Insurance fraud can take many forms, depending on the type of insurance involved and who is responsible for committing the act of fraud. Most commonly, it is the act of a policy holder providing false information to an insurer for the purpose of securing an undue claim.
The crime of insurance fraud can be charged as either a misdemeanor or felony, depending on the amount of money allegedly defrauded, the circumstances of the case, and the criminal record of the defendant. District attorneys and various state and federal agencies have specialized task forces devoted specifically to prosecuting insurance fraud cases, and thus, it is imperative that the defendant obtain a top insurance fraud defense lawyer when facing these serious charges.
Auto Insurance Fraud
Fraud and fraud allegations are particularly prevalent with regard to auto insurance. This is partly a product of the mandatory status of auto insurance for those who wish to legally drive a vehicle, for this makes it a very common type of insurance. Another factor is that the huge volume of auto insurance claims for genuine accidents makes it difficult for insurers to sift through the mountain of claims and then thoroughly investigate each one they find suspicious.
Three of the most common forms of auto insurance fraud are:
- Staging an accident, normally with the help of a friend
- Inflating a price claim far beyond its true value
- Destroying one's own vehicle and then reporting it as stolen
- Arranging for a friend to "steal" one's car, and then filing a claim on its disappearance
Other Types of Insurance Frau
In difficult economic situations, such as heavy debt or a failing business, many are tempted to file false claims to collect on an insurance policy. Business, home, health care, auto, and unemployment insurance are among the many types of insurance affected. Each insurance type will see different fraud schemes that correspond to the nature of the insurance policy. Some examples are as follows:
- Setting fire to your own business property when the business is bankrupt
- Setting fire to your home to collect on your home insurance policy
- Filing false work-search information with your unemployment insurance or collecting benefits in multiple states simultaneously
- An employer giving false information on the reason for firing a former employee or on how much he paid that employee to avoid making contributions to unemployment insurance funds
- Health care companies charging for non-existent services, over-billing, or getting kickbacks for agreeing to prescribe certain drugs
- Filing false information with workers comp insurers or with welfare agencies in order to receive unlawful benefits
Conspiracy to Commit Insurance Fraud
While it is possible for a fraud to be attempted alone, in many cases, there are multiple co-conspirators involved. "Conspiracy" occurs whenever two or more people agree in advance to a plan designed to defraud funds from an insurer and then take action to carry that plan out.
Prosecutors may bring circumstantial evidence to attempt to convict you as a co-conspirator. We at Jeff Voll can counter each element of the case brought against you and find other evidences that work in your favor. Skilled prosecutors will work zealously to convict you, so it is crucial to have experienced defense attorneys working in your behalf.
Bad Faith Insurance Fraud
To act in "bad faith" is essentially to act deceptively and with intention to defraud and avoid complying with the law. Bad faith is notoriously difficult to define legally in a precise way, but some of its telltale signs are rather obvious:
- A failure to weigh the merits of a claim in a reasonable amount of time. Foot dragging may well amount to ignoring the claim.
- Denying a claim without a reasonable basis for doing so.
- Failing to make a full investigation of a claim and take all the relevant facts into account.
- Offering an extremely low settlement and then using intimidation tactics to force a policy holder to agree to it.
Insurers have an obligation to act in good faith with their clients, and heavy fines, significant jail terms, a damaged reputation, and a ruined career can all result from a bad faith insurance fraud conviction.
While policy holders sometimes file false claims, insurance companies themselves sometimes fail to deal fairly and honestly with their clients and uphold the terms of their own policies. An insurance policy is a contractual agreement that obligates insurers to defend you against claims, indemnify you against successful claims, and to make a reasonable settlement with you for your own losses.
If you believe an insurer has failed in these duties, broken their contract, and acted in bad faith toward you, you can file a civil action against them for a "tort" (a civil wrong). Punitive damages will be added to the insurance claim itself, if the tort is successful, resulting in an even larger sum paid out.
The "Red Flag System"
Due to the high frequency of insurance fraud, insurers cannot hope to investigate every single claim that they may have their suspicions about. At the same time, they are legally obligated to process claims in a timely manner. Therefore, insurance companies use computer-based algorithms to "red flag" the claims they consider most likely to be fraudulent. They then proceed to vigorously investigate and prosecute these flagged claims.
While the practical reasons for the "red flag system" are understandable, the fact is that this system leads to many innocent persons being prosecuted for insurance fraud. A computer cannot truly determine your guilt or innocence by processing an algorithm. We at the Law Offices of Jeff Voll know how to refute false allegations of fraud created by insurer's red-flagging procedures.
Skilled Insurance Fraud Defense
At Jeff Voll, we have a formidable team of experts who successfully defeat allegations of insurance fraud day in and day out. Our fraud specialist knows how to counter the arguments of prosecutors because he used to be a prosecutor in a state anti-fraud agency. We also have top investigators and researchers who can contribute to winning your case. Using an experienced insurance fraud defense attorney could mean the difference between a quick dismissal and a long prison sentence. Contact us today at 323-467-6400, and we can build a defense strategy that will result in the best possible outcome for your case.