If you or a loved one have been accused of committing insurance fraud, or fear you may soon be charged with this crime, you should waste no time in availing yourself of an experienced defense attorney. State of California anti-fraud agencies have abundant funding and are keen to prosecute these cases, and unless you have expert legal help on your side, you could be wrongfully convicted.

At Los Angeles Criminal Attorney, we have deep experience across a wide range of insurance fraud case types. We are familiar with all relevant state and federal laws and will do everything possible to ensure the best obtainable outcome to your case. To learn more, contact us 24/7 at 424-333-0943.

What Is Insurance Fraud?

Insurance fraud schemes vary greatly and can be committed in regard to any type of insurance and by either insurees or insurers. However, most instances involve a policy holder making false statements (or withholding important information) in order to secure or increase a claim. 

Below, we will look at just a few of the most common types of insurance fraud, but you can learn more by visiting some of our other service pages that cover specific types of insurance fraud (e.g. Worker's Compensation Insurance Fraud).

Auto Insurance Fraud

Fraud is especially common with auto insurance, partly because it is mandated and thus nearly universally purchased; but also partly because of the large volume of genuine claims that makes it easier for fraud claims to hide like the proverbial "needle in a haystack."

Among the most common acts of auto insurance fraud are:

  • Staging fake accidents, usually with help from an accomplice.
  • Destroying an insured vehicle and then claiming it was stolen.
  • Having an accomplice "steal" your vehicle.
  • Submitting a claim for a genuine accident that is highly inflated.

Fraud on Other Types of Insurance

In rough economic times, fraud claims become common on a wide range of insurance policy types. Here are some examples:

  • With home or business insurance, setting your own property on fire in order to collect on the loss.
  • With unemployment insurance, collecting benefits while currently employed or not actively searching for work; or, an employer falsifying the reason an employee leaving or else reporting a lower salary to minimize the claim amount.
  • With worker's compensation insurance, claiming an injury happened on the job site when it did not.
  • With health insurance, healthcare providers filing claims for services they never performed or filing the same claim multiple times.
  • With welfare agencies, claiming children or others as dependents when they live somewhere else.

In the case that two or more persons colluded to carry out an insurance fraud scheme, conspiracy charges can also apply. This may involve a policy holder and a friend or a policy holder and an insurance claims adjuster.

"Bad faith insurance fraud" occurs when an insurer does not pay out on a valid claim and never had any intention of doing so. Evidence of bad faith can include: not weighing a claim's merits fairly or in a timely manner, denying claims without giving a good reason, not investigating claims fully, and offering very "low-ball" settlements. Policy holders can file civil actions to seek both the desired claim and additional punitive damages for bad faith insurance fraud, but it will take a skilled lawyer as it can be difficult to prove.

Getting "Red Flagged"

Unfortunately, many innocent people are accused of insurance fraud, and in large part, it stems from the "red flag" system. Since insurers do not have time to scrutinize every claim submitted in detail, and yet must pay out claims in a reasonable amount of time, they use computer algorithms to pick out "suspicious" claims. They often then investigate and pursue these claims, even though computers cannot truly judge guilt/innocence.

Possible Punishments

Insurance fraud can be charged as either a misdemeanor or a felony, and the precise punishments will vary greatly since there are so many specific types of insurance fraud.

As a misdemeanor, an insurance fraud conviction in California will often get you a maximum of 12 months in jail and a maximum fine of $10,000.

Felony-level insurance fraud will normally be punishable by 2 to 5 years in county jail and a fine of twice the value of the amount defrauded or $50,000 (whichever is greater).

However, a felony for worker’s comp insurance fraud can receive fines as high as $150,000 or more, depending on how much money was taken by fraud.

Additionally, with many forms of insurance fraud, those who have a prior felony conviction (for insurance fraud) on their records will be sentenced to 2 extra years in jail. For two prior felonies, it would be 4 extra years, and so forth.

Finally, the defendant will have to pay full restitution to the defrauded insurer or government agency and all financially affected parties. And many professionals can lose their jobs and their licenses if convicted of any kind of insurance fraud.

Prosecution vs. Defense

The crux of the battle in the courtroom, in insurance fraud cases, is over evidence establishing the defendant had an intent to defraud. Not the mere presence of false information being submitted but the purpose to thereby extract undeserved benefits must be demonstrated.

Some might wonder how anyone could accidentally submit a false claim, but in fact, it could be that the policy holder genuinely believed the information was correct or made a simple mistake. And in the case of omissions, it may be the defendant didn't realize the information was required.

In many cases, a skilled defense lawyer can find weaknesses in the prosecution's case and get the charges dismissed, or at least, get them reduced.

Contact Us Today

At Los Angeles Criminal Attorney, we stand ready to defend you against any and all charges of insurance fraud. We have intricate knowledge of the details of California insurance fraud law and extensive experience in the courtroom. 

For a free legal consultation and immediate attention to your case, call us anytime 24/7 at 424-333-0943.