Insurance companies will try nearly anything to avoid paying a claim. They may even go so far as to reporting a policyholder or claimant to the California Department of Insurance Special Investigative Unit with the hopes of drumming up criminal charges against this individual. The major categories of criminal insurance fraud are: (1) Automobile Insurance Fraud ; (2) Worker’s Compensation Fraud ; (3) Property, Life & Casualty Fraud ; and (4) Disability & Healthcare Fraud.Sadly, everyday many innocent men and women face false felony charges for insurance fraud in the 58 counties across the State of California.
Criminal Insurance Fraud in California
In the State of California, insurance fraud is covered by Penal Code § 548-551. Insurance fraud laws encompass varying degrees of criminal action and can be punishable as either felonies or misdemeanors. One of the first questions that must be answered in every insurance fraud case is whether or not there is a fraud. In order to answer the question, the definition of fraud must be understood. In general terms and with respect to insurance fraud, fraud occurs when someone knowingly lies to obtain some benefit or advantage to which they are not otherwise entitled, or to deny some benefit that is due and to which someone is entitled, or to obtain an insurance policy at less than the proper rate, cost or premium. Criminal insurance fraud must be distinguished from abuse, i.e., exaggerating a complaint or disability that falls short of an outright lie. Perceived abuse in the insurance context is not a crime, whereas, criminal fraud, if it can be proven by the prosecution is.
In order for the prosecution to prove beyond a reasonable doubt that an individual is guilty of insurance fraud, the prosecution must establish each element of fraud beyond a reasonable doubt. Accordingly, the prosecution must prove the following four elements of fraud:
- There was a false representation;
- The false representation was knowingly made;
- The false representation must be made for the intent of obtaining a benefit that is not due, denying a benefit that is due or obtaining insurance at less than the proper rate, premium or cost; and
- The false representation must be material, i.e., the false representation was important because the parties would have acted differently had it been known that the false representation was incorrect.
If you are being investigated for insurance fraud it is imperative that you contact an experienced criminal defense lawyer like Nafiz M Ahmed right away. Mr. Ahmed can you help you try to avoid costly mistakes in the investigative stages of your case before you ever meet with a detective from the Special Investigative Unit of the California Department of Insurance or other local law enforcement agency and you doing any of the following:
- Alter documents or other evidence
- Conceal or attempt to conceal evidence
- Destroy or attempt to destroy evidence
- Recruit false witnesses
- Offer false evidence, i.e., tell a lie to try to get out of suspected insurance fraud
- Confess to a crime
Don’t try taking on an experienced detective of the California Department of Insurance Fraud Division because you are likely going to lose. These individuals are sworn peace officers and can request warrants, conduct surveillance and interviews, and testify in court against you. Level the playing field with a top flight criminal defense attorney if you think that you are being investigated for potential insurance fraud.
California Insurance Fraud Laws
Amongst the California Penal Code sections that prohibit insurance fraud is section 550. Generally, according to California Penal Code §550, “it is unlawful to do any of the following or to aid, abet, solicit, or conspire with any person to do the following:
- Knowingly present or cause to be presented any false or fraudulent claim for the payment of a loss or injury, including payment of a loss or injury under a contract of insurance.
- Knowingly present multiple claims for the same loss or injury, including presentation of multiple claims to more than one insurer, with an intent to defraud.
- Knowingly cause or participate in a vehicular collision, or any other vehicular accident, for the purpose of presenting any false or fraudulent claim.
- Knowingly present a false or fraudulent claim for the payments of a loss for theft, destruction, damage, or conversion of a motor vehicle, a motor vehicle part, or contents of a motor vehicle.
- Knowingly prepare, make, or subscribe any writing, with the intent to present or use it, or to allow it to be presented, in support of any false or fraudulent claim.
- Knowingly make or cause to be made any false or fraudulent claim for payment of a health care benefit.
- Knowingly submit a claim for a health care benefit that was not used by, or on behalf of, the claimant.
- Knowingly present multiple claims for payment of the same health care benefit with an intent to defraud.
- Knowingly present for payment any undercharges for health care benefits on behalf of a specific claimant unless any known overcharges for health care benefits for that claimant are presented for reconciliation at that same time.
- For purposes of paragraphs (6) to (9), inclusive, a claim or a claim for payment of a health care benefit also means a claim or claim for payment submitted by or on the behalf of a provider of any workers’ compensation health benefits under the Labor Code.
It is also against the law to do or knowingly assist or abet with anyone to do any of the following:
- Present or cause to be presented any written or oral statement as part of, or in support of or opposition to, a claim for payment or other benefit pursuant to an insurance policy, knowing that the statement contains any false or misleading information concerning any material fact.
- Prepare or make any written or oral statement that is intended to be presented to any insurer or any insurance claimant in connection with, or in support of or opposition to, any claim or payment or other benefit pursuant to an insurance policy, knowing that the statement contains any false or misleading information concerning any material fact.
- Conceal, or knowingly fail to disclose the occurrence of, an event that affects any person’s initial or continued right or entitlement to any insurance benefit or payment, or the amount of any benefit or payment to which the person is entitled.
- Prepare or make any written or oral statement, intended to be presented to any insurer or producer for the purpose of obtaining a motor vehicle insurance policy, that the person to be the insured resides or is domiciled in this state when, in fact, that person resides or is domiciled in a state other than this state.”
—from California Penal Code §550
Penalties and Consequences for Insurance Fraud in California
It is estimated that 40% of all auto theft claims and auto-related medical claims are actually fraudulent. As such, insurance adjusters scrutinize every case closely in attempts to catch insurance fraud perpetrators. Unfortunately, innocent men and women can get caught in these webs, and without an experienced San Mateo criminal defense lawyer, they could face serious penalties and consequences if convicted.
The majority of California’s insurance laws are wobblers, which means that you can be charged with either a misdemeanor or a felony, depending on the particulars surrounding your case. If you have a criminal history, or if you have had prior fraud convictions, you could face enhanced penalties and longer sentences. You can also be convicted of insurance fraud if you aided, abetted, or conspired to commit insurance fraud-even if you were not the one who committed the fraud.
If you are convicted of insurance fraud in the State of California, you can face the following penalties and consequences:
- Misdemeanor Insurance Fraud
- Informal or summary probation
- Up to 6 months or 1 year in county jail
- Maximum fine of $10,000 and actual restitution
- Felony Insurance Fraud
- Formal probation
- 16 months to 5 years in California state prison
- Additional 2 year sentence for every prior conviction of insurance fraud Maximum of $50,000 or double the amount of fraud
- Maximum of $50,000 or double the amount of fraud
Examples of Automobile Insurance Fraud in California
There are numerous examples of automobile fraud in the State of California. Some of the most common examples of fraud, include:
- Staging collision rings
- Forcing another driver to rear-end your car
- Filing a fraudulent medical report
- Reporting an accident that never existed
- Claiming that you live in a different city or state to obtain a lower premium
- Reporting your car stolen when it is just hidden or abandoned
- Asking a body shop to inflate the estimate to include old damage to vehicle
- Claiming an injury is worse than it truly is
Worker’s Compensation Insurance Fraud in California
There are four major statutes covering worker’s compensation insurance fraud. The statutes can be broken down into claims-related fraud and premium-related fraud. The statutes prohibiting claims-related fraud are found in California Insurance Code section 1871.4 and California Penal Code section 550. Likewise, the statutes covering premium-related fraud are found in California Insurance Code sections 11760 and 11880.
San Mateo County Insurance Fraud Criminal Defense Lawyers
At Ahmed & Sukaram, our San Mateo criminal defense attorneys stand ready to fight serious allegations of insurance fraud. We know that insurance agents and prosecutors can be myopic in evaluating the merits of potential insurance fraud case. That’s why we complete a thorough investigation that is designed to expose the holes in the prosecution’s case against you. We won’t rest until we have the charges against you reduced or dismissed all together. After all, our San Mateo criminal defense attorneys realize what is truly at stake in insurance fraud cases-your freedom and your future.
If you are charged with insurance fraud in Redwood City, Palo Alto, San Jose, or in any of the surrounding Bay Area cities and counties, contact the dynamic legal team of Ahmed & Sukaram immediately. You are not alone-call Ahmed & Sukaram today at 866-477-0965 or email us through this site in order to set up a no obligation consultation. If you prefer to video chat, please connect with us using Skype at Nafiz.Ahmed59.