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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. R.C. - Vancouver Provincial Court

Charges: Assault.
Issue: Whether there was a substantial likelihood of conviction in this case.
Result: Mr. Johnson was able to provide information to Crown counsel which resulted in Crown entering a complete stay of proceedings just prior to the trial date. No criminal record.

R. vs. K.A. - Surrey Provincial Court

Charges: Assault; Breach of Release Order.
Issue: Whether it was in the public interest to proceed with the criminal charges.
Result: Mr. Mines was able to persuade Crown counsel to proceed by way of a Peace Bond and to enter a stay of proceedings on the criminal charges. No criminal record.

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

Charges: Personation, Use of Forged Identity Documents, Resist Arrest.
Issue: Whether the search and seizure of the documents was an unlawful Charter breach.
Result: Mr. Mines was able to persuade Crown and the Court that, in all the circumstances, it was in the public interest to grant our client a conditional discharge without any reporting condition. 

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

Charges: Assault with a Weapon; Assault Causing Bodily Harm (domestic).
Issue: Whether there was a substantial likelihood of a conviction and whether it was in the public interest to proceed.
Result: Mr. Mines was able to convince Crown counsel to enter a stay of proceedings just prior to the trial date. No criminal record.

R. vs. J.B. - ICBC Fraud Investigation

Charge: Theft Under$5000.
Issue: Whether there was a public interest in approving the charge.
Result: Mr. Johnson was able to persuade Crown counsel that there was no public interest in approving any charge whatsoever. No criminal record.

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

Charge: Assault (domestic).
Issue: Whether it was appropriate for our client to be granted a conditional discharge.
Result: Mr. Mines was able to persuade the trial judge to grant our client a conditional discharge rather than the conviction that Crown counsel was seeking. No criminal record.

R. v. M.P. - Vancouver Provincial Court

Charge: Theft Under$5000.
Issue: Whether there was a public interest in approving the charge.
Result: Mr. Johnson was able to persuade Crown counsel that there was no public interest in approving any charge whatsoever. No criminal record.

R. vs. O.A. - Surrey Provincial Court

Charge: Assault (domestic). Issue: Given the lack of clarity…

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

strong>Charges: Sexual Assault; Assault; Theft Under; Breach of Undertaking.
Issue: Given our client's circumstances and the circumstances of the allegations, whether it was in the public interest for Crown to proceed with all charges.
Result: Mr. Mines was able to persuade Crown counsel to proceed only on the assault charge and to stay proceedings on all other charges. After considering Mr. mines' submissions, the Court granted our client a conditional discharge and placed him on probation for 12 months. No criminal conviction.

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

Charges: Assault with a Weapon; Assault Police Officer.
Issue: Given some weakness in the assault with weapon charge and the rehabilitative steps our client had taken, whether it was appropriate for the Crown to seek the jail sentence they were originally seeking.
Result: Mr. Johnson was able to persuade Crown counsel to enter a stay of proceedings on the AWW charge and to jointly seek a conditional discharge on the assault police officer charge. No jail. No criminal conviction.

R. vs. S.K. - Surrey Provincial Court

Charges: Fraud Over $5000 (from Employer).
Issue: Given the civil settlement  we were able to obtain on our client's behalf, whether it was in the public interest to proceed with criminal charges.
Result: Mr. Johnson, after successfully negotiating a civil settlement with the complainant, was able to persuade Crown counsel to not approve the criminal charges that RCMP had recommended. No jail. No criminal record.

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

Charges: Impaired Driving; Driving Over .08.
Issue: Whether it was in the public interest for Crown counsel to proceed with the criminal charges.
Result: Mr. Johnson was able to persuade Crown to allow our client to resolve this matter by pleading guilty to a lesser offence under the Motor Vehicle Act. Our client received a driving prohibition and fine. 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.