Insurance Fraud

An Insurance Fraud Defense Attorney with the Experience You Need

In the state of California, insurance fraud is defined as trying to collect on an insurance policy by using fraudulent means. It can be car insurance, home insurance, or life insurance policy. It can involve providing false information to the insurance company (on a claim or on an application for a policy), faking an accident or an injury to collect money, or committing arson to collect insurance money.

You can count on insurance fraud to be aggressively prosecuted. This is a serious charge that can come with life-long consequences. It is essential that you choose the right insurance fraud defense attorney. That attorney is Simmons Wagner, LLP. Call us now at (949) 439-5857 to request a consultation.

Auto Insurance Fraud

Put simply, auto insurance fraud refers to knowingly making a false statement that involves a vehicle, with the specific intent to get an insurance payment. This can include:

  • False claims to the insurance company about an incident that involves your car, like damage in an accident or theft.
  • Presenting a statement to an insurance carrier that you live in California in order to get California insurance, but you actually live in another state.
  • Damaging or abandoning your vehicle to collect the insurance money.
  • Intentionally taking part in a collision in order to collect insurance money.
  • Submitting several insurance claims for a single incident.

Note that the insurance company does not have to actually suffer financial loss. Simply attempting to commit car insurance fraud is enough to be charged. Though car insurance fraud is a wobbler (meaning it can be charged as a felony or a misdemeanor), you can count on the prosecutor generally charging it a  felony. Potential penalties can include:

  • Jail time
  • Fines
  • Restitution
  • Probation

Legal defense options include proving that you did not have the intent to defraud the insurance company, or there is a lack of overwhelming evidence that you committed the crime in question.

Workers’ Compensation Fraud

Workers’ compensation pays an injured or disabled employee if their injury occurred at work. This type of insurance fraud can involve receiving (or attempting to receive) payment when you are not entitled to receive it. Common examples include:

  • Submitting claims for injury treatment that you did not receive
  • Submitting more than one claim for a single injury
  • Making statements you know are false with the purpose of receiving worker’s compensation benefits
  • Encouraging others to make false statements about your claim
  • Exaggerating the seriousness of your injury
  • Claiming an injury was work-related when it was not

Like auto insurance, this is a wobbler offense. A misdemeanor conviction can lead to:

  • One year in jail
  • Fines of up to $150,000 or twice the amount of the fraud
  • Restitution

The best defense will depend on numerous factors but you can contact Simmons Wagner, LLP for a consultation to determine your best defense options.

Health Insurance Fraud

While healthcare fraud generally involves private insurance companies, it can also include Medicare and/or Medicaid, at which point the government is the victim. Healthcare fraud involves making false statements or taking part in deceptive acts with the intent of receiving money either from a health insurance company or a government agency. Examples include:

  • Billing an insurance company for services that were not performed
  • Submitting more than one claim for one incident
  • Overcharging for services that were performed

Health insurance fraud is almost always charged as a felony and penalties can include:

  • Five years in state prison
  • Fines of up to $50,000 or twice the amount of the fraud (whichever is more)

Two of the Most Common Defenses to Insurance Fraud

While we will work to find the right defense for your specific case, generally a defense against insurance fraud charges will involving showing one or both of the following:

  • You did not know. One element that the prosecutor must prove is that you knew what you were claiming was false. If we can create doubt that you knew you were providing inaccurate or fraudulent information, then you could avoid a conviction.
  • You did not mean to. Likewise, the prosecutor must prove that you intentionally submitted inaccurate or false information. It might be that you made an honest mistake, in which case you are not guilty of insurance fraud.

To learn more about how we can help you fight these and other insurance fraud cases, contact Simmons Wagner, LLP at (949) 439-5857 to request a consultation.