The Co-operators goes to court

The insurer seeks $7 million in damages for fraudulent claims filed by Toronto-area medical clinics.

The Co-operators has filed a Statement of Claim (SOC) with the Ontario Superior Court of Justice against five Toronto-area assessment clinics.

Co-operators General Insurance Company and its subsidiary COSECO Insurance Company are seeking $7 million in damages, following more than a year of intensive investigation. The SOC details several alleged abuses related to assessments and treatments of injured auto insurance claimants by the following defendants:

  • 2171713 Ontario Inc.
  • Century Diagnostic & Assessment Centre Inc.
  • Fairview Assessment Centre Inc.
  • M.D. Consult Inc. o/a Toronto Regional Medical Assessment Centre and Danny Grossi
  • Pacific Assessment Centre Inc.

These abuses include:

•Unauthorized use of regulated health practitioners’ electronic signatures on documents such as assessments and treatment plans
•Submitting requests for assessments and treatment that clients are not aware of, which are unnecessary and/or never rendered
•Submitting invoices for payment related to assistive devices that are unnecessary and/or never purchased

IBC, Co-operators back fraud fight

The Ontario government has recently taken additional steps to help in the fight against insurance fraud, and both The Co-operators and Insurance Bureau of Canada (IBC) congratulate the government for taking this important step. Acting on a 2011 Budget commitment, the government announced the composition of an Auto Insurance Anti-Fraud Task Force, noting that its work is already underway.

Ontario, and in particular the Greater Toronto Area, has long been a North American hotbed of fraud. It is estimated that fraud and abuse account for $1.3 billion of the $9 billion Ontario drivers pay in premiums every year, according to a media release. Ontario offers the richest benefits and has the most expensive auto insurance in Canada.

“Insurance fraud is a serious problem that affects all Ontarians who are concerned about crime, public safety and increased auto insurance premiums,” said Ralph Palumbo, vice president, Ontario, IBC in a press release. “We appreciate that the government has moved quickly to form the Anti-Fraud Task Force, and look forward to continuing to work with government and other stakeholders to ensure that honest Ontarians are not victimized by fraud and abuse of the system.”

IBC worked with the government to set up the Anti-Fraud Task Force, which brings together stakeholders from the insurance industry, academia and the justice sector, as well as a consumer advocate. The association looks forward to working with the Task Force on an ongoing basis to assist in implementing its recommendations regarding detection, investigation and enforcement.

Meanwhile, The Co-operators has implemented new procedures and practices to detect fraudulent activity during the claims process. It has also committed additional resources and expanded its Special Investigations Unit to deter fraudulent activity. The organization will continue to work diligently to bring those responsible to justice, to ensure that clients’ premium dollars are going towards those injured in accidents, not criminal activity, stated a media release.

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