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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. A.J. – Insurance Fraud Investigation

Charges: Fraud Over $5,000 Investigation.
Issue: Given that we were able to negotiate a civil settlement of this $13,000 insurance claim overpayment, whether it was in the public interest to proceed with a criminal prosecution.
Result: Mr. Mines was able to negotiate a settlement of the alleged fraudulent claim. We obtained a full Release, ending the matter in both the civil and criminal context. No further liability. No criminal charges.

R. vs. M.M. – New Westminster Police Investigation

Charge: Sexual Assault Investigation.
Issue: Whether there was sufficient evidence for police to recommend that criminal charges be approved.
Result: Mr. Gauthier was able to guide our client through the police investigation, and to provide police with information on our client's behalf. Ultimately, police decided not to forward any charge to Crow. No charges approved. No criminal record.

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

Charges: Fraud Under $5,000
Issue: Given our client's repayment of the alleged fraudulent health insurance benefits, whether it was in the public interest to proceed with criminal charges.
Result: Mr. Gauthier was able to settle the matter civilly on our client's behalf without any further civil or criminal proceeding. No charges were approved.

R. vs. A.S. – Port Coquitlam Provincial Court

Charges: Assault (domestic) 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 continue with the criminal prosecution.
Result: Mr. Mines was able to steer our client through a course of rehabilitation and persuaded Crown to stay the assault charge and to allow our client to enter into a Peace Bond.

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

Charges: Assault; Uttering Threats.
Issue: Whether there was sufficient evidence for criminal charges to be approved.
Result: Mr. Mines was able to provide Crown counsel with additional information and persuaded Crown that it was not in the public interest to proceed with any criminal charges.

R. vs. M.H.E. – Abbotsford Provincial Court

Charges: Assault.
Issue: Whether it was in the public interest to proceed with a criminal prosecution.
Result: Mr. Mines was able to provide information to Crown counsel regarding our client's circumstances and was able to persuade Crown that there was no public interest in proceeding with a criminal prosecution. No criminal record.

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

Charges: Sexual Assault; Assault.
Issue: Given the rehabilitative steps we guided our client through, the nature of the sex assault itself and our client's true remorse, whether a jail sentence or house arrest were required.
Result: Mr. Mines was able to persuade Crown counsel to make a joint submission for a conditional discharge. After hearing Mr. Mines' submissions on our client's behalf, the trial judge granted our client the discharge. No jail or house arrest. No criminal conviction.

R. vs. N. O. – Courtenay Provincial Court

Charges: Assault Causing Bodily Harm x2; Assault x3.
Issues: Whether there was a substantial likelihood of a conviction.
Result: Mr. Gauthier was able to provide information to Crown counsel which cast the complainant's credibility and reliability into doubt. The Crown made an adjournment application which Mr. Gauthier opposed. Mr. Gauthier was able to persuade Crown to stay all of the criminal charges upon our client entering into a Peace Bond. No jail; No criminal record.

R. v. K.T. – Insurance Fraud Investigation

Charges: Fraud Under $5000.
Issue: Given our client's repayment of the alleged fraudulent health insurance benefit claims, whether it was in the public interest to proceed with criminal charges.
Result: Mr. Mines was able settle the matter on our client's behalf and received a Release from the insurer ending the matter without any further civil or criminal proceeding. No charges were approved.

R. vs. A.H. – Vancouver Supreme Court

Charges: Sentence Appeal - Forcible entry; Assault with a weapon.
Issue: Whether the Supreme Court would uphold our client's conditional discharge that was granted to our client by the Provincial Court.
Result: After hearing Mr. Gauthier's submissions on this sentence appeal, the Supreme Court justice agreed with Mr. Gautier and ruled that the sentence was appropriate in all the circumstances. The court dismissed the Crown's appeal. The conditional discharge was upheld.

R. v. J.F. – Dawson Creek Provincial Court

Charge: Sexual Assault.
Issue: The credibility of the complainant's testimony during this three day trial.
Result: After vigorous cross examination of the complainant and another Crown eyewitness, Mr. Gauthier made submissions which were accepted by the trial judge. The court found our client to be not guilty and aquitted him of the charge. No jail. No criminal record.

R. vs. D.C. – Port Coquitlam Provincial Court

Charges: Sexual Assault (x2).
Issue: In the circumstances of these historic charges and our client's rehabilitation, whether a community based sentence was appropriate.
Result: Notwithstanding that Crown counsel sought a 20 month jail sentence, the trial judge agreed with Mr. Mines' submission that, in the circumstances of our client's genuine remorse and rehabilitation, it was appropriate to  grant a conditional sentence of 21 months. 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.