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What to Do if You’re Arrested for Insurance Fraud

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When most of us think of insurance fraud, we envision someone who purposely makes a false claim in order to obtain money they have no right to collect—we think of faked or exaggerated injuries or losses. But the truth is that insurance fraud can happen to anyone, sometimes through no intentional deceit of their own. There are two primary categories of insurance fraud: “hard fraud” and “soft fraud”.  
  • Soft fraud: This occurs when people decide to stop being totally truthful with their insurance company. People who are generally good and honest justify it by thinking everyone does it, that it’s just little white lies and it’s not hurting anyone in the grand scheme of things. But soft fraud is still illegal, and it does hurt people—it’s one of the contributing factors in raised insurance costs.
  • Hard fraud: This is the type of fraud that typically comes to mind—someone intentionally fakes or exaggerates an injury, accident, theft, or other loss to get money from their insurance company that they’re not entitled to. These people tend to act alone, but it’s becoming more common for organized crime rings to develop schemes to steal millions of dollars.
  In any insurance fraud case, there are a few core elements that must be proven beyond a reasonable doubt before fraud charges will be pursued.

Core Elements of Fraud

  1. A false or intentionally misleading statement that was knowingly made.
  2. This statement is related to a payment or claim.
  3. This statement is material, meaning the statement can affect the amount of the claim.
Insurance fraud can even happen through no fault of your own, such as through a shady mechanic or car parts supplier, or a doctor billing for services that were never provided. Here are some of the most common insurance fraud schemes, and what you can do if you find yourself in the middle of one. insurance fraud lawyer

Types of Fraud

Auto Insurance Fraud

Perhaps someone forgot to renew their auto insurance policy before it lapsed, and then they get into a car accident a few days later. So they renew their policy, but then file a claim saying the accident occurred right after they got their insurance back. Or, you get into a car accident and exaggerate the extent of the damage to get a bigger payout. Learn more about Auto Insurance Fraud 

Health Insurance Fraud

This occurs when someone decides to fake or exaggerate an injury when submitting a claim to their insurer, in pursuit of either money or prescription medications. Healthcare providers can also be at fault for this, such as when they submit claims to a patient’s insurance company for services they never actually provided.

Property Insurance Fraud

This fraud deals with homes, places of business, or other coverage for real property (i.e., buildings or land) or personal property. The homeowner who purposely causes a pipe to burst in his home is guilty of this, as is the owner of an insured expensive piece of jewelry who claimed the item was stolen when it wasn’t. Exaggerating a legitimate loss is also a form of property insurance fraud—such as the business owner whose storefront caught fire and who decided to overstate the true extent of the damage to get a bigger check.

Life Insurance Fraud

This is when someone fakes their own or another person’s death in an attempt to collect life insurance payments. This is typically done by forging a death certificate of a family member.

Common Defenses for Fraud

Some defenses are unique to fraud, and some are not. An experienced professional can help you identify if one or more of the following apply to your particular case.

Non-Fraudulent Statement 

For a statement to be fraudulent, certain conditions have to be met. If the statement is a statement of opinion, or regards a prediction of future events, it doesn’t count as fraudulent. Fraudulent statements must pertain to existing fact, and must not be mere statements of opinion. In these cases, a statement can be argued to be non-fraudulent, and the defendant potentially proved innocent of fraud.

An absence of Intent to Commit a Crime

Fraud also requires a certain level of intent; fraud is defined in large part by intentional deceit, and thus fraud did not occur any time deceit was not intended. In other words, intentionally falsifying information—for instance, falsifying information on a government application in order to secure benefits one does not otherwise qualify for—is indicative of fraud, while the accidental falsification is not. Someone who mistakenly provides the wrong information can often be proven innocent of fraud charges.

Insufficient Evidence 

As with many criminal charges, a defendant of fraud charges can be proven innocent if there is a lack of sufficient evidence on the part of the prosecution. In criminal cases, a defendant has to be proven guilty of all aspects of the applicable charges “beyond a reasonable doubt.” In the event there is insufficient evidence to support the charges brought against the defendant, the defendant can be acquitted.

What You Can Do 

The penalties for insurance fraud are most often set by the state, and so they vary widely across the nation. The criminal history of the defendant and the amount of money stolen are also factors in determining fines and jail time. An attorney with the right experience can teach you your rights, explain your options, and help you understand your local laws regarding the issue. If you are charged with insurance fraud, don’t hesitate to call San Diego criminal defense attorney Bradley Corbett.  

Bradley Corbett

Bradley Corbett is a criminal defense attorney in San Diego. He graduated from Brigham Young University in Provo Utah in 2004. Later he enrolled at Thomas Jefferson School of Law in San Diego where he participated in a prestigious internship program with the Los Angeles County Public Defender. Since then he has handled over 2,000 cases.

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