TTC launches suit against Manulife Financial
Plan administrator allegedly violated ‘duties of care,’ which contributed to losses
The TTC is suing Manulife Financial for as much as $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 filed in Ontario Superior Court of Justice 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 Manulife to officially respond to the lawsuit within three weeks.
In an email, Manulife spokesperson 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 by Green Shield Canada at the end of 2016. The new administrator 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. In some cases, costs were inflated. Healthy Fit and the employees and their eligible family members split benefits payouts totalling 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 federal prison.
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 the em- ployees 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.