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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. J.C. - Quesnel Provincial Court

Charges: Assault (domestic).
Issue: Whether it was in the public interest to proceed with the prosecution given the rehabilitative steps we guided our client through.
Result: Mr. Gauthier was able to persuade Crown counsel to stay the criminal charge upon our client entering into a Peace Bond. No criminal record.

R. vs. S.C. - Surrey RCMP Investigation

Charge: Theft/Fraud Over $5000.
Issue: Whether it was in the public interest to proceed with a criminal prosecution in this $400,000 fraud/theft from employer case.
Result: Mr. Mines was able to reach a civil settlement with the complainant and was able to persuade police to not forward any criminal charges. No criminal conviction; no jail.

R. vs. K.C. - Richmond Provincial Court

Charges: Fraud Under $5000; Possession of Stolen Property (from Employer).
Issue: Given our client's circumstances and the circumstances of the offence, whether it was in the public interest to proceed with a criminal prosecution.
Result: Mr. Johnson was able to persuade Crown counsel to refer our client to Restorative Justice and the Alternative Measures Program and to stay the criminal charges upon completion. No criminal record.

R. vs. McKenzie - Vancouver Provincial Court

Charge: Assault.
Issue: Given the rehabilitative steps we were able to guide our client through, whether it was in the public interest to proceed with the criminal prosecution.
Result: Mr. Johnson was able to persuade Crown counsel to stay the assault charge and to make a joint submission for a Peace Bond. No criminal record.

R. vs. H.V. - Vancouver Youth Justice Court

Charges: Assault (x2).
Issue: Whether there was a substantial likelihood of a conviction.
Result: Mr. Mines was able to provide additional information to police and Crown which resulted in Crown deciding to not approve any criminal charges.

R. vs. T.K. and H.B. - Surrey RCMP Investigation

Charges: Assault (x2).
Issue: Whether there was a substantial likelihood of a conviction.
Result: Mr. Mines was able to provide additional information to police and Crown which resulted in Crown deciding to not approve any criminal charges.

R. vs. M.M. - Courtenay Provincial Court

Charges: Sexual Assault (police investigation).
Issue: Whether it was in the public interest to proceed with criminal charges.
Result: Mr. Johnson was able to persuade police that it was in the parties' best interest and not contrary to the public interest to resolve this matter through Restorative Justice. No charges were approved. no criminal record.

R. vs. A.V. - Vancouver Provincial Court

Charges: Fraud Under $5000 (police investigation).
Issue: Whether it was in the public interest to proceed with the prosecution.
Result: Mr. Mines was able to assist our client to make civil restitution and to persuade police to not recommend any criminal charges. No charge was approved. No criminal record.

R. vs. J.P - North Vancouver Provincial Court

Charges: Assault; Breach of Undertaking (domestic).
Issue: Whether there was a substantial likelihood of a conviction and whether it was in the public interest to proceed.
Result: Mr. Johnson was able to persuade Crown counsel to stay all of the criminal charges and to allow our client to enter into a peace bond. No jail. No criminal record.

R. vs. F.K. - Vancouver Provincial Court

Charges: Dangerous Driving; Obstruct/Resist Arrest (Reduced to MVA charge).
Issue: Whether the Crown would be able to prove that our client had the necessary element of  intent for a criminal conviction.
Result: Mr. Mines was able to persuade Crown counsel to proceed on a lesser charge under the Motor Vehicle Act of speeding relative to the road conditions. Our client was sentenced to a driving prohibition. No criminal record.

R. vs. E.Z. - Vancouver Provincial Court

Charges: Assault with a Weapon; Possession of a Weapon for a Dangerous Purpose.
Issue: Whether there was a substantial likelihood of a criminal conviction.
Result: Mr. Mines was able to persuade Crown that there were flaws in the evidence and that a conviction was highly unlikely. No charges were approved. No criminal record.

R. vs. G.M.G. - Vancouver Provincial Court

Charges: Assault; Theft Under $5000.
Issue: Whether our client was acting to defend his spouse when he physically engaged with the complainant.
Result: Mr. Mines was able to provide further evidence to Crown counsel which persuaded Crown that there was no substantial likelihood of a conviction. Complete stay of proceedings. 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.