Insurance adjuster accused of making 99 fraudulent claim payments

Insurance adjuster accused of making 99 fraudulent claim payments | Insurance Business Canada

Insurance News

Insurance adjuster accused of making 99 fraudulent claim payments

Proposal outlines possible penalties

Insurance News

By
Terry Gangcuangco

The Financial Services Regulatory Authority of Ontario (FSRA) has accused Ulrich Fabrice Avognon of violating the Insurance Act through fraud.

According to the FSRA, Avognon is alleged to have repeatedly engaged in unfair or deceptive practices, specifically by billing for goods or services related to an insurance claim that were not delivered to the claimant or were provided in a significantly substandard manner in violation of section 6(1) of the unfair or deceptive acts or practices rule.

In response to the supposed breach, the FSRA has proposed a compliance order and is seeking an administrative penalty of $100,000 against Avognon, who has requested a hearing before the Financial Services Tribunal to challenge the proposal.

It is being proposed that Avognon be ordered to immediately cease acting as an insurance adjuster in Ontario or in respect of Ontario insurance claims; acting in any capacity that requires a licence under the Act; and engaging in the business of insurance in Ontario.

The FSRA noted in its notice of proposal: “Starting in February 2023, Avognon began inputting charges in insurance claim files for towing and car storage, or for rental car services. The towing and car storage, or rental car services were not required for the insured on these claims and the insured did not receive these services.

“Avognon input false invoice numbers into the system used to adjust claims and created false payees for the tow and storage companies, or rental car companies. For the false payees, Avognon input his own personal bank account information for accounts he opened at a bank or credit union. After inputting this information, Avognon issued electronic funds transfer payments to his own personal accounts for his personal use.”

According to the regulator, Avognon made 99 fraudulent claim payments between February 9, 2023 and May 25, 2023, receiving a total of $221,543.02 directly to bank accounts he controlled.

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