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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. C.Y. – Richmond Provincial Court

Charges: Assault with a weapon ( reduced to Peace Bond).
Issue: Given the rehabilitative steps we were able to guide our client through, whether it was in the public interest to proceed with the criminal prosecution.
Result: Mr. Mines was able to persuade Crown counsel to allow our client to resolve this matter with a s. 810 Recognizance (Peace Bond) for a period of 12 months. Stay of proceedings on the criminal charge. No criminal record.

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

Charges: Theft and Fraud Over $5000 (from employer).
Issue: Whether the pre-charge delay of 3.5 years would reduce the sentence in this $215,000 employee fraud case.
Result: Mr. Mines was able to persuade the trial judge and Crown counsel that there was merit to our application for a judicial stay of proceedings based on our client's inability to properly defend the charges due to a delay of about 4 years in getting the charges approved. Notwithstanding this breach of trust, Mr. Mines was able to negotiate a plea arrangement in which our client received a 2 year conditional sentence order with a 10 pm curfew for 12 months. No monies were ordered to be repaid. No jail.

R. vs. M.P. – Abbotsford Police Investigation

Charges: Uttering Threats.
Issue: Whether it was in the public interest to proceed with a criminal prosucution.
Result: Mr. Gauthier was able to provide information to Crown and to ultimately persuade Crown counsel to not approve any charge in this case. No charge approves. No criminal record.

R. vs. J.H. – Abbotsford Provincial Court

Charge: Failing to stop at an accident resulting in bodily harm.
Issue: Given the circumstances of the offence, our client's background and his extreme remorse, whether a jail sentence was warranted.
Result: Mr. Gauthier was ble to direct our client through a course of psychological counselling and was able to persuade Crown counsel to agree to a non-custodial sentence. After hearing Mr. Gauthier's submissions, the Court sentenced our client to a 12 month conditional sentence. No jail.

R. vs. Q.G. – Vancouver Provincial Court

Charges: Theft Over $5000 (from employer).
Issue: Whether Crown counsel had sufficient evidence to meet the charge approval standard.
Result: Mr. Mines was able to persuade Crown counsel that important evidence would be missing from a cenrtal witness and to not approve any charges. No criminal record.

R. vs. K.H. – Abbotsford Provincial Court

Charges: Breaking and entering a dwelling house and committing an indictable offence, wearing a mask for the purpose of committing an indictable offence, breach of release order.
Issue: Whether it would be consistent with the principles of sentencing for our client to serve his sentence in the community.
Result: Mr. Johnston provided Crown counsel with information which, along with our client's rehabilitative progress and good compliance with strict bail conditions, persuaded the Crown to seek a jail sentence of under two years for his role in a violent "home invasion". After hearing Mr. Johnston's submissions, the court agreed it would not be inconsistent with the principles of sentencing for our client to serve his sentence in the community instead of in custody. This was a significant result for our client as home invasion convictions typically result in lengthy jail sentences served in federal prison. No further time in custody.

R. vs. G.T. – Surrey Provincial Court

Charge: Assault.
Issue: Given the rehabilitative steps we were able to guide our client through, whether there was a public interest in proceeding with a criminal prosecution.
Result: Mr. Johnston provided Crown counsel with information which, along with our client’s progress with counselling, persuaded the Crown to gradually relax our client’s bail conditions and ultimately direct a stay of proceedings on the charge. No further prosecution. No criminal record.

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

Charges: Impaired Driving.
Issue: Whether Crown counsel could prove the impaired driving offence in light of evidence brought forward by Mr. Gauthier which suggested that our client did not voluntarily consume the drug that may have contributed to the the manner of his driving and the ensuing accident.
Result: Mr. Gauthier was able to persuade Crown counsel to proceed on the lesser charge of dangerous operation and, rather than being convicted of impaired driving, our client was granted a conditional discharge. No criminal conviction.

R. vs. D.H.P. – Vancouver Provincial Court

Charges: Assault causing bodily harm; mischief to property under $5000.
Issue: Whether there was a substantial likelihood of a conviction on the assault causing bodily harm charge.
Result: Mr. Mines was able to persuade Crown counsel to enter a stay of proceedings on the assault causing bodily harm charge. After hearing Mr. Mines' submissions, the court granted our client a conditional discharge and ordered restitution in relation to the smart phone that was damaged. No criminal conviction.

R. vs. W.J.M. – Port Coquitlam Provincial Court

Charge: Assault.
Issue: Given the rehabilitative steps we were able to guide our client through, whether there was a public interest in proceeding with a criminal prosecution.
Result: Upon presenting Crown counsel with a psychological report regarding our client's low risk to commit a similar act, Mr. Gauthier was able to persuade Crown to not approve any criminal charges whatsoever. No prosecution. No criminal record.

R. vs. J.A. – Vancouver Provincial Court (DCC)

Charges: Assault; Assault Peace Officer (x2).
Issue: Given the circumstances of our client being severely intoxicated and acting out f character, whether a criminal conviction was appropriate.
Result: Mr. Mines was able to provide Crown counsel with our client's background information resulting in a joint recommendation to the Court for a conditional discharge. No criminal conviction.

R. vs. E.L. – Vancouver Provincial Court

Charges: Aggravated Assault; Breach of Probation.
Issue: Given the context of the offences and our client's rehabilitative efforts, whether a jail sentence was appropriate.>br> Result: Mr. Johnston informed Crown counsel of the significant rehabilitative progress our client had made since the offence dates and persuaded Crown to not pursue the 16 month  jail sentence they had been seeking. Crown agreed to proceed on the less serious charge of assault causing bodily harm and to stay the remaining charges. After hearing Mr. Johnston's submissions, the court granted our client a one year conditional sentence sentence and two years of probation. This was a particularly positive outcome for our client, who had a prior conviction for a similar offence. 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.