Insurance Crime

Équité Association provides investigative services to help contain the premiums of honest Canadian policyholders

Insurance Crime: Recognize it. Report it.

Whether you are just learning to drive or are an experienced driver, you can be the target of criminal activities related to insurance fraud. Équité cooperates with insurers and authorities to detect, deter and disrupt opportunistic and premeditated insurance fraud schemes that put public safety and security at risk. 

Opportunistic Fraud Scenarios

When someone uses a legitimate loss to make an inflated claim and obtain an unwarranted insurance payment, this is known as opportunistic insurance fraud. These situations can involve: 

  • Pre-collision vehicle damage that is included in an auto insurance claim
  • Additional damage that is inflicted to the vehicle after a collision to increase the cost of the repairs
  • A person who exaggerates injuries following a collision to collect benefits (also known as personal injury fraud). Examples include:
    • Malingering injuries and extended recuperation time
    • Medical services fraud involving a health care practitioner who exaggerates the severity of a patient's legitimate injury and increases the amount billed for assessments, treatment and/or assistive devices
  • Offering or accepting "free" health care treatment for an injury that is unrelated to a collision or not medically necessary
  • Encouraging anyone to participate in fraudulent activity
  • Misrepresenting the condition, mileage, or value of installed components of a vehicle that has been stolen 
  • Making a claim for property that was not actually stolen or damaged during a real vehicle theft or break-in

Misrepresenting the facts regarding fire, water, theft or collision damages so that otherwise uninsured losses can be claimed. 

Premeditated Insurance Fraud 

This type of fraud occurs when someone devises a way to claim for an insured loss event. Premeditated fraud often involves extreme action, such as:

  1. Causing a vehicle collision with unsuspecting drivers or staging a collision with other conspirators. One or more people then claim and collect benefits from insurance companies for non-existent injuries. This kind of fraud may also have related financial and human costs, as unsuspecting victims often suffer very real injuries.
  2. Making an insurance claim for an event – collision, vehicle theft, break-in, etc. – that never happened
  3. A health care facility charging an insurance company for medical services that were never provided
  4. A health care facility using a medical practitioner's professional credentials to charge an insurance company for services that were not rendered
  5. Encouraging anyone to participate in fraudulent activity
  6. Intentionally burning a vehicle
  7. Falsely reporting a vehicle or its contents as damaged or stolen
  8. Devising a way to avoid paying insurance premiums, including:
    • Reporting residency at one address when living at another
    • Not reporting licensed drivers in the household, or misrepresenting primary vehicle drivers – this may occur when an inexperienced driver is actually the principal driver but a parent or grandparent is reported as the principal driver on the policy
    • Knowingly purchasing phony proof of insurance cards or pink slips
    • Failing to report significant changes to the condition, value or use of insured vehicles – for instance, making deliveries or transporting passengers for a fee or as part of a paid service such as a daycare when a vehicle is insured only for personal use.

Don't Be Scammed – How Équité Supports Fraud Prevention 

Équité's investigative services works with and on behalf of its member companies to investigate the involvement of organized crime groups in insurance fraud. These groups often plan staged collisions and may have ownership or interest in service-provider companies that could profit from false insurance claims. Examples of service providers include body shops, tow truck companies, legal representative firms, health clinics, and assessment centres. 

Take the Time. Report the Crime.

Help catch fraudsters. If you have witnessed or have information about insurance fraud or a potential crime, you can: