Protect yourself against insurance fraud.
Learn how to prevent, recognize and report fraudulent claims and other insurance scams.
What is insurance fraud?
Insurance fraud is defined as the intentional submission of false or incomplete information for financial gain.
This may occur when a claimant attempts to obtain some benefit or advantage to which they are not otherwise entitled.
There are three main types of fraud:
- Plan-member fraud – for example providing false information on an insurance claim, or working or collecting an income while receiving disability benefits.
- Provider fraud – for example, if your dentist submits a claim for a night guard when you actually received a teeth-bleaching service.
- Provider and plan-member fraud – for example, if an optical store employee agrees to write you a receipt for expensive prescription lenses when you bought a pair of non-prescription designer sunglasses.
How does insurance fraud affect me?
When others commit insurance fraud, it directly affects your group benefits plan. Fraud increases plan costs for your employer – putting your own coverage at risk. You may end up needing to pay increased premiums or lose certain benefits to cover these higher costs.
What happens if I commit insurance fraud?
If you knowingly withhold information or misrepresent the facts to make a false claim, you are committing fraud. Your claim could be denied; and you may be penalized or prosecuted after an insurance fraud investigation is completed.
What is RBC Insurance doing to help prevent insurance fraud?
As a leading provider of Group Benefits in Canada, RBC Insurance is committed to deterring fraud.
We are members of the Canadian Life and Health Insurance Association Anti-Fraud Committee, which facilitates collaboration with other insurers to reduce fraud.
Our dedicated team of fraud experts also works closely with industry associations, government and law enforcement to help protect you against fraud 24/7.Learn more about how RBC protects you.
What can I do to help prevent insurance fraud?
Working together is the best way to combat insurance fraud. There are plenty of ways you can help.
- Protect your personal information. Always keep benefits cards and information in a safe place. Don’t share PIN numbers or other personal details. Remember, anyone who has access to your insurance information can submit fraudulent claims.
- Review documents for accuracy. Ensure your Explanation of Benefits claim statements are correct and double-check receipts to be sure you received what is being charged to your plan.
- Never sign blank claim forms. If a provider asks you to sign a blank claim form you should report it. You don't want anyone submitting fraudulent claims in your name.
- Keep your benefit plan coverage details and maximums private. Healthcare practitioners should recommend treatment based on your medical needs, not your coverage.
- Be sure the claims you submit are for supplies and services that are medically necessary. Providing false claim documents or exaggerating services constitutes fraud. Don’t accept receipts for services or supplies you have not received.
- Talk to your Claims Adjustor if you are unclear on any of the questions or steps in the claim process. Remember, mistakes can happen, and you can unintentionally enter in incorrect information when filling out forms or reporting your claim. If you realize you have made a mistake, let us know right away so we can help correct the situation.
Protect Your Plan. Report Insurance Fraud.
If you suspect fraud is occurring, call our confidential phone line to report it anonymously.