State Farm Mutual Automobile Insurance Company is suing a Toronto-based assessment centre and four individuals for more than $11 million, alleging that false and fraudulent documentation was submitted in the name of Assessment Direct Inc.
In a statement of claim filed Feb. 12 in the Ontario Superior Court of Justice, State Farm alleged treatment plans for motor vehicle accident claimants were filled out by Assessment Direct, and/or the individuals also named in the lawsuit, "in the name of health professionals who either never worked at Assessment Direct, were not employed by Assessment Direct at the time the treatment plan was assigned, did not have the qualifications represented on the treatment plan, and/or who never recommended the services and/or assistive devices allegedly that recommended therein."
The allegations have not been proven in court.
State Farm claims to have approved many of the requests, "paying approximately $1.4 million known to date, for services and assistive devices which were not recommended and/or provided by the health professional who allegedly signed the documentation."
Assessment Direct is located on Bathurst St. south of Lawrence St. in Toronto. According the corporate website, the firm's offerings include independent medical examinations, treatment programs and assistive devices, plus multi-functional evaluations for patients injured in auto accidents.
In its lawsuit, State Farm is seeking, among other things, $3 million in damages for fraud, fraudulent misrepresentation and/or unjust enrichment, $3 million in damages for conspiracy and $5 million in aggravated and/or punitive damages.
State Farm alleged in its lawsuit that it received insurance claims purportedly signed by two doctors who never worked for Assessment Direct and who allegedly did not give Assessment Direct permission to include their signature on claims. Two directors and two office managers were also named as defendants.