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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. K.C. – Delta Police Investigation

Charges: Assault Causing Bodily Harm.
Issue: Whether it was in the public interest to proceed with criminal charges for this alleged assault that occured in the context of a recreational sporting activity.
Result: Mr. Mines provided information to the police investigator on our clients's behalf. Ultimately police decided to not recommend any criminal charges. No prosecution; no criminal record.

R. vs. K.J. – Surrey Provincial Court

Charge: Uttering Threats.
Issue: Given the circumstances of the alleged offence and 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. Gauthier was able to persuade Crown counsel to stay the proceedings and to resolve this matter with a 12 month Peace Bond. No criminal record.

R. vs. Z.A. – Burnaby RCMP Investigation

Charge: Assault (domestic).
Issue: Whether the allegations of this domestic allegation would meet the Crown counsel's charge approval standard.
Result: Mr. Gauthier was able to provide information to Crown counsel that ultimately led to Crown declining to approve any criminal charge. Our client's Undertaking was withdrawn, permitting him to resume contact with his spouse. No criminal record.

R. vs. K.L. – North Vancouver Provincial Court

Charges: Assault.
Issue: Given the information we provided to Crown counsel on behalf of our client, whether  it was appropriate to proceed with a criminal prosecution.
Result: Mr. Gauthier was able tp persuade Crown counsel that this matter did not meet the charge approval standard. Croen elected to not approve any charges. No prosecution. No criminal record.

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

Charges: Assault with a weapon.
Issue: Given the circumstances of the offence and the rehabilitative steps that we were able to guide our client through, whether it was in the public interest for our client to be granted a conditional discharge in this case involving our client not obeying  a traffic flag person and assaulting her with her car.
Result: Mr. Mines was able to persuade Crown and the Court to grant our client  a conditional discharge. Our client was placed on probation with a term to perform community service work.

R. vs. X.Z. – Vancouver Provincial Court

Charges: s.810 Recognizance (Peace Bond) Application.
Issue: Whether there was sufficient evidence for the crown to prove that the complainant's fear was reasonable.
Result: Mr. Gauthier was able to provide information to Crown that helped persuade Crown to enter a stay of proceedings. No Peace Bond was imposed on our client.

R. vs. Z.Y. – Healthcare Insurance Fraud Investigation

Charges: Fraud Under $5000.
Issue: Given the prompt repayment of restitution that we made on our client's behalf, whether it was in the public interest to proceed with a criminal prosecution.
Result: Mr. Gauthier was able to persuade the investigator to not forward any charges for prosecution. No criminal record.

R. vs. A.M. – Port Coquitlam Provincial Court

Charges: Pointing a firearm; assault with a firearm.
Issue: Given the context of the offence and our client's remorse and rehabilitation, whether a jail sentence was appropriate.
Result: Mr. Mines was able to direct our client through a course of counselling and was able to persuade Crown counsel to make a joint recommendation for a community based sentence rather than the 2 year jail sentence that was Crown's original sentencing position. After hearing Mr. Mines' submissions, the court granted our client an 18 month conditional sentence, followed by 12 months probation. No jail.

R. vs. T.B. and M.L. – Surrey RCMP Investigation

Charges: Possession of Stolen Property over $5000.
Issue: Whether police had sufficient grounds to recommend criminal charges against our clients.
Result: After Mr. Gauthier consulted with the investigator, RCMP decided to refer the case for civil forfeiture and to not pursue  any criminal charges against our clients. No prosecution. No criminal record.

R. vs. I.M. – ICBC Insurance Fraud Investigation

Charges: Fraud/misrepresentation.
Issue: Whether our client actually intended to make a misleading or fraudulent automobile accident claim.
Result: After consulting with us, our client provided an explanation to the investigator that resulted in ICBC deciding to not recommend any charges.  No prosecution. No criminal record.

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

Charges: Theft (from employeer) Over $5000.
Issue: Whether there was a substantial likelihood of a conviction and whether it was in the public interest to proceed with a criminal prosecution.,br> Result: Upon Mr. Mines providing information to Crown counsel that our client had fully settled the matter civilly and that there was a significant chance that a key Crown witness would be unavailable at trial, Crown counsel entered a stay of proceedings. No criminal record.

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

Charges: Residential Breaking and Entering x3; Possession of a prohibited weapon; driving offences.
Issues: Whether it was in the public interest to proceed on all outstanding charges and whether 30 months jail was an appropriate sentence.
Result: Mr. Johnston was able to provide information to Crown counsel about our client's significant rehabilitation plan and persuaded Crown to drop 8 counts against our client. Mr. Johnston persuaded the court to impose a sentence of 12 months' jail rather than the 30 months the Crown was seeking.

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.