WHAT IS THE DEFINITION OF INSURANCE FRAUD?
Insurance fraud is defined as an individual or group of individuals committing an act with the intent to obtain benefits or payments to which they aren’t entitled to or deny benefits to those that are rightfully entitled to them. Insurance fraud can include filing a false claim for an accident that never occurred, staging an accident to file a claim, claiming unnecessary medical expenses, or promising individual’s insurance coverage but never providing that coverage – just to name a few. According to California Penal Code 550, it as illegal to “aid, abet, solicit, or conspire” to submit “any false or fraudulent claim for the payment of a loss of injury.” Also, it is illegal to submit multiple claims, present false or fraudulent claims for loss of property, or make a claim or multiple claims for a health benefit that you didn’t receive. Failure to abide by Penal Code 550 can result in jail time, a $50,000 fine or double the amount of the fraud (whichever is greater), or a combination of both. The fraudulent act doesn’t have to be completed to be charged. When the act and the intent to commit fraud are both present you can be charged with insurance fraud (2).
WHAT TO DO IF YOU ARE A VICTIM OF INSURANCE FRAUD
The National Insurance Crime Bureau (NICB) released its 2012 questionable claims referral reason analysis and reported some startling facts. The number of questionable claims rose dramatically from 2010 to 2012 with a 26.7% increase. The total number of questionable claims were 116,268 and California was the highest state with 21,935 questionable claims. Penal Code 550(b)(2) specifically warns about submitting a false statement claim and the punishments tied to that. Insurance fraud doesn’t just include auto accidents though. It can include:- Life insurance
- Health care insurance
- Property insurance
- Premium theft
- Worker’s compensation
- Personal injury
WHAT ARE THE CONSEQUENCES Of INSURANCE FRAUD?
If you’re being investigated for insurance fraud the insurance company will compile all the information that they need before they charge you. They’ll look at when the policy was put into effect when the accident happened when claims were filed, those involved, and third-party members (doctors, tow truck agencies, police reports). The length of the investigation into your claim can vary depending on how suspicious it is.
Insurance fraud is most often charged as a felony, although in limited cases it can be a misdemeanor. A felony conviction can have serious ramifications in your life. A few consequences include:
- Inability to own a firearm
- Loss of voting rights
- Inability to serve on a jury
- Barred from getting a pilot’s license
- Barred from getting a private radio license
- Ineligible to enlist in the Armed Forces
- Holding a federal office
- Receiving government benefits
- And travel restrictions