Insurers urged to get written conflict-of-interest statements from law firms and treatment/assessment facilities

Insurers wishing to expose potential insurance fraud should be getting written conflict-of-interest statements from legal, treatment and assessment facilities, a fraud investigator suggests.
Donna Ford, an insurance fraud investigator with Northwood & Associates, addressed the topic of insurance fruad at the Annual Toronto Fraud Forum on Sept. 29.
The Association of Certified Fraud Examiners and the Canadian Association of Special Investigation Units jointly sponsored the meeting.
In an email exchange following the forum, Ford observed that under the previous SABS, there was a conflict of interest disclosure section in the Treatment Plans (OCF 18 and 23). Although there is no such disclosure section on the forms under the new SABS, she wrote, there is still a requirement to disclose any conflict of interest to the insurer.
“If the insurer is noticing patterns of claimants going to the same combination of legal representatives, treatment facilities or assessment facilities, I suggest the insurer write to all three and ask if there is any conflict of interest,” Ford writes.
Those letters should be produced at arbitration and trial, especially if there is no response, Ford said.
Insurers should also provide this information to the Investigation Services Division (ISD) of the Insurance Bureau of Canada (IBC) to investigate any undisclosed conflicts.
“We all know that conflicts lead to over-treatment and over-billing.”