TTC launches lawsuit against Manulife Financial
Transit agency alleges insurance firm needed to do more to detect benefits fraud scheme that led to the firing, quitting or early retirement of more than 170 TTC staff.

TheStar.com
Sept. 21, 2017
David Rider

The TTC is suing Manulife Financial for as much of $5 million in connection with a benefits plan administered by the company and allegedly defrauded by TTC employees.

The transit service announced Thursday it was proceeding with a claim in Ontario Superior Court of Justice originally filed last year.

“The TTC alleges that Manulife Financial did not have appropriate fraud management controls in place nor were there systems in place to detect and analyze unusual trends or patterns that might indicate fraud or abuse,” a news release states.

“The TTC maintains that Manulife breached its duties of care, which contributed to the losses suffered by the TTC and, thus, the public.”

The TTC has asked them to officially respond to the lawsuit within three weeks.

In an email, Manulife spokesman Sean Pasternak said the company doesn’t comment on active litigation.

“Manulife takes fraudulent insurance claims seriously,” he wrote. “Manulife works with policyholders, law enforcement and others in order to detect and prevent fraudulent activity for the benefit of our customers.”

Amid concerns about the TTC claims — and those of other city employees who got large quantities of erectile dysfunction drug Viagra and the powerful painkiller Fentanyl — Manulife was replaced as the city’s plan administrator at the end of 2016 by Green Shield Canada, which won a five-year contract.

The TTC was tipped in 2014 that employees were making claims to a company called Healthy Fit for orthotics, braces, and other medical devices through the Manulife-administered city benefits plan.

No devices or services were provided, or costs were inflated. Healthy Fit and the employees, and their eligible family members, split benefits payouts totaling millions of dollars.

Last week, Healthy Fit proprietor Adam Smith of Mississauga pleaded guilty to two counts of fraud over $5,000. He was sentenced to two years in a federal penitentiary.

The TTC says that, to date, 170 TTC employees have been fired or resigned, or retired early to avoid dismissal, while 10 former employees face criminal charges.

TTC investigators continue to interview employees. When evidence suggests improper benefits billing, repayment is demanded and they face discipline that can include dismissal.

The transit service says its annual benefit costs for 2016 were down almost $5 million from the previous year.

Toronto’s auditor general has been digging into fraudulent claims for city employees, including prescribed drugs, massage therapy, orthotic supports and braces, and more.

Beverly Romeo-Beehler earlier this year called on the city to toughen fraud-protection mechanisms and said that, since Manulife is no longer administering the benefits plans, and is not obliged to co-operate with her probes, she had abandoned plans for an audit focused on dental claims.