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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. A.N. - Vancouver Provincial Court

Charges: Assault with a Weapon.
Issue: Given the rehabilitative steps we guided our client through, whether it was in the public interest for Crown to seek a conviction on this charge.
Result: Mr. Johnson was able to persuade Crown to permit our client to plead to the lesser offence of common assault. After hearing Mr. Johnson's submissions, the court granted our client a conditional discharge. No criminal conviction.

R. vs. J.J. - Richmond Provincial Court

Charges: Assault Causing Bodily Harm.
Issue: Whether there was a substantial likelihood of  the Crown being able to prove that bodily harm occurred.
Result: Mr. Johnson was able to persuade Crown to permit our client to plead to the lesser offence of common assault. After hearing Mr. Johnson's submissions, the court granted our client a conditional discharge. No criminal conviction.

R. vs. S.W. - Vancouver Provincial Court

Charge: Assault (domestic).
Issue: Given that the complainant had instigated the altercation, whether it was in the public interest for our client to be convicted of the offence.
Result: We were able to guide our client through a course of rehabilitation and, after hearing Mr. Mines' submissions, the Court granted our client a conditional discharge and placed him on a non-reporting probation order for six months. No criminal conviction.

R. vs. S.W. - Richmond Provincial Court

Charge: Refusing to comply with a testing demand.
Issue: Given the circumstances of the offence and our client, whether it was in the public interest to proceed with the criminal prosecution.
Result: Mr. Mines was able to persuade Crown counsel to proceed on the lesser Motor Vehicle Act offence of driving without due care. Rather than a criminal conviction and a minimum 12 month driving prohibition, our client was liable to pay a $350 fine and a 2 month driving prohibition. No criminal record.

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

Charge: Driving While Prohibited.
Issue: Given the circumstances of the offence and our client, whether it was necessary for Crown to proceed with the driving while prohibited charge, which carries a mandatory minimum 12 month driving prohibition.
Result: Mr. Johnson was able to persuade Crown to proceed on the lesser Motor Vehicle Act charge of driving without a driver's licence. After hearing Mr. Johnson's submissions our client was sentenced to a fine and a 4 month driving prohibition.

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

Charge: Assault Causing Bodily Harm (domestic).
Issue: Whether the Crown could prove that bodily harm resulted and, whether the rehabilitative steps our client had taken justified the Court granting a conditional discharge.
Result: Mr. Mines was able to persuade Crown counsel to proceed on the charge of common assault. After hearing Mr. Mines' submissions, the Court granted our client a conditional discharge. No criminal conviction.

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

Charge: Assault; Threatening.
Issue: Whether there was a substantial likelihood of conviction in this alleged "road rage" case.
Result: Mr. Johnson was able to provide information to Crown counsel on our client's behalf that led Crown to conclude there was no substantial likelihood of conviction. No charge approved. No criminal record.

R. vs. M.D. - North Vancouver Provincial Court

Charges: Theft Under $5000; Uttering Threats.
Issue: Whether, given our client's circumstances and remorse, whether it was in the public interest for criminal charges to proceed.
Result: We were able to provide information to police investigators which resulted in police deciding to not forward any charges to Crown. No criminal record.

R. vs. H.L. - Richmond Provincial Court

Charge: Sexual Assault.
Issue: Whether there was a substantial likelihood of a conviction.
Result: Mr. Johnson was able to provide information to the Crown on our client's behalf that persuaded Crown that the case did not meet the charge approval standard. No charge was approved. No criminal record.

R. vs. S.F. - Provincial Court of Newfoundland

Charge: Possession for the Purpose of Trafficking (Marijuana).
Issue: Whether it there was a substantial likelihood of obtaining a conviction.
Result: Upon considering Mr. Johnson's representations, Crown counsel concluded that there was no longer a likelihood of conviction. Crown withdrew the charge, bringing the matter to an end. No criminal record.

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

Charge: Application for firearms prohibition and forfeiture.
Issue: Whether Crown could establish that our client posed a risk to himself or others.
Result: Mid trial, Mr. Mines was able to obtain a successful resolution in which our client consented to an 18 month prohibition rather than the 5 years Crown had been seeking.  Further, rather than having to forfeit the  $15,000 worth of weapons that police seized,  Crown agreed to allow our client to sell them to a suitable buyer.

R. vs. C.B. - Vancouver Police Investigation

Charge: Possession of proceeds of crime.
Issue: Whether there was any lawful authority to arrest our client and seize funds from him.
Result: Mr. Johnson was able to persuade the investigating officer that there was no basis to search our client and to return the $2400 cash that he had seized. No charges approved. Not 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.