• Vancouver at night

Insurance Fraud

The Charge

People charged with insurance fraud are alleged to have attempted to obtain insurance funds or some other benefit that they are not entitled to under their policy. Police and Crown counsel treat insurance fraud seriously because fraudulent claims account for a significant portion of all claims received by insurers and cost billions of dollars to insurance providers. Types of insurance fraud are diverse and occur in all areas of insurance. They can vary in range of severity, from minor exaggeration of a claim to deliberately causing an accident or damage. Those charged with insurance fraud are generally prosecuted under s. 380 of the Criminal Code – Fraud over $5000.  If the fraudulent misrepresentation involves a claim for loss or damage of a motor vehicle, people may be charged uinder s. 42 of the Insurance (Vehicle) Act. British Columbia law subjects those convicted of defrauding I.C.B.C. to fines of up to $50,000 and jail for up to 2 years.

The Investigation

Whether under the Criminal Code or the Insurance (Vehicle) Act, a person being investigated for insurance fraud is typically suspected of making a false representation to the insurer. Often, the first contact a suspect will have is not with police, but rather, with an insurance adjuster or an investigator employed by the insurer. Significantly, because it is not the government dealing with the suspect through a police agent, an insurance fraud suspect has no right to be advised of their right to silence or their right to counsel before they are engaged in conversation by a civilian investigator.  For this reason, we strongly advise anyone being investigated of insurance fraud to contact us before going into any type of interview. We are generally able to assist people with their obligation to provide information to an insurer without providing information that may incriminate them.

When retained by clients who are being investigated for insurance fraud, our goal is to assist our client with their obligations to communicate with the insurer, and to decrease the chance of a charge being approved. In those cases, however, where police are recommending charges, our job is to work toward ensuring that our clients are not arrested in a public or embarrassing way. Rather, we will work with police and Crown and attempt to bring our client to answer to the charge in an out-of-custody, businesslike fashion.

Recent Successes

R. v. J.C. – Vancouver Provincial Court

Charges: Uttering a threat; Posession of a weapon (knife) for a dangerous purpose.
Issue: Given our client's circumstances and the circumstances of the incident, whether it was in the public interest to proceed with a criminal prosecution.
Result: Mr. Gauthier was able to provide Crown with background information about our client and the incident which caused Crown to conclude it was not in the public interest to continue the prosecution. Stay of proceedings. No criminal record.

R. v. M.M. – North Vancouver Provincial Court

Charges: Theft Under $5000 (shoplifting).
Issue: Whether it was in the public interest to proceed with a criminal prosecution in this $900 shoplifting case.
Result: Mr. Mines was able to provide information to Crown counsel about our client's personal circumstances, resulting in Crown referring our client to the Alternative Measures program. No criminal record.

R. v. J.Z. & Q.M. – Insurance Fraud Investigation

Charges: Fraud Over $5,000.
Issue: Whether our client's were responsible for approximately $15,000 in false claims unknowingly made in their names by a health care provider.
Result: Mr. Gauthier was able to settle with the insurance provider. No criminal charges were forwarded against our clients. Mr. Gauthier was also able to assist with the first steps of recovering the funds from the dishonest health care provider. No criminal record.

R. v. V.N. – Surrey Provincial Court

Charges: Sexual Assault (police investigation).
Issue: Whether there was sufficient evidence to support a criminal prosecution.
Result: Mr. Gauthier opposed the police application to extend the time period they could continue to retain seized evidence and he provided advice to our client in steering him through the investigation. The matter concluded with no criminal charges being forwarded to Crown. No criminal record.

R. v. R.T. – Insurance Fraud Investigation

Charge: Insurance Fraud Under $5,000 investigation.
Issue: Given our client's rehabilitation and repayment of disputed claims, whether it was in the public interest to proceed with a criminal prosecution.
Result: Mr. Mines was able to persuade the insurance company to settle the matter on a civil basis. No criminal charges forwarded. No criminal record.

R. v. G. A.G. – Vancouver Provincial Court

Charge: Assault (domestic).
Issue: Whether there was a substantial likelihood of a conviction in this case.
Result: Mr. Mines was able to persuade Crown counsel that, given the lack of cooperation by the complainant, that there was no prospect of a conviction. Crown counsel did not approve any charges and, on Mr. Mines' representations, agreed to cancel the scheduled court date and to direct police to cancel our client's Undertaking to Appear. No criminal record.

R. v. L.M. – Vancouver Provincial Court

Charge: Mischief Over $5000.
Issue: Whether Crown could prove the value of damage alleged to have been caused by our client.
Result: Mr. Mines was able to persuade Crown counsel that because it could not accurately prove the value of damage, and that our client had taken appropriate steps of self-rehabilitation,  Crown elected to not approve any charges. No criminal record.

R. v. H.K. – Port Coquitlam Provincial Court

Charge: Assault.
Issue: Whether it was in the public interest to proceed with a criminal prosecution in this "road rage" case.
Result: Mr. Mines was able to provide information to Crown counsel about our client's personal circumstances and the circumstances of the incident which resulted in Crown staying the charge after our client completed Alternative Measures. No criminal record.

R. v. J.S. – North Vancouver Provincial Court

Charges: Uttering Threats (x3).
Issue: Whether or not our client was entitled to be sentenced to a conditional discharge rather than being convicted of this offence.
Result: Upon hearing Mr. Gauthier's submissions on our client's behalf, the Court granted our client a conditional discharge rather than entering a conviction. No criminal record.

R. v. S.G. – Surrey Provincial Court

Charges: Assault; Mischief. Issue: Given the rehabilitative steps that we guided our client through and advocating on her behalf that there was a reasonable self defence issue, whether there was a substantial likelihood of securing a conviction.
Result: Mr. Gauthier was able to persuade Crown counsel that there was no substantial likelihood of a conviction. Ultimately Crown entered a stay of proceedings. No criminal conviction. No criminal record.

R. v. K.B.K. – Vancouver Provincial Court

Charges: B&E; Assault; Distribute Intimate Images.
Issue: Whether the Crown could comply with a defence disclosure request and possibly face a Charter application to have charges stayed due to unreasonable delay.
Result: On the eve of the trial, Mr. Mines was able to persuade Crown to allow our client to plead guilty to the least serious charge, assault by slapping. Crown nonetheless sought a conviction and probation, but after hearing Mr. Mines' submissions, the trial judge granted our client a conditional discharge. No criminal conviction.

R. v. C.B.S. – Richmond Provincial Court

Charges: B&E; Assault; Distribute Intimate Images.
Issue: Whether the Crown could comply with a defence disclosure request and possibly face a Charter application to have charges stayed due to unreasonable delay.
Result: On the eve of the trial, Mr. Mines was able to persuade Crown to allow our client to plead guilty to the least serious charge, assault by slapping. Crown nonetheless sought a conviction and probation, but after hearing Mr. Mines' submissions, the trial judge granted our client a conditional discharge. No criminal conviction.

The Defence

Crown counsel has the obligation to prove insurance fraud beyond a reasonable doubt. What this means, essentially, is that Crown must prove that the accused, with the intention to defraud, provided false information to the insurer. Generally, a defence to insurance fraud is that the accused did not intend to provide a false statement, but rather, the information was provided in good faith. The common denominator of any insurance fraud claim is, therefore, the intent to defraud. In evaluating whether a person had the intent to defraud, it is important to analyze their experience and background. Is this a motorist’s first claim? Did they completely misrepresent a fact or merely exaggerate the fact? Did the person know that what they misrepresented was wrong?

We’re always happy to hear from clients during the investigation stage of their case. This is because we are often able to offer these clients the best potential outcome – the chance of no charges being approved at all. In our many years of defending fraud charges, we’ve learned that many complainants are more interested in being compensated for their loss than they are in pursuing a criminal conviction. Our goal, therefore, is to attempt to negotiate a civil settlement of a suspected fraudulent insurance claim. A civil settlement will often result in the complainant not wanting the criminal charges to proceed but, even when charges do proceed, restitution will be seen as a mitigating factor by the court.

In cases where Crown does proceed with insurance fraud prosecutions, our job is to prepare for trial so as to challenge any evidence that is not properly brought before the court. This may include challenging search warrants or production orders. It may also include exclusion arguments based on the Canada Evidence Act which sets out the rules that Crown counsel must comply with in order to tender business records, banking records and electronic documents into the trial process. Ultimately, our goal is to work toward keeping our clients out of custody and/or preventing them from being convicted of insurance fraud.

Start with a free consultation.

If you are being investigated by police or if you’ve been charged with a criminal or driving offence, don’t face the problem alone. Being accused of an offence is stressful. The prospects of a criminal record or jail sentence can be daunting. Even if you think there is no defence, we may be able to help. To schedule a free initial consultation with one of our Vancouver lawyers, contact us now.