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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.M. - Vancouver Provincial Court

Charge: Assault Causing Bodily Harm.
Issue: Whether it was in the public interest for our client to receive a conviction on this charge.
Result: Mr. Johnson was able to persuade the Court to grant our client a conditional discharge. No conviction.

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

Charge: Commit Indecent Act.
Issue: Whether it was appropriate for Crown to proceed with the charge.
Result: Mr. Mines was able to present information on our client's behalf and was able to persuade Crown counsel that there was no longer any public interest in proceeding with this matter. Stay of proceedings. Warrant cancelled. No criminal record.

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

Charge: Driving While Prohibited.
Issue: Whether it was in the public interest to proceed with the charge.
Result: Mr. Johnson was able to persuade Crown to proceed on the lesser offence of driving without a valid licence. Rather than a mandatory minimum 12 month driving prohibition, our client was sentenced to a $300 fine and a 3 month prohibition.

R. vs. L.W. - North Vancouver Provincial Court

Charge: Criminal Harassment (reduced to Peace Bond).
Issue: Whether it was in the public interest for Crown to prosecute our client on the criminal harassment charge;
Result: Mr. Johnson was able to persuade Crown to stay the criminal charge upon our client entering into a s. 810 Peace Bond for 12 months. No criminal record.

R. vs. K.M. - Surrey RCMP Investigation

Charge: Sexual Assault.
Issue: Whether there was sufficient evidence to meet the Crown's charge approval standard.
Result: Mr. Johnson was able to steer our client through the investigation and was able to provide information to police and Crown which culminated in Crown counsel's decision to not approve any charges. No criminal record.

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

Charge: Driving While Prohibited.
Issue: Whether it was in the public interest for Crown to proceed with the charge.
Result: Mr. Johnson was able to persuade Crown to allow our client to plead to s. 24(1) of the Motor Vehicle Act. Rather than the mandatory minimum 12 month driving prohibition, our client was sentenced to a $300 fine and a two month driving prohibition.

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

Charges: Sexual Assault x2; Sexual Interference.
Issue: Given the extensive information that we were able to provide to Crown counsel, whether there remained a substantial likelihood of a conviction.
Result: Mr. Johnson was able to persuade Crown counsel to enter a stay of proceedings on all counts. No jail. No criminal record.

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

Charge: Assault (reduced to s. 810 Peace Bond).
Issue: Given the rehabilitative steps we were able to guide our client through, whether it was appropriate for Crown to proceed.
Result: Mr. Mines was first able to persuade Crown to proceed on a Peace Bond application rather than the criminal assault charge. He was then able to persuade Crown to withdraw its Peace Bond application. No criminal record.

R. vs. T.K.- Abbotsford Provincial Court

Charge: Driving without consideration; driving past police vehicle; speeding.
Issue: Whether it was in the public interest to proceed with all counts, which upon conviction would have led to a driving prohibition.
Result: Mr. Mines was able to negotiate a resolution where our client pleaded guilty to only a three point speeding ticket and police withdrew the remaining counts. Our client was sentenced to a fine. No driving prohibition.

R. vs. E.W. - 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 for our client to receive a criminal conviction.
Result: After hearing Mr. Johnson's submissions on our client's behalf, the court granted our client a conditional discharge. No criminal conviction.

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

Charge: Driving while Prohibited.
Issue: Whether it was in the public interest to proceed with this charge which carries a one year mandatory minimum driving prohibition.
Result: Mr. Johnson was able to persuade Crown counsel to permit our client to resolve this matter by pleading guilty to the lesser offence of driving without a valid licence. Our client was sentenced to a fine. No driving prohibition.

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

Charge: Assault (domestic).
Issue: Given the rehabilitative steps we were able to guide our client through, whether it was in the public interest for the Crown to continue with the prosecution.
Result: Mr. Mines was able to persuade Crown to enter a stay of proceedings, bringing the matter to an end. 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.