A disability management company charged under the Ontario Insurance Act with knowingly making false or misleading statements to an insurer has been found not guilty. The charges were brought on behalf of the Financial Services Commission of Ontario.
The charges alleged that the company made false statements to an insurer to obtain payment for services that it said that it had provided. Two principals of the company were also charged. The business of the company was providing assistive devices and also arranging for assessments to determine persons’ eligibility for insurance benefits under the Statutory Accident Benefits Schedule pursuant to the Ontario Insurance Act.
The essence of the charges was that a doctor had not assessed certain accident victims – for which the disability management company sought payment from the insurer for services – and had not authorized the company to sign a form indicating that the doctor had indeed assessed those persons.
The court held that there was uncertainty in the evidence as to whether the doctor had met with the accident victims, and that the prosecution had not proven that it was unreasonable for the company to believe that it had the consent of the doctor to use the doctor’s name on the forms submitted to the insurer. The doctor admitted that she had not kept careful track of her visits with the accident victims.
At the very least, this case illustrates that the Financial Services Commission of Ontario and other regulatory bodies take seriously the various stakeholders’ obligation to be truthful when they provide information.
R. v. Ontario Disability Management et al., 2013 ONCJ 470 (CanLII)