����AV

The Applicant was separated from service for submitting false information in three claims for dental treatment to the Medical Insurance Plan provider, Cigna, for reimbursement. The Applicant’s due process rights were respected because during the investigation he was properly informed of the subject and purpose of the interview and afforded sufficient notice. He also had no objections as to the conduct of the interview when asked at the end of his interview. With respect to the claim that the Applicant insisted was, in fact, genuine, the Tribunal concluded that the allegation had not been proven by clear and convincing evidence because: a) the Applicant had no interest in falsifying a claim to the benefit of his wife, who was insured as a family member under the same plan; b) the explanation by the dentist is not entirely unreasonable; and c) the undated OPG, apparently belonging to a female, indeed displayed a prosthetic crown on the tooth indicated in the dentist’s report. The facts in relation to the other two claims were established by clear and convincing evidence in light of the Applicant’s admissions to the investigator and to the Tribunal. The Applicant’s conduct violated staff regulations 1.2(b) and 1.2(q) and therefore amounted to misconduct. There was no reason to interfere with the disciplinary measure because the measure applied was in line with past cases involving submitting false information in relation to a medical claim or abusing the medical insurance provided by the Organization.