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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. – Surrey Provincial Court

Charge: Criminal Harassment; Breach of a recognizance.
Issue: Whether it was appropriate to resolve this domestic harassment by ending the criminal prosecution.
Result: Mr. Gauthier was able to persuade Crown counsel to stay the criminal charges upon. our client entering into a Peace Bond for a period of 12 months. No criminal record.

R. vs. R.N. – RCMP Investigation

Charge: Possession of child pornography.
Issue: Whether police would be able to prove that our client was the only person that had access to the IP address on which the unlawful material was downloaded.
Result: Mr. Mines provided information to the police investigator that led the investigator to close the file with no charges recommended against our client. No jail. No criminal record.

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

Charges: Assault; Uttering Threats.
Issue: Whether it was appropriate for the court to enter a conviction.
Result: Mr. Gauthier was able to steer our client through a course of rehabilitation and was able to persuade Crown counsel and the Court to grant our client a conditional discharge.  No criminal conviction.

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

Charge: Breach of Probation (no contact).
Issue: Whether the Crown could prove that our client intended to breach the "no contact" order that he was subject to.
Result: Mr. Mines was able to persuade Crown counsel that our client bumped into the complainant accidentally. Crown counsel entered a stay of proceedings, bringing the matter to an end. No criminal record.

R. vs. T.X. – Insurance Fraud Investigation.

Charge: Assault (domestic).
Issue: In light of the rehabilitative steps our client completed, whether there was a public interest in proceeding with this child discipline/assault case.
Result: Mr. Mines was able to rely on the extraordinary circumstances of the case and our client's commitment to ongoing family counselling. He was able to persuade Crown counsel to enter a stay of proceedings. No criminal record.

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

Charge: Assault (domestic).
Issue: In light of the rehabilitative steps our client completed, whether there was a public interest in proceeding with this child discipline/assault case.
Result: Mr. Mines was able to rely on the extraordinary circumstances of the case and our client's commitment to ongoing family counselling. He was able to persuade Crown counsel to enter a stay of proceedings. No criminal record.

R. vs. S.L. – ICBC Investigation

Charges: Failing to remain at the scene of an accident.
Issue: Whether our client was obligated to provide a possibly incriminating  statement to the adjuster that could have led to criminal charges and a loss of  insurance coverage.
Result:  Mr. Mines was able to provide the required information to ICBC on our client's behalf. No charges were  recommended. No loss of insurance coverage.

R. vs. R. L. – New Westminster Supreme Court (jury).

Charge: Sexual Assault.
Issue: The credibility and reliability of the complainant and  our client who both testified in this historic sexual assault case.
Result: After  9 hours of deliberations, the jury was deadlocked and could not reach an unanimous decision. No conviction. The trial judge remitted the matter back to court to set a new trial.

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

Charge: Dangerous Driving Causing Bodily Harm.
Issue: Whether there was a substantial likelihood of a criminal conviction and whether it was in the public interest to proceed with a criminal charge.
Result: Mr. Johnson was able to persuade Crown counsel to proceed under the Motor Vehicle Act rather than the Criminal Code. After gearing Mr. Johnson's submissions, the Court sentenced our client to a $100 fine and a 3 year driving prohibition. No criminal record. No jail.

R. vs. S.G. – Coquitlam RCMP Investigation

Charge: Theft Under $5000 (shoplifting).
Issue: Whether it was in the public interest to proceed with a criminal prosecution.
Result: Mr. Gauthier was able to persuade the investigating RCMP member to not forward criminal charges after we settled the matter civilly on our client's behalf. No criminal record.

R. v. J.D. – Richmond Provincial Court

Charge: Assault.
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 refer our client to the Alternative Measures Program and to enter a stay of proceedings. No criminal record.  

R. vs. C.L. – Civil Fraud Investigation

Charge: Fraud/Theft from employer.
Issue: Whether it was in the public interest to proceed with criminal charges.
Result: Mr. Johnson was able to negotiate repayment on our client's behalf and obtained a civil release from the employer. No charges were forwarded to Crown counsel. 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.