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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. vs. M.P. – ICBC insurance fraud investigation.

Charge: Insurance fraud.
Issue: Whether it was in the public interest to proceed with a criminal prosecution.
Result: Mr. Gauthier was able to steer our client through the investigation by helping our client rectify the fraudulent information that he had provided to I.C.B.C. No charges approved. No criminal record.

R. vs. S.B. – Port Coquitlam Provincial Court

Charges: Assault Causing Bodily Harm; Assault Police Officer.
Issue: Given our client's severe mental health issues, whether he was criminally responsible for the offences.
Result: Mr. Gauthier was able to provide information about our client's mental health history to Crown counsel and, ultimately, was able to persuade Crown to end the prosecution. Stay of proceedings. No jail. No criminal record.

R. vs. J.H. – Vancouver Provincial Court

Charge: Mischief Under $5000.,br> Issue: Whether it was in the public interest to proceed with a criminal prosecution.
Result: Mr. Gauthier provided information about our client to Crown counsel and was able to persuade Crown that there was no public interest in prosecuting this matter. No charge approved. No criminal record.

R. vs. B.C. – Vancouver Provincial Court

Charge: Mischief Under $5000.
Issue: Whether it was in the public interest to proceed with a criminal prosecution.
Result: Mr. Gauthier provided information about our client to Crown counsel and was able to persuade Crown that there was no public interest in prosecuting this matter. No charge approved. No criminal record.

R. vs. W.F. – Richmond Provincial Court

Charge: Assault.
Issue: Whether this road rage incident was a criminal offence or a consensual fight.
Result: Mr. Johnson was able to present Crown counsel with video evidence which confirmed that the complainant had engaged in a consensual altercation. Stay of proceedings. No criminal record.

R. vs. K.Y. – Surrey Provincial Court

Charge: Assault Causing Bodily Harm.
Issue: Whether the 18 month jail sentence Crown had sought was reasonable in all the circumstances.
Result: Mr. Johnson provided information to the Crown and Court and ultimately persuaded the trial judge to sentence our client to a 7 month conditional sentence , followed ny 18 months probation. No jail.

R. vs. G.W. – North Vancouver RCMP Investigation

Charge: Assault with a weapon.
Issue: Whether there was sufficient evidence to support a criminal prosecution.
Result: Mr. Johnson was able collect information from a defence witness and represent to police that our client should not  be prosecuted. Police concluded their investigation without recommending any criminal charge against our client. No criminal record.

R. vs. J.S. – Vancouver Provincial Court

Charge: Assault with a Weapon.
Issue: Given the rehabilitative steps we directed our client to complete, whether it was in the public interest to proceed with the criminal prosecution.
Result: Mr. Gauthier was able to persuade Crown counsel to not approve any charge prior to the scheduled first court appearance. No criminal record.

R. vs. S.L. – Port Coquitlam Provincial Court

Charges: Possession of a loaded prohibited firearm; Unlawful storage of firearms.
Issue: Whether the warrant used to search our client's premises was lawful; whether our client posed a risk to re-offend.
Result: Mr. Mines was able to point to potential flaws in the warrant and police search which culminated in Crown's agreement to not pursue their original sentencing position of a 2-3 year jail sentence. Rather, the court accepted a joint submission of a 12 month conditional sentence with a curfew for the first six months. No jail.

R. vs. M.K.A. – Vancouver Provincial Court

Charges: Assault with a Weapon (x2).
Issue: Whether it was in the public interest for the court to grant our client a conditional discharge.
Result: Mr. Mines was able to direct our client through a course of rehabilitative counselling, and after hearing Mr. Mines' submissions, the trial judge granted our client a conditional discharge. No criminal conviction.

R. vs. K.D. – Vancouver Provincial Court

Charges: Assault (domestic).
Issue: Given the rehabilitative steps that we were able to guide our client through, whether there was a public interest in continuing with the prosecution.
Result: Mr. Mines was able to persuade Crown counsel to amend the bail condition to allow "permissive contact" with the complainant, and after providing Crown with a report from our client's psychologist Crown counsel ended the prosecution. Stay of proceedings. No criminal record.

R. vs. J.L. – Vancouver Provincial Court

Charges: Sexual assault; Unlawful Confinement; Assault by Choking.
Issue: Given the impact of the additional evidence that Mr. Johnson provided to Crown counsel, whether there was a substantial likelihood of a conviction.
Result: Crown counsel agreed that the new evidence significantly undermined the strength of the case.  Crown counsel entered a stay of proceedings, bringing the prosecution to an end. No jail. No criminal record.

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.