Accident Benefits

Self-Employed Claimants: Business Records

In this case we examine the circumstances relating to a claim for Accident Benefits submitted by the owner of a retail store. After submitting the Application for Accident Benefits (OCF - 1/59) a request was made for business and financial records to support the claim for lost income. Being self-employed, the Claimant's income from the business operations would be the same as the income that would be used for the purpose of the Income Replacement Benefit calculation.

In response to the requests, the Claimant provided detailed source business records in the form of sales invoices. An examination of these records revealed that the name of the retail establishment had been altered on each of them - with a different store name and address being inserted. Although the altered information proved, in fact, to be correct, further inquiries were conducted to verify the financial information represented by the invoices. The company's financial records (i.e. bank statements, cancelled cheques) were also requested but none were provided so a further investigation was conducted by interviewing a selected number of customers that were noted on the sales invoices.

The investigation revealed that some of these customers, in fact, had never been in the store and others that had shopped in the store in the past had not done so on the date noted on the invoices submitted by the Claimant. This investigation determined that a minimum of four invoices had been altered and submitted to the insurance company with the intention that they be used as the basis for income quantification.