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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. A.S. – Vancouver Provincial Court

Charges: B & E, Fraud over $5000, Motor vehicle theft; Identity theft, Driving while prohibited (x2).
Issue: Given our client’s personal circumstances and rehabilitative efforts, what would be the appropriate sentence.
Result:  Mr. Johnston was able to persuade Crown to make a joint submission for time-served, followed by a period of probation. The Crown directed stays of proceedings on several charges.  After hearing Mr. Johnston's submissions on our client's behalf, the sentencing judge noted that he would have ordinarily imposed a lengthy jail sentence for an accused in our client's position, but he accepted the joint submission. No further jail.

R. v. M.A.K. – Vancouver Provincial Court

Charge: Possession of fentanyl and carfentanil for the purposes of trafficking.

Issue: Given the information Mr. Johnston provided to Crown counsel regarding our client’s personal circumstances and the circumstances of the alleged offence, whether it was appropriate to proceed with a criminal prosecution.

Result: Mr. Johnston was able to persuade the Crown that there were issues with respect to the Crown's evidence such that it was unlikely our client would be convicted at trial, and that there was insufficient public interest in continuing to prosecute our client in any case. Given this informaton, the Crown directed a stay of proceedings on the charge. No criminal record.

R. v. S.B. – Vancouver Provincial Court

Charge: Carrying a Concealed Weapon.
Issue: Given the information Mr. Johnston was able to provide to Crown counsel regarding the circumstances of the incident and our client's background, whether it was in the public interest to proceed with a criminal prosecution.
Result: Mr. Johnston persuaded Crown counsel that there was insufficient public interest, leading Crown to enter a stay of proceedings. No criminal record.

R. v. M.A. Insurance Fraud Investigation

Charge: Insurance Fraud Under $5000.
Issue: Given our client's rehabilitation and repayment of the disputed funds, whether it was in the public interest to proceed with a criminal prosecution.
Result: Mr. Gauthier was able to persuade the insurance company to settle the matter on a civil basis. No criminal charges were forwarded. No criminal record.

R. v. D.S. – Whitehorse Yukon Territorial Court

Charge: Section 810 Recognizance (Peace Bond) Application.
Issue: Whether the Informant could prove her allegations on a balance of probabilities.
Result: After Mr. Gauthier' communications with the Informant, she declined to advance the case and, on the day of the trial, the court withdrew the Application. No record.

R. v. E.N. – North Vancouver Provincial Court

Charge: Fraud Under $5000.
Issue: Given the information Mr. Gauthier provided to Crown counsel regarding our client's personal circumstances and the circumstances of the alleged offence, whether it was appropriate to proceed with a criminal prosecution.
Result: Mr. Gauthier was able to persuade Crown that there wa sno substantial likelihood of a conviction resulting ultimately in Crown declining to approve a charge. No criminal record.

R. v. E.N. – North Vancouver Provincial Court

Charge: Mischief Under $5000.
Issue: Given the information Mr. Gauthier provided to Crown counsel regarding our client’s personal circumstances and the circumstances of the alleged offence, whether it was appropriate to proceed with a criminal prosecution.
Result: Mr. Gauthier was able to persuade Crown that there was no substantial likelihood of a conviction resulting ultimately in Crown declining to approve a charge. No criminal record.

R. v. K.D. – Vancouver Provincial Court

Charges: Failing to Remain at the Scene of an Accident.
Issue: Whether our client's Charter rights were breached due to unreasonable delay.
Result: Mr. Mines was able to provide information to Crown counsel that ultimately caused Crown  to proceed against our client as the owner and not the driver of the vehicle. He plead to the lesser charge of Failing to Remain under the Motor Vehicle Act and received a fine, but no driving prohibition. No criminal record.

R. v. H.C. – Vancouver Provincial Court

Charges: Sexual Assault; Sexual Interference.
Issue: Whether the complainant held herself out to be at least 16 years of age and whether our client took reasonable steps to ascertain her age.
Result: Mr. Mines was able to provide information to Crown counsel on our client's behalf that established that our client did take reasonable steps to ascertain the complainant's age. In the result, Crown declined to approve any criminal charges. No criminal record.

R. v. A.L. – Vancouver Provincial Court

Charges: Tax Evasion (Excise Tax Act); Fraud Over $5000 x2.
Issue: Given our client's cooperation with the investigation, his civil settlement and his genuine remorse, whether a jail sentence was appropriate for this almost one million dollar tax evasion case.
Result: Mr. Mines was able to provide medical and financial information to Crown counsel that ultimately led Crown to proceed on the fraud charges rather than seeking an almost one million dollar mandatory fine under the Excise Tax Act. The Court accepted the joint submission for a 2 year less a day conditional sentence and probation. No jail.

R. v. A.R. – Vancouver Provincial Court

Charges: Assault (reduced to Peace Bond).
Issue: Given the rehabilitative steps we were able to guide our client through, whether it was in the public interest continue with a criminal prosecution.
Result: Mr. Mines was able to persuade Crown counsel to proceed with a Peace Bond rather than the criminal assault charge. No criminal record.

R. v. T.C. – Fraud Over $5000 Investigation

Charge: Fraud Over $5000.
Issue: Given the civil settlement of this $245,000 misappropriation from employer case, whether there was any interest in pursuing  a criminal investigation and prosecution.
Result: Mr. Johnson was able to negotiate a civil settlement and obtained a Final Release from the complainant. No criminal investigation occurred. No risk of jail or criminal prosecution.

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.