Accident Benefits Fraud

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Fraud always has a victim, and criminals typically target those who are the most vulnerable. Accident benefits fraud is known as a ‘gateway fraud’, because is the entry point for deeply complex and sophisticated organized fraud networks, including synthetic identify fraud, healthcare fraud and more.

Accident benefits fraud impacts people at their most vulnerable, while also funding organized crime networks. When it comes to accident benefits fraud, criminals may try to maximize insurance payouts without ensuring the injured person receives the care they need.

Types of Accident Benefits Fraud

Proper care not delivered to the injured person

• This fraud occurs when a provider claims services on behalf of an injured individual, but that individual may not receive the care claimed. For example, an unreliable healthcare centre may collude with a tow truck company with the goal of finding a recent collision and exploiting the injured driver’s vulnerability. This may include maximizing accident benefits pay outs without providing total care claimed to the injured person.

Fake accident collusion

• The accident resulting in the need for accident benefits claims may be on paper only. For example, a network of individuals working within healthcare, tow trucking or an auto body shop may conspire to forge documentation to claim benefits for an incident that never occurred. Kickbacks might be shared across the organizations for reported damage, towing, storage and healthcare services for an incident that never happened.

However the fraud occurs, there is a consistent pattern of fraudulent funds from the accidental benefits claims used to fund organized crime networks. Accident benefits fraud can be attempted with or without the knowledge of the claimant. If there is an injured individual, they may be left without proper or fulsome care, as their claim coverages are billed for services never received, with the funds going directly to criminal organizations.  

To report information about insurance crime by phone (available 24/7), please call 1-877-422-TIPS (English) or 1-866-422-4331 (service en français). If you would like to remain anonymous, please call our partners at Crime Stoppers Canada (available 24/7) at 1-800-222-TIPS.