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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. P.S.A. - Vancouver Provincial Court

Charge: Assault.
Issue: Whether there was a substantial likelihood of a conviction.
Result: Mr. Johnson was able to direct Crown counsel to gaps in the police investigation resulting in Crown deciding to not approve any charge in this matter. No criminal record.

R. vs. S.J. - Port Coquitlam Provincial Court

Charge: Driving While Prohibited. Issue: Whether the crown…

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

Charge: Assault; Uttering Threats (domestic).
Issue: Given the rehabilitative steps our client achieved under our direction, whether there was a public interest in proceeding with the criminal prosecution.
Result: Mr. Johnson was able to persuade Crown counsel to stay the charges.  All restrictive conditions removed. No criminal record.

R. vs. C.S. - Port Coquitlam Provincial Court

Charge: Assault (domestic).
Issue: Whether there was a substantial likelihood of a conviction.
Result: Mr. Mines was able to point to a lack of evidence with respect to the charge resulting in Crown counsel entering a stay of proceedings. No criminal record.

R. vs. N.D. - Richmond Provincial Court

Charge: Sexual Assault.
Issue: Whether there was a substantial likelihood of a conviction.
Result: Mr. Johnson was able to direct Crown counsel to various flaws in the prosecution's case. On the eve of a 4 day trial, Crown agreed to resolve this matter by way of a nine month Peace Bond. No criminal record.

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

Charge: Driving While Prohibited.
Issue: Whether it was appropriate for Crown counsel to proceed on this charge, which carries a mandatory minimum 12 month driving prohibition.
Result: Mr. Johnson was able to persuade Crown to proceed on the lesser offence of driving without a valid driver's licence. After hearing Mr. johnson's submissions, the court imposed a $500 fine. No driving prohibition.

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

Charge: Assault Causing Bodily Harm.
Issue: Given the rehabilitative steps our client had taken, whether it was in the public interest to proceed with the criminal charge.
Result: Mr. Johnson was able to persuade Crown counsel to stay the criminal charge. Our client entered into a Peace Bond for a period of 9 months. No criminal record.

R. vs. Z.H. - Port Coquitlam Youth Court

Charge: Assault Causing Bodily Harm.
Issue: Whether, given the history between our client and the complainant, it was reasonable for our client apply  the level of force he used.
Result: Mr. Johnson was able to persuade Crown to not approve any criminal charge but, rather, to resolve the matter through Restorative Justice. No criminal record.

Y.Y. vs. Superintendent of Motor Vehicles - Review of Driving Prohibition

Charge: Notice of Intent to Prohibit.
Issue: Whether RoadSafety BC had appropriate reasons to prohibit our client from driving for 4 months.
Result: Mr. Johnson was able to persuade the Superintendent's adjudicator that the 4 month driving prohibition was not warranted. The driving prohibition was reduced to 2 months.

R. vs. R.H. - North Vancouver Provincial Court

Charges: Assault (x2); Threatening; Breach of Undertaking (domestic).
Issue: Given the rehabilitative steps our client had taken, whether it was appropriate for the Court to convict him.
Result: Mr. Mines was able to persuade Crown to proceed on only a single count of assault. After hearing Mr. Mines' submissions, the Court granted our client a conditional discharge. No criminal conviction.  

R. vs. D.I. - Vancouver Provincial Court

Charges: Dangerous Driving Causing Bodily Harm; Driving Without Due Care and Attention.
Issue: Whether it was appropriate for Crown to charge our client under the Criminal Code or the Motor Vehicle Act in regard to an accident where our client's vehicle struck a cyclist from behind, causing serious injury.
Result: Mr. Mines was able to provide information to Crown which resulted in Crown proceeding under the Motor Vehicle Act. After hearing Mr. Mines' submissions, the Court sentenced our client to a $1000 fine and limited his ability to drive for 12 months. No criminal conviction. No loss of insurance coverage. No jail.

R. vs. C.G. - North Vancouver Provincial Court

Charge: s. 810 Peace Bond Application.
Issue: Given the rehabilitative steps our client had taken, whether the complainant continued to have fear of our client.
Result: Mr. Mines was able to persuade Crown counsel to withdraw its Peace Bond application. No conditions. No 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.