Employee's testimony 'strains her credibility': Arbitrator
Despite 19 years of service, a lab assistant who worked for Calgary Laboratory Services was dismissed after the employer learned of multiple false claims she filed with the company’s health-insurance provider.
Christina Munoz, who worked most recently at the Peter Lougheed Hospital in Calgary, submitted her first false claim for massage therapy treatments for $89.25 on July 13, 2013, and then continued to do so 75 other times up until May 17, 2015.
After Munoz failed to respond to requests from the insurer, Sun Life, her internet access to the account was suspended on April 28. By that time, Sun Life had verified with the massage therapist that no appointments had happened with Munoz during the times requested.
On May 25, Sun Life sent an email to Munoz and requested receipts for three claims that totalled $357 that were filed in March of that year.
On July 29, 2016, an investigator with the fraud risk management department of Sun Life sent a letter to Munoz. It requested further proof of the March 2015 claims and it gave an Aug. 9 deadline to provide the receipts or further action would be taken.
Nothing further was received by Sun Life and on Aug. 11, Janelle Hawke, group accounts benefits executive at Sun Life, emailed Munoz to advise her the insurer was now investigating 76 claims totalling $6,783 (of which $6,188.25 was paid to Munoz), over a two-year period.
On Aug. 30, Sun Life and Munoz worked out a repayment arrangement whereby she would pay the insurer $250 per month for 24 months.
On Sept. 9, Munoz met with Denise Kitsul, senior human resources consultant with the employer, to explain why the false claims were filed. She said that her husband had been unemployed for two years and the couple were being sued by the Canada Revenue Agency (due to them owing about $14,000 in back taxes), which caused a strain on their finances.
But on Oct. 24, 2016, Munoz was dismissed. She was accused of submitting false claims “even after Sun Life notified you several times your claims were being audited. At no time did you come forward to admit your actions to defraud the employer and Sun Life prior to our investigatory meeting,” said the letter of termination.
(The delay in the firing was because Munoz was off work due to medical reasons.)
Munoz testified that her actions left her feeling “terrible and horrible” but that money woes was the sole reason for her submitting false claims.
The union, the Health Sciences Association of Alberta (HSAA), grieved the decision and argued because of her long tenure and the fact that she had made arrangements to pay off the debt, this was a mitigating factor.
Arbitrator John Moreau (backed by fellow board members Kayla Simpson, Trina Avey) disagreed and upheld the termination.
“What is striking here, besides the considerable amount of money involved, is the extended period of time over which (Munoz) filed false claims. She kept up this behaviour for almost two years starting in July 2013 with regular reimbursement requests from Sun Life,” said Moreau.
Despite her family’s personal financial circumstances causing the actions, this was not enough of a mitigating factor, according to the arbitrator. “Those are relevant considerations but do not in themselves or collectively provide a basis for reinstatement given the gravity and ongoing nature of (Munoz’s) offence.”
Munoz’s testimony was also questioned by the arbitrator.
“To say that she did not pay attention to the May 25, 2015, email when there is clear evidence that she opened it strains her credibility. The fact that she did not submit any further claims after May 19, 2015, one week before she received the May 25, 2015, email from Sun Life also raises a high suspicion that she knew Sun Life was actively investigating her false claims,” said Moreau.
Reference: Calgary Laboratory Services and Health Sciences Association of Alberta. John Moreau — arbitrator. Damon Bailey, Iain Bailey for the employer. Dennis Bennett for the employee. April 10, 2018. 2018 CarswellAlta 684
