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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. v. S.C. – Vancouver Police Investigation

Charge: Assault.
Issue: Whether there was credible evidence that would meet the charge approval standard.
Result: Mr. Gauthier provided information to the investigating officer that led the investigator to conclude that our client was not chargeable with a criminal offence. No charge approved. No criminal record.

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

Charges: Assault; Forcible Confinement (domestic).
Issue: Given the rehabilitative steps we were able to guide our through, whether it was in the public interest for our client to be sentenced to a criminal record.
Result: Mr. Gauthier was able to persuade Crown to proceed only on the assault charge and, after hearing Mr. Gauthier's submissions, the Court granted our client a conditional discharge. No criminal conviction.

R.M. vs. Superintendent of Motor Vehicles

Charge: 90 Day Immediate Roadside prohibition.
Issue: Whether the police report established, on balance, that our client had refused to provide a breath sample during a roadside impaired driving investigation.
Result: The adjudicator agreed with Mr. Mines' submissions that our client's evidence was more reliable than the evidence set out in the Police Report to the Superintendent. The 90 day driving prohibition was overturned and our client was ruled eligible to resume driving.

R. vs. E.W. – Fort Nelson Provincial Court

Charge: Assault (domestic).
Issue: Whether there was a substantial likelihood of a criminal conviction.
Result: Upon reviewing the allegations, Mr. Mines made representations to Crown counsel resulting in Crown agreeing that there was no reasonable prospect of convicting our client. No charges were approved. No criminal record.

R. vs. H.K. – Vancouver Provincial Court

Charges: Assault Peace Officer; Mischief Under $5000.
Issue: Whether it was in the public interest to proceed with criminal charges.
Result: Mr. Gauthier was able to  persuade Crown counsel to allow our client into the Alternative Measures Program and to enter a stay of proceedings on both charges upon our client completing the program. No criminal record.

R. vs. R.S. – Richmond Provincial Court

Charge: Breach of Probation (from weapons charge).
Issue: Whether there was a public interest in proceeding with the prosecution of our client who had failed to complete a course of court ordered counselling.
Result: Mr. Gauthier was able to steer our client through an equivalent course of counselling. Upon completion, Crown counsel stayed the proceedings. No criminal record.

R. vs. S.P. – Vancouver Provincial Court

Charge: Mischief Causing Danger to Life.
Issue: Given the medical evidence Mr. Gauthier provided to Crown counsel, whether it was in the public interest to proceed with the criminal prosecution.
Result: Mr. Gauthier was able to persuade Crown counsel to enter a stay of proceedings. No criminal record.

R. vs. R.A. – Vancouver Provincial Court

Charges: Breaking & Entering; Unlawful Confinement; Assault.
Issue: Whether it was in the public interest for the prosecution to continue against our client, a U.S. citizen who was in Canada on a visitor's visa.
Result: Mr. Mines was able to persuade Crown counsel to enter a stay of proceedings on all charges upon our client agreeing to a Deportation Order. No criminal record.

R. vs. P.N. – Surrey Provincial Court

Charge: Dangerous Driving Causing Death. Issue: Whether Crown could prove that our client had the necessary intent to prove that she was guilty of the criminal charge. Result: Mr. Mines was able to persuade Crown counsel to proceed under the Motor Vehicle Act rather than the Criminal Code. After hearing Mr. Mines'  submissions, the Court sentenced our client to 60 days to be served on weekends. The Crown had originally sought a sentence in the range of 2 years.

R. vs. L.A. – New Westminster Provincial Court

Charge: Breach of Probation (from domestic assault charge).
Issue: Whether it was in the public interest to prosecute our client for failing to report and complete counselling.
Result: Mr. Gauthier was able to guide our client back onto an alternative course of rehabilitation and persuaded Crown counsel to enter a stay of proceedings. No criminal conviction.

R. vs. M.K. – Richmond Provincial Court

Charges: Uttering Threats; Extortion.
Issue: Given the age of the charges and the rehabilitative steps our client had taken, whether a jail sentence was appropriate.
Result: Mr. Mines was able to persuade Crown counsel to seek a non custodial sentence. After hearing Mr. Mines' submissions, the Court granted our client a suspended sentence and placed him on probation for 16 months. No jail.

R. vs. K.A. – Western Communities Provincial Court

Charge: Assault (domestic).
Issues: Given the information we provided to Crown counsel regarding the complainant's past unlawful behaviour toward our client, whether there was a substantial likelihood of a conviction.
Result: As a result of the information we provided, Crown counsel withdrew the charge. No further bail restrictions. 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.