Insurance Fraud Charges in Ontario: Penalties, Investigations and Defences

Last updated: October 10, 2026

Most insurance fraud charges in Ontario are laid as fraud under section 380 of the Criminal Code. If more than $5,000 is involved, the maximum sentence is 14 years in prison. If the amount is $5,000 or less, the Crown can proceed by indictment, where the maximum is two years, or by summary conviction, where the maximum is two years less a day, a $5,000 fine, or both. Ontario can also prosecute false statements to an insurer under the Insurance Act, with fines of up to $250,000 for a first conviction.

A claim that turns out to be wrong is not automatically a crime. The Crown has to prove that you did something dishonest and that you knew it could cost the insurer money. This guide explains what counts as insurance fraud, which laws apply in Ontario, how investigations start, what the examination under oath involves, the penalties a court can impose, and the issues that usually decide these cases.

Insurance fraud charges in Ontario at a glance

• The usual charge: fraud under section 380 of the Criminal Code. Forgery, using a forged document and arson for a fraudulent purpose are sometimes laid as well.
• Maximum sentence: 14 years for fraud over $5,000. For fraud of $5,000 or less, two years on indictment, or two years less a day and a $5,000 fine on summary conviction.
• Minimum sentence: two years in prison when the total value is more than $1 million and the Crown proceeds by indictment.
• Provincial charges: knowingly false or misleading statements to an insurer are an offence under section 447 of Ontario’s Insurance Act, with fines of up to $250,000 for a first conviction and $500,000 for each later one.
• Where it starts: often with the insurer’s own investigators, before police are involved.
• Discharges: not available for fraud over $5,000, because that offence carries a 14 year maximum.

What is insurance fraud?

Insurance fraud is using a lie, a deceit or some other dishonest means to get money or a benefit from an insurer that you are not entitled to, or to put the insurer’s money at risk. The Criminal Code has no separate offence called insurance fraud. Prosecutors use the general fraud section, and sometimes other offences that fit what happened.

How insurance fraud happens

• Car insurance claims. A collision that was staged or never happened, an injury that is invented or exaggerated, or treatment, rehabilitation or assessments billed but never provided. Ontario’s Insurance Act makes it an offence to knowingly make a false statement to an insurer to get paid for goods or services, whether or not the insured person received them.
• Home and property claims. Inflating the value of stolen or damaged items, claiming for things that were never owned, or setting a fire to collect on a policy.
• Applications and renewals. False information about who drives a car or where it is kept is a common source of disputes with insurers. Whether it becomes a criminal case depends on the evidence of intent and of a loss or risk of loss.
• Fake proof of insurance. Having, using, selling or showing a false or invalid insurance card is an offence under Ontario’s Compulsory Automobile Insurance Act.
• Workplace benefit plans. Claims to a group health, dental or drug plan for treatment or products that were never received. The Criminal Code fraud section applies to these claims in the same way it applies to auto and property claims.
• Forged paperwork. Fake receipts, invoices, repair estimates or medical notes can lead to forgery charges, or to a charge of using a forged document, on top of fraud.

The laws that apply in Ontario

An insurance fraud file can involve federal criminal law, provincial insurance law, or both. These are the penalties each law sets.

Offence	Law	Penalty
Fraud over $5,000	Criminal Code, s. 380(1)(a)	14 years in prison
Fraud of $5,000 or less	Criminal Code, s. 380(1)(b)	2 years on indictment. On summary conviction, 2 years less a day, a $5,000 fine, or both (s. 787)
Fraud totalling more than $1 million, prosecuted by indictment	Criminal Code, s. 380(1.1)	Minimum of 2 years in prison
Forgery	Criminal Code, ss. 366 and 367	10 years on indictment, or a summary conviction penalty
Using a forged document (uttering)	Criminal Code, s. 368	10 years on indictment, or a summary conviction penalty
Fire or explosion damage with intent to defraud	Criminal Code, s. 435	10 years on indictment, or a summary conviction penalty
Knowingly false or misleading statement to an insurer about a benefit, failing to report a material change within 14 days, or a false statement to get paid for goods or services	Insurance Act, s. 447(2)(a.1) to (a.3)	Fine of up to $250,000 on a first conviction and up to $500,000 on each later conviction
Having, using, selling or showing a false or invalid insurance card	Compulsory Automobile Insurance Act, s. 13.1	Fine of $10,000 to $50,000 on a first conviction, and $20,000 to $100,000 on a later conviction
Giving police an insurance card for a vehicle that is not insured	Compulsory Automobile Insurance Act, s. 2(3)	Fine of $5,000 to $25,000 on a first conviction and $10,000 to $50,000 on a later conviction, plus a possible licence suspension of up to one year

A few details matter in practice. Under section 435, the fact that the accused held or was a beneficiary of a fire insurance policy on the property is something the court can use to infer an intent to defraud. Charges under the Insurance Act are provincial offences that carry fines, not jail, but the court can also order compensation or restitution (s. 447(5)), and the charge must be laid within two years of the date the facts first came to the attention of the Chief Executive Officer of the Financial Services Regulatory Authority of Ontario (s. 449). For a fraud charge that the Crown prosecutes summarily, proceedings have to start within 12 months of the events unless the prosecutor and the defendant agree otherwise (Criminal Code, s. 786(2)).

What the Crown has to prove

The Supreme Court of Canada set out the test for fraud in R. v. Théroux in 1993. The Crown has to prove four things beyond a reasonable doubt:

1. A prohibited act: a deceit, a falsehood or some other fraudulent means.
2. Deprivation caused by that act: an actual loss, or putting someone’s financial interests at risk.
3. That you knew you were doing the prohibited act.
4. That you knew the act could cause that loss or risk.

Two points follow from this test. First, the insurer does not have to pay anything out. A false claim that put its money at risk can be enough. Second, believing you did nothing wrong is not a defence on its own. The Court said a person who knowingly deceives will not be acquitted because they believed what they were doing was honest. The question is what you knew about the facts, for example whether you knew a statement on a claim form was false.

The amount matters too. For a conviction of fraud over $5,000, the Crown has to prove the value is over that line. If it cannot, the court can still convict of the lesser offence of fraud of $5,000 or less, which carries a much lower maximum.

How an insurance fraud investigation usually starts

Many files begin with the insurer, not the police. An adjuster or the insurer’s special investigations unit notices something that does not add up: a claim made soon after a policy started, invoices that do not match the treatment records, or an account of an accident that changes. The insurer may ask for documents, a written statement or a sworn statutory declaration.

For larger or organized cases, insurers work with Équité Association, an independent not-for-profit organization that took over the Insurance Bureau of Canada’s investigative services on October 1, 2021. Insurers and Équité can take what they find to the police. Police fraud units decide whether to investigate and lay charges, and a Crown prosecutor then screens every charge. Under Ontario’s charge screening directive, a charge may only proceed if there is a reasonable prospect of conviction and it is in the public interest.

One change to watch: Ontario has passed an amendment to the Insurance Act (s. 101.3) that will require insurers to send information about automobile insurance fraud to FSRA’s Chief Executive Officer or an agency the CEO designates. As of October 2026, it has not been proclaimed in force, and FSRA’s guidance on its Fraud Reporting Service says its effective date has not yet been determined.

The examination under oath in a car accident claim

If you apply for accident benefits after a collision, the Statutory Accident Benefits Schedule lets the insurer require you to attend an examination under oath. It is a sworn interview about your claim. Section 33 of the Schedule sets the ground rules:

• Within 10 business days of a request, you must give the insurer the information it reasonably needs to decide your entitlement, a statutory declaration about the circumstances of the claim, your address and proof of identity.
• You can be required to attend an examination under oath, but not more than one on matters relating to the same accident.
• You are entitled to be represented by a lawyer or another representative of your choice, at your own expense.
• The insurer must give reasonable advance notice of the date and place, your right to representation, the reasons for the examination, and the fact that it will be limited to matters relevant to your entitlement to benefits.
• If you do not comply, the insurer does not have to pay benefits for that period. If you comply later and give a reasonable explanation for the delay, the insurer must resume payments and pay the amounts it held back.

An examination under oath is part of your insurance claim, not a police interview. Your answers are given under oath, though, and if the insurer suspects fraud, what you said can become part of the material it passes to police. If an insurer has raised fraud, get legal advice before you attend.

If police contact you

A call from an officer asking you to come in and give your side is a request, not an order. You have the right to remain silent. If you are arrested or detained, you have the right under section 10(b) of the Canadian Charter of Rights and Freedoms to speak to a lawyer without delay, and you should use it before you answer questions.

If you are charged, police can release you with a court date and conditions, or hold you for a bail hearing. Once the case is in court, you are entitled to disclosure of the Crown’s evidence, which in a fraud case can include claim files, bank records, invoices and the insurer’s investigation reports.

Insurance fraud punishment in Canada: how sentences are decided

The maximum depends on the charge and the amount, as set out in the table above. Within those limits, the judge looks at the facts and at the person. Section 380.1 of the Criminal Code tells judges to treat the following as aggravating in a fraud sentencing:

• a fraud of significant size, complexity or duration, or with a significant degree of planning;
• a large number of victims;
• a significant impact on victims given their age, health or financial situation;
• taking advantage of the high regard in which the offender was held in the community;
• not complying with a licensing requirement or professional standard that normally applies to the activity involved;
• hiding or destroying records about the fraud or about where the money went.

The same section says a person’s employment, skills, status or reputation cannot be treated as mitigating if those things were relevant to, contributed to or were used in committing the fraud.

Discharges and conditional sentences

• Discharge. A discharge means no conviction is registered. Under section 730, it is not available for an offence with a minimum punishment or a maximum of 14 years, so it is off the table for fraud over $5,000. It can be available for fraud of $5,000 or less, forgery, using a forged document and arson for a fraudulent purpose, if the judge decides it is in your best interests and not contrary to the public interest.
• Conditional sentence. A jail sentence of less than two years can be served in the community under strict conditions if that would not endanger the community and is consistent with the principles of sentencing. Fraud is not on the list of excluded offences in section 742.1, but a conditional sentence cannot be imposed for an offence with a minimum jail term, such as fraud over $1 million prosecuted by indictment.

Restitution and prohibition orders

A judge can order you to repay the insurer’s loss as part of the sentence (s. 738). In an Insurance Act prosecution, the court can order compensation or restitution in addition to a fine. A court can also make an order under section 380.2 barring a person convicted of fraud, or discharged on conditions, from any job or volunteer role that involves authority over another person’s real property, money or valuable securities, for any period the court considers appropriate.

Consequences outside the courtroom

Your claim and your policy

For property insurance, the statutory conditions in section 148 of Ontario’s Insurance Act say that any fraud or wilfully false statement in a statutory declaration about the loss vitiates, meaning defeats, the claim of the person who made it (Statutory Condition 7). For car accident benefits, the insurer can stop paying benefits if you wilfully misrepresented material facts in your application, after giving you notice of the reasons (SABS, s. 53), and you can be required to repay benefits that were paid because of wilful misrepresentation or fraud (SABS, s. 52).

Immigration

If you are not a Canadian citizen, a fraud charge needs attention right away. Fraud over $5,000 carries a maximum of 14 years, so a conviction for it is serious criminality under section 36(1)(a) of the Immigration and Refugee Protection Act, whatever sentence is imposed. A conviction for any federal offence is also serious criminality if a jail term of more than six months is imposed. Our page on criminal charges and immigration consequences explains more.

A criminal record

A conviction stays on your record until a record suspension is granted. Under section 4 of the Criminal Records Act, if you are otherwise eligible, you can apply 10 years after your sentence ends for an offence prosecuted by indictment, or five years for a summary conviction offence. The sentence includes any jail, probation and payment of any fine. See our record suspension page for the process.

Issues that often decide insurance fraud cases

Every case turns on its own evidence. These are the questions a defence review usually starts with.

• Was there dishonesty? A mistake, a misunderstanding about what a policy covers or poor record keeping is not fraud. The Crown has to prove a dishonest act, not just an inaccurate one.
• What did you know? Clinics, tow and repair shops and brokers sometimes submit paperwork in a client’s name. If you did not know a document or statement was false, the mental element of fraud is not proven.
• Can the Crown prove the amount? A conviction for fraud over $5,000 requires proof that the value went over that line.
• Who did what? In cases with several accused, such as staged collisions or clinic billing schemes, the Crown has to prove what each person did and knew.
• Was the evidence lawfully obtained? Phone records, bank records, emails and clinic files can be gathered with warrants or production orders. If police obtained evidence in breach of the Charter, the defence can ask the court to exclude it under section 24(2), using the test from R. v. Grant (2009).
• Has the case taken too long? Fraud cases often involve a large volume of documents. Charges can be stayed for unreasonable delay. For offences committed on or after July 18, 2026, a new part of the Criminal Code keeps the Jordan framework but adds rules on case complexity and on time that does not count, and a judge can stay the charges only if no other remedy would be appropriate and just.

Diversion and withdrawal

Fraud is not on the list of offences that Ontario prosecutors are barred from referring to a community justice program, such as the Direct Accountability Program. Under directive D. 4 of the Crown Prosecution Manual, the Crown can refer an eligible case, and charges can be withdrawn or stayed once the program is completed. The factors the Crown must consider include the person’s age and health, any prior findings of guilt or earlier diversion, their role in the offence, remorse and willingness to take part, and any restitution already made.

What to do if an insurer or police contact you

1. Do not destroy, change or hide documents, messages or files. Concealing or destroying records about a fraud is an aggravating factor at sentencing.
2. Do not give police a statement until you have spoken to a lawyer.
3. If the insurer has raised fraud, get advice before an examination under oath or a recorded statement.
4. Gather your own records: the policy, the claim, receipts, photos, and emails or texts with the insurer, clinic, shop or broker.
5. If you are not a Canadian citizen, tell your lawyer at the first meeting.
6. If you are released on conditions, follow them exactly.

Frequently asked questions

Is insurance fraud a criminal offence in Canada?

Yes. It is usually charged as fraud under section 380 of the Criminal Code, which carries up to 14 years in prison when more than $5,000 is involved. In Ontario, knowingly false or misleading statements to an insurer are also a provincial offence under the Insurance Act.

How long can you go to jail for insurance fraud in Canada?

The maximum is 14 years for fraud over $5,000, and two years for fraud of $5,000 or less prosecuted by indictment. Fraud totalling more than $1 million carries a minimum of two years when prosecuted by indictment. The actual sentence depends on the facts, the amount and the person’s background.

Is an exaggerated or mistaken claim fraud?

A mistake is not fraud. An exaggeration can be, if you knowingly gave false information and knew it could put the insurer’s money at risk. The Crown has to prove both parts.

Can my insurance company report me to the police?

Yes. Insurers and Équité Association can refer suspected fraud to police, who decide whether to lay charges. A Crown prosecutor then decides whether the charge can proceed.

Do I have to attend an examination under oath?

For accident benefits, yes, if the insurer requires it, but not more than once on matters relating to the same accident, with reasonable notice and with a representative of your choice at your own expense. If you do not comply, the insurer does not have to pay benefits for that period.

Can insurance fraud charges be withdrawn?

Yes. A charge may only proceed if there is a reasonable prospect of conviction and it is in the public interest, and fraud can be referred to a community justice program in suitable cases, with charges withdrawn or stayed once the program is completed.

Talk to a Toronto insurance fraud lawyer

Kazandji Law defends people charged with fraud, forgery and related offences in Toronto and across the GTA, with offices in Toronto, North York, Thornhill and Oakville. If you are facing insurance fraud charges in Ontario, or an insurer or the police have raised fraud with you, call 647-588-3234 or contact us online for a free, confidential consultation. You can also read more about fraud over $5,000, fraud under $5,000, forgery and arson charges, or visit our Toronto fraud defence page.

Sources

• Criminal Code, R.S.C. 1985, c. C-46: s. 380, s. 380.1, s. 380.2, s. 366, s. 367, s. 368, s. 435, s. 730, s. 738, s. 742.1, s. 786 and s. 787 (Justice Laws, current to September 21, 2026)
• Insurance Act, R.S.O. 1990, c. I.8, ss. 101.3 (not yet in force), 148, 447 and 449
• Statutory Accident Benefits Schedule, O. Reg. 34/10, ss. 33, 52 and 53
• Compulsory Automobile Insurance Act, R.S.O. 1990, c. C.25, ss. 2 and 13.1
• Immigration and Refugee Protection Act, s. 36 and Criminal Records Act, s. 4
• R. v. Théroux, Supreme Court of Canada, 1993
• Crown Prosecution Manual: D. 3, Charge Screening and D. 4, Community Justice Programs for Adults
• Financial Services Regulatory Authority of Ontario: Fraud prevention and reporting and Automobile Insurance Fraud Reporting guidance
• Insurance Bureau of Canada, IBC transfers its investigative services to Équité, September 27, 2021

This article is general information about Ontario and Canadian law, not legal advice about your situation.