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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. T.L. - Vancouver Provincial Court

Charges: Indecent Act; Mischief (reduced to Peace Bond).
Issue: Whether the Crown could prove that our client intended to commit a criminal offence.
Result: Mr. Mines was able to persuade Crown counsel to enter a stay of proceedings on the the criminal charges upon our client entering into a Peace Bond. No criminal record.

R. vs. B.I. - Vancouver Provincial Court

Charges: Assault.
Issue: Given the Covid-19 pandemic, whether it was appropriate to refer our client into the Alternative Measures Program for this assault by spitting offence.
Result: Mr. Mines was able to provide Crown counsel with compelling information about our client which resulted in Crown allowing our client into Alternative Measures and staying the charge upon our client completing the program. No criminal record.

R. vs. T.F. - Surrey Provincial Court

Charges: Assault with a Weapon; Uttering Threats x2; Unlawful Confinement.
Issues: Whether Crown could prove that a weapon was used or that the complainant was unlawfully confined.
Result: Mr. Mines was able to persuade Crown counsel to accept pleas to the lesser charges of common assault and uttering a threat. After hearing Mr. Mines' submissions on our client's behalf, the trail judge granted our client a conditional discharge. No jail; no permanent criminal record.

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

Charge: Driving while prohibited.
Issue: Whether it was in the public interest to proceed with the prohibited driving charge.
Result: Mr. Johnson was able to persuade Crown counsel to proceed on the lesser charge of driving without possessing a valid driver's licence. Rather than the 12 month minimum mandatory driving prohibition, our client received a 4 month prohibition.

R. vs. J.L. - Surrey 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 to continue with the criminal prosecution.
Result: Mr. Johnson was able to persuade Crown counsel to enter a stay of proceedings on the assault charge upon you entering into a s. 810 peace bond. No criminal record.

R. vs. R.M. - Insurance fraud investigation

Charge: Fraud Under $5000.
Issue: Whether there was a public interest in proceeding with the prosecution in this extended health insurance fraud matter.
Result: Mr. Johnson was able to negotiate a civil settlement and to persuade the investigator to not pursue a prosecution. No criminal record.

R. vs. D.P. - Vancouver provincial Court

Charge: Uttering a Threat (reduced to Peace Bond).
Issues: Whether the words uttered were clearly a threat or not.
Result: Mr. Mines was able to persuade Crown counsel that the words were vague. Crown agreed to end the criminal prosecution upon our client entering into a Peace Bond with a "no contact" condition. No criminal record.

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

Charges: Mischief to Property (x2).
Issue: Whether, given our client's circumstances, it was appropriate to continue the criminal prosecution of this matter which involved damage in excess of $5000 to two vehicles.
Result: Mr. Johnson was able to persuade Crown counsel to allow our client into the Alternative Measures Program and to stay both criminal charges upon completion. No criminal record.

R. vs. V. P. - Vancouver Provincial Court

Charges: Assault, Uttering Threats.
Issue: Given the context of this threatening and assault by spitting offence, whether it was appropriate for our client to be convicted.
Result: Mr. Gauthier provided additional information to the Crown and the Court about our client and was able to persuade the judge to grant our client a conditional discharge. No criminal conviction.

R. vs. P. I. - Vancouver Provincial Court

Charges: Sexual Assault (reduced to assault).
Issue: Given our client's mental health issues, whether it was in the public interest for Crown to continue with the sex assault prosecution.
Result: Mr. Johnson was able to provide information top Crown counsel and to persuade Crown to proceed with a charge of common assault. After hearing Mr. Johnson's submissions, the court granted our client a conditional discharge. no criminal conviction. no jail, no sex offender registry.

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

Charges: Assault Causing Bodily Harm; Choking; Uttering Threats (domestic).
Issue: Whether the complainant's allegation was credible, given the alibi evidence Mr. Johnson was able to provide to Crown counsel.
Result: Based on Mr. Johnson's representations, Crown counsel entered a stay of proceedings on all charges. No jail. No criminal record.

R. vs. L.J.A. - New Westminter Provincial Court

Charges: Assault Causing Bodily Harm, Threatening, Mischief to property, Resist Arrest.
Issue: Whether our client would be sentenced to the 4 month jail sentence Crown was seeking.
Result: On the eve of the trial date, Mr. Mines was able to persuade Crown to only proceed on the assault causing bodily harm charge and, after hearing Mr. Mines' submissions, the court granted our client a suspended sentence. Crown stayed the remaining charges. 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.