we’re like a dog on a pant leg.”

So, with Aviva estimating that auto insurance fraud costs policyholders $2 billion a year, how much of it can realistically be eliminated?

“You’ll never get it all,” Rasbach says. “The answer is somewhere between almost all of it and some of it.”

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