• Vancouver at night

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. K.A. – Surrey Provincial Court

Charge: Assault Causing Bodily Harm.
Issue: Whether the complainant and the Crown witnesses gave reliable and crdible evidence at trial.
Result: After vigorous cross examination, the trail judge accepted Mr. Gauthier's submissions that Crown counsel had failed to prove its case. Not guilty verdict. No criminal record.

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

Charge: Assault (domestic).
Issue: Whether the information police provided to Crown counsel would cause Crown to conclude there was a substantial likelihood of obtaining a conviction.
Result: Mr. Mines provided information to Crown on our client's behalf. He was able to persuade Crown that our client was in fact the victim of an assault and was acting in self defence. No charges were approved. No criminal record.

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

Charges: Criminal Harassment (domestic).
Issue: Whether our client's mental state was such that Crown counsel could prove that she had the necessary level of intent to be convicted of a criminal offence.
Result: Mr. Gauthier was able to provide our client's medical documentation to Crown which resulted in Crown deciding not to proceed with the prosecution. Stay of proceedings. No criminal record.

R. vs. J.X. – Vancouver Provincial Court

Charges: Driving while prohibited (MVA).
Issue: Whether the delay in approving the charge was relevant to our client's right to a speedy trial.
Result: Mr. Mines was able to persuade Crown counsel to proceed on the lesser offence of driving without a valid driver's licence. Rather than a 12 month driving prohibition and 10 penalty points, our client was sentenced to a 3 month driving prohibition and received only 3 penalty points.

R. vs. Q.B. – North Vancouver RCMP investigation

Charges: Sexual assault.
Issue: Whether or not the acts complained of were consensual or not, and whether it was in the public interest to proceed with a criminal prosecution.
Result: Mr. Mines provided further information to th einvestigator on our client's behalf that ultimately led to police declining to recommend any criminal charges. No charge was approved. No criminal record.

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

Charges: Assult (domestic).
Issue: Given the rehabilitative steps we were able to guide our client through, whether it was in the public interest for Crown counsel to continue the criminal prosecution.
Result: Based on the information Mr. Mines provide regarding our client, Crown directed a stay of proceedings bringing the matter to an end. No criminal record.

R. vs. E.E. and B.L. – Insurance Fraud Investigation

Charges: Fraud; misrepresentation.
Issue: Whether it was in the public interest to proceed with a criminal investigation and prosecution.
Result: Mr. Gauthier was able to negotiate a civil settlement on our clients' behalf resulting in an end to the matter. No police investigation. No criminal record.

R. vs. S.G. – North Vancouver Provincial Court

Charges: Assault (x2). Issue: Whether our client was involved in a consensual fight; used reasonable force in defending himself, or was guilty of two counts of assault. Result: At the conclusion of  a three day trial and hearing Mr. Gauthier's submissions on our client's behalf, the trial judge found our client not guilty on both counts. No jail. No criminal record.

R. v. K.T. – Delta Police Investigation

Charges: Criminal Harassment.Issue: Whether it was in the public interest to proceed with a criminal prosecution.
Result: Mr. Gauthier was able to provide the police investigator with information about our client and the circumstances of the incidents that led to the discontinuation of the investigation. File closed. No criminal charges recommended.

R. vs. G.P. – New Westminster Provincial Court

Charge: Theft Under $5000 (from employer).
Issue: Given the rehabilitative steps we were able to guide our client through, whether it was contrary to the public interest for the court to grant our client a conditional discharge.
Result: Crown counsel's position was that our client should be sentenced to jail but after considering our client's positive pre-sentence report and Mr. Mines' submissions on our client's behalf, the court granted a conditional dischege. No criminal conviction.

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

Charge: Assault (domestic).
Issue: Given the rehabilitative steps we were able to guide our client through, whether there was contrary to public interest for  our client to be granted a conditional discharge.
Result: Mr. Gauthier was able to persuade Crown to not proceed on a  breach of bail allegation; to agree to not seek forfeiture of our client's firearms, and to make a joint submission for a conditional discharge with probation. No criminal conviction.

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

Charge: Fear of safety allegation (Peace Bond Application).
Issue: Given the information we were able to provide to Crown counsel, whether it was in the public interest to proceed with the Peace Bond application against our client.
Result: Mr. Gauthier was able to persuade Crown counsel to enter a stay of proceedings so that our client was no longer subject to any of the restrictive conditions he was bound by.

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.