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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. D.R. - Vancouver Provincial Court

Charge: Assault (domestic).
Issue: Whether it was in the public interest to proceed with the prosecution.
Result: Mr. Mines was able to persuade Crown counsel to enter a stay of proceedings on the assault charge. Our client entered into a 12 month Peace Bond. No criminal record.

R. vs. B.Z. - Port Coquitlam Provincial Court

Charge: Assault (domestic).
Issue: Given the rehabilitative steps we were able to direct our client through, whether it was in the public interest to proceed with this prosecution.
Result: Mr. Johnson was able to provide Crown counsel with information that allowed him to persuade Crown to enter a stay of proceedings. No criminal record.

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

Charges: Driving While Prohibited.
Issue: Whether it was in the public interest for Crown to proceed with the prosecution of this offence which carries a 12 month mandatory minimum driving prohibition.
Result: Mr. Johnson was able to persuade Crown counsel to proceed on the lesser offence of driving without a valid licence. Our client received a $500 fine and a 30 day driving prohibition.

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

Charges: Sexual Interference.
Issue: Whether the Crown could prove that our client sexually interfered with his niece.
Result: After a 6 day trial, Mr. Johnson was able to persuade the trial judge that there was reasonable doubt as to the complainant's credibility and reliability. Not guilty. No jail. No criminal record.

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

Charges: Theft Under $5000 (shoplifting).
Issue: Whether it was in the public interest to proceed with the prosecution.
Result: Mr. Mines was able to provide Crown counsel with information that led Crown to resolve this matter with a Caution Letter. No charges were approved. No criminal record.

R. vs. B.R. - Vancouver Youth Court

Charges: Assault Causing Bodily Harm; Assault with a Weapon.
Issue: Whether our client was acting in self defence when he injured the complainant with a knife during an altercation.
Result: Mr. Mines was able to provide information to Crown counsel that resulted in Crown declining to approve any charges. No criminal record.

R. v. C.C. - Surrey provincial Court

Charges: Impaired Driving, Dangerous Driving Causing Death. Issues: Whether police breached our client's Charter rights during the investigation; whether the court would accept the Crown's sentencing submission.
Result: Mr. Mines was able to persuade Crown counsel that police breached our client's right against an unlawful seizure of his breath samples. This resulted in the Crown's inability to prove the Impaired Driving / Over .08 offences.  The Crown had originally been seeking up to 4.5 years jail, but sought a one year jail sentence on the Dangerous Driving Causing Death charge. After hearing Mr. Mines' submissions, the court found that 5 months was the appropriate sentence.

R. vs. B.S. - North Vancouver RCMP Investigation

.Charge: Uttering Threats.
Issue: Whether there was a public interest in proceeding with the proposed charge.
Result: After Mr. Johnson made  representations to the investing officer, police advised that no charges would be forwarded to Crown counsel. No criminal record.

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

Charge: Driving While Prohibited.
Issue: Whether it was in the public interest to proceed with the charge, which carries a one year mandatory minimum driving prohibition upon conviction.
Result: Mr. Mines was able to persuade Crown counsel to proceed on the lesser charge of driving without a valid drivers license. The court agreed with Mr. Mines' submissions and imposed a fine but did not impose any driving prohibition.

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

Charges: Driving While Prohibited.
Issue: Whether it was in the public interest to proceed with the charge.
Result: Mr. Mines was able to persuade Crown counsel to allow our client to plead to the lesser offence of driving without a valid driver's license. Rather than face a mandatory minimum 12 month driving prohibition, our client was sentenced to a fine. No driving prohibition.  

R. vs. J.C. - Quesnel Provincial Court

Charges: Assault (domestic).
Issue: Whether it was in the public interest to proceed with the prosecution given the rehabilitative steps we guided our client through.
Result: Mr. Gauthier was able to persuade Crown counsel to stay the criminal charge upon our client entering into a Peace Bond. No criminal record.

R. vs. S.C. - Surrey RCMP Investigation

Charge: Theft/Fraud Over $5000.
Issue: Whether it was in the public interest to proceed with a criminal prosecution in this $400,000 fraud/theft from employer case.
Result: Mr. Mines was able to reach a civil settlement with the complainant and was able to persuade police to not forward any criminal charges. No criminal conviction; no jail.

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.