What to Do When Accused of Insurance Fraud

An accusation of insurance fraud can present significant legal challenges, making it essential to understand the steps you need to take. Whether the allegations involve health, auto, life, property, or workers’ compensation insurance, the situation can be complex and potentially have severe consequences.

By familiarizing yourself with the relevant information and securing appropriate legal support, you will be better equipped to navigate these challenges and work towards a favorable outcome.

Common types of insurance fraud

Insurance fraud is a widespread issue that takes many forms. Allegations of fraudulent schemes vary, from individual policyholders to healthcare providers, repair shops to insurance brokers. Some of the most common types of allegations of insurance fraud include:

Health insurance fraud: Submitting false claims, billing for nonexistent services, receiving kickbacks, or forging prescriptions
Auto insurance fraud: Making false injury claims, staging accidents, and rolling back odometers to increase resale value
Life insurance fraud: Filing false information, forging death certificates, faking deaths, or committing murder to claim life insurance
Property insurance fraud: Exaggerating storm damage, reporting nonexistent losses, staging thefts, and committing arson
Workers’ compensation fraud: Claiming benefits while employed, exaggerating injuries, or creating false records.

Given the serious nature of these offenses, it is crucial to understand how to respond if you are accused of insurance fraud.

How are false insurance claims handled?

Several elements must be met to establish cases of insurance fraud:

To establish a case of insurance fraud, it must be proven that the claimant knowingly made false claims with the intent to deceive the insurance company for personal gain. This requires a high level of proof, including evidence of planning or premeditation, and often involves greater penalties.
There must also be evidence that the deliberate deception was meant to defraud the insurance company to receive unentitled benefits.
It must be shown that the insurance company relied on the misinformation to pay out claims, resulting in financial loss.

It’s important to note that both the attempt and the act of obtaining benefits under false pretenses are criminal charges. Specific intent requires a high level of proof and planning or premeditation.

What to do if you are accused of insurance fraud

If you have been accused of insurance fraud, your next steps are crucial. How you respond can dramatically affect the outcome of your case. Here is a clear and strategic approach to safeguarding your legal rights.

Stay silent and secure an attorney immediately

The moment you learn about the accusation, resist the urge to respond without legal counsel present. Even offhand remarks can be taken out of context and used against you.

Your priority should be contacting a criminal defense attorney who has experience with insurance fraud cases to protect your rights and help you build a solid defense from the start.

Gather and organize all relevant documents

Collect all documentation related to your insurance policy, any claims you have made, and all correspondence with the insurance company.

This should include the original policy, claim forms, emails, letters, and supporting materials like photos, receipts, or medical records. Store these documents securely. Importantly, do not modify or destroy any records—doing so could be interpreted as an attempt to obstruct justice, which would severely damage your case and carry its own potential criminal charges.

Keep your case confidential and avoid witness contact

Keep all details of your case private. While well-intentioned, conversations with friends, family, or coworkers are not protected by attorney-client privilege and could be used against you.

Also, avoid contacting potential witnesses, even if you believe they might support your version of events. Reaching out to witnesses could be viewed as an attempt to influence their testimony, which is a serious offense.

Leave all communication regarding the case to your legal team.

Work closely with your attorney to understand the charges

Partner with your attorney to meticulously review the specific allegations against you. They will carefully review the evidence the insurance company or prosecutors have gathered, such as discrepancies in your claim or unusual financial transactions.

This analysis is essential. Understanding the charges will enable your attorney to craft a defense strategy tailored to your situation.

However, your attorney depends on your cooperation and transparency. Whether the defense involves challenging the accusation of intentional fraud or demonstrating that any mistakes were unintentional, your cooperation and transparency are essential.

Insurance fraud cases can be complex. The stakes are high. Not only could a conviction lead to severe penalties, including hefty fines, restitution, imprisonment, and a criminal record that follows you for life, but it could hinder your ability to obtain insurance or negatively impact your professional life.

Potential consequence of insurance fraud

In New Jersey, depending on the specifics of the situation, insurance fraud can be charged as a third-degree crime, punishable by up to 5 years in prison and fines of up to $15,000, or a second-degree crime, if five or more acts of fraud are committed, carrying up to 10 years in prison.

Other consequences may include:

Civil penalties (including triple damages)
Damage to your reputation
Loss of insurance coverage or higher premiums
Loss of professional licensure

Consult with a New Jersey fraud attorney

At Dughi, Hewit, & Domalewski, our criminal defense attorneys will represent you in every correspondence, negotiating to resolve your situation out of court. Should your case go to trial, we will guide you through the complexities of the process so you can make informed decisions that preserve your rights.

Contact Us Today!