Prevent and denounce fraud

What is insurance fraud?

Fraud is any deliberate action that enables individual insureds or suppliers to obtain a reimbursement of expenses to which they are not entitled.

The consequences of fraud

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Higher premiums
Group insurance premiums are calculated based on group consumption, among other things. When benefits are paid following the submission of inappropriate claims, the premiums may be increased.


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Reduced coverage
If the group insurance plan costs increase, the policyholder could decide to decrease or withdraw certain services.


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Health risks
The administration of unnecessary care represents a health risk. Moreover, false treatments burden a patient’s file needlessly. They could also compound the difficulty associated with underwriting a private insurance plan (particularly for life and disability insurance).


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Dismissal
If fraud is demonstrated, the employer may apply sanctions against the employee, to the extent of suspension or dismissal.

How to protect yourself

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Protect your personal and confidential information.


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Review your claim history online regularly.


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Store your plan documents (booklet and service card) in a secure location.


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If you have any questions concerning a supplier, contact La Capitale.


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Check your receipts to ensure that all the treatment items indicated were indeed administered.

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Do not sign any claim forms in advance, and report any supplier who asks you to do so.

How to report a suspicious situation

If you witness or know of a suspicious situation, contact us. 

1 800 463-4856

Email us