California Insurance Fraud Lawyer

Should You Hire An Insurance Fraud Attorney?

Insurance fraud has increased in California over the last few years. There are many kinds of insurance fraud, including auto insurance fraud, fire insurance fraud, property insurance fraud, and homeowners' insurance fraud. If you have been arrested for an insurance fraud case or are under investigation for an insurance fraud case, you will want the help of a California criminal defense attorney. The team of knowledgeable California financial crime lawyers at My Rights Law is here for you. Contact us completing our secure web or call 888-702-8882 for a free case consultation.

Reports Of Insurance Fraud

When a person files a claim for insurance benefits, the insurance company will investigate the claim. If an insurance company thinks the claim was fraudulent, it will report it to law enforcement as attempted fraud. This report could lead to criminal penalties under the California Insurance Code. Any claim can result in criminal charges if the insurance company thinks it was made fraudulently. My Rights Law has a proven history of defending people cited for insurance fraud. If you've been charged with insurance fraud, contact us today to go over the details and discuss your legal options.

Definition Of Insurance Fraud

Insurance fraud under California law is any action that seeks to receive compensation from an insurance company on untrue grounds. For instance, filing a workers' compensation claim while not being injured could be committing insurance fraud. Likewise, a claim that exaggerates injuries from a car crash can also be deemed insurance fraud.

For insurance fraud to occur in California, two elements are necessary:

1. An individual must have the intent to defraud the insurance company and do it knowingly;
2. A person must act on that intent by filing a fraudulent claim.

Both aspects must be present and established for a defendant to be convicted of insurance fraud. No actual loss must happen – so a claim can be rejected or under investigation when insurance fraud charges are filed against a person.

California Insurance Code Section 1871 defines insurance fraud as providing untrue info to their insurance company or to another individual's insurance company, resulting in money or services being provided to which they are not authorized.

Instances of insurance fraud could include:

• Claiming that property was damaged in an accident when it wasn't damaged
• Faking an accident to receive money
• Overstating the damage to property
• Wrongly stating that a car was stolen to collect money
• Burning property to obtain insurance money
• Lying about a personal physical injury to get cash
• Car crashes
• Car property
• Medical insurance fraud
• Life insurance fraud
• Workers’ compensation insurance fraud
• Fire insurance fraud
• Property insurance fraud
• Healthcare insurance fraud

More insurance fraud areas are covered as follows:

• California Insurance Code Section 1872.8 defines auto insurance fraud
• Motor Vehicle Theft and Motor Vehicle Insurance Fraud Reporting 1874.2(a)
• California Penal Code section 550(a)(5) covers knowingly preparing or making a writing intended to support a false insurance claim. Health care benefit fraud is addressed more specifically in section 550(a)(6)–(9).

Insurance fraud can be filed as a felony or a misdemeanor. Elements that law enforcement uses to resolve the level of crime to charge may include the extent of the false info and the amount of the economic loss.

California Penal Code Sections 548 – 551 – Auto Insurance Fraud

Car insurance fraud under California Penal Code Section 548 means you knowingly made an untrue statement involving an auto with the specific intent to get an insurance payment. Under California law, you commit automobile insurance fraud when you:

• Make an erroneous claim to an insurance company about an incident involving your cars, such as damage sustained in an accident or theft.[1]
• Intentionally damage or abandon your car to collect insurance funds.[2]
• Submit numerous insurance claims for the same accident
• Knowingly participate or start a car collision to collect insurance funds.
• Submit a written or oral statement to an insurance carrier to get auto insurance that you reside in California, but you reside in another state.

There are many standard ways people commit car insurance fraud. For example, someone abandons their care and then tells the insurance company it was stolen. Another example is when someone wrongly informs their insurance company they were involved in a crash, but there was no collision. Another instance involves cases where someone was involved in a crash that only caused minor damage, but they claim major damage and spent much more money on repairs. Finally, one more example is when someone intentionally slams on their breaks to cause an accident to receive an insurance payment.

California laws deal primarily with presenting false car insurance claims with a specific intent to defraud an insurance company. It's essential to mention that it's not legally required that the targeted insurance company suffer financial loss. Just the attempt is enough to face charges. The legal punishments for a conviction of car insurance fraud include jail time, weighty fines, restitution, and probation. The prosecutor will file an auto insurance fraud case as a felony offense in most cases. Legal defenses generally include you had no intent to defraud the insurance company, or there is not enough evidence to convict you. If you face allegations of car insurance fraud, call a criminal defense lawyer at our law firm to go over your case.

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California Penal Code Section 550 – Health Care Benefit Fraud

California Penal Code section 550(a)(5) is not the definition of health care fraud. It covers knowingly preparing or making a writing intended to support a false insurance claim. Health care benefit conduct is addressed more specifically in section 550(a)(6)–(9). Those provisions apply when a person knowingly makes a false or fraudulent claim for payment of a health care benefit, submits a claim for a benefit that was not used by or for the claimant, presents duplicate claims for the same benefit with intent to defraud, or presents undercharges without simultaneously reconciling known overcharges for the same claimant. Section 550(a)(10) also treats qualifying workers’ compensation health-benefit claims as health care benefit claims for these provisions.

• Section 550(a)(6): knowingly making or causing a false or fraudulent claim for payment of a health care benefit.
• Section 550(a)(7): knowingly claiming a health care benefit that was not used by or on behalf of the claimant.
• Section 550(a)(8): knowingly presenting multiple claims for the same health care benefit with intent to defraud.
• Section 550(a)(9): presenting undercharges for a claimant without presenting known overcharges for that claimant for reconciliation at the same time.

The investigating agency and charging law can depend on who allegedly paid the claim. A false claim to a private insurer may be prosecuted under California insurance-fraud law. Medi-Cal is California’s Medicaid program, and suspected Medi-Cal provider fraud may involve the California Department of Justice’s Division of Medi-Cal Fraud and Elder Abuse, the California Department of Health Care Services, and applicable state or federal laws. Medicare is a federal program; suspected Medicare fraud can involve federal investigators and prosecutors, including HHS-OIG and the U.S. Department of Justice. A single investigation can involve more than one agency or statute.

Under Penal Code section 550(c)(2), violations of section 550(a)(6)–(9) are public offenses. When the claim or amount at issue exceeds $950, the statute permits felony punishment of two, three, or five years, or misdemeanor punishment of up to one year in county jail, with the fines described in section 550(c)(2)(A). When the claim or amount at issue is $950 or less, section 550(c)(2)(B) provides up to six months in county jail and/or a fine of up to $1,000. Claims may be aggregated over a 12-consecutive-month period; if the aggregate exceeds $950, they may be charged under the higher-amount provision. The $950 figure is therefore a charging and punishment threshold for these health care benefit offenses, not a definition of whether conduct is fraudulent.

Possible defenses depend on the evidence and may include lack of knowledge or intent to defraud, a legitimate service or benefit, an innocent billing or coding error, unreliable records, mistaken identity, or failure to prove a false claim. Our criminal defense attorneys can review the billing records, medical records, communications, and agency evidence before advising on a defense strategy.

California Penal Code Sections 549 – 550 – Workers' Compensation Fraud

Workers' compensation fraud is outlined in California Insurance Code 1871.4 and Penal Code Sections 549-550. Workers' compensation is a kind of insurance that pays a worker for an injury or a disability that occurred at work. This means workers' compensation fraud can be perpetrated when you receive payment or attempt to receive payment for which you were not entitled. The most common examples of workers' compensation are committed when you:

• Knowingly make untrue statements with the goal of receiving workers' compensation benefits[3]
• Prompt others to make untrue statements about a worker's compensation claim
• File a claim for treatment of an injury when you were not treated[4]
• Submit numerous claims for the same harm
• Claim you were hurt at work, but the injury was not work-related
• Lie about the extent of your actual injury

Workers' compensation fraud is a "wobbler," meaning you could be charged with a misdemeanor or felony crime based on your charges and criminal history circumstances.[5] If convicted for a misdemeanor violation of workers' compensation fraud, the punishments include up to one year in jail, a fine of up to $150,000, or two times the amount of fraud, and restitution.[6]

Typical Legal Defenses For Insurance Fraud

Our experienced insurance fraud defense attorneys can use many different legal defenses to help you dodge a conviction. The most common defenses include the following:

• Lack of Knowledge:For the state to get a conviction for insurance fraud, they must be able to establish you knew what you were claiming was not true. If our lawyers can cast some reasonable doubt that you didn't realize your claims were false, you can likely sidestep a conviction. For instance, if you claimed on insurance paperwork because another person told you the claim was true, we could argue you did not knowingly make a false claim.
• Lack of Intent:Likewise, the prosecutor has to prove you intentionally submitted a false claim to be found guilty of insurance fraud. In some cases, our attorneys might be able to argue it was an accident or an honest mistake. In most fraud-related cases, intent is the absolute key element of the crime. If we can doubt your actual intent, you stand a good chance of avoiding a conviction.

Experienced California Insurance Fraud Lawyer

Insurance fraud is a grave charge

, and you may wish to have an experienced defense to guard yourself if you've been accused. A conviction could mean serious time behind bars, thousands of dollars in fines, and a damaged reputation. Our firm, My Rights Law has the knowledge you need to get a reduced sentence or walk away free of any charges. Contact us by calling 888-702-8882 or leave a message on our secure web form today for free case consultation.

Other financial crimes we defend include: Money Laundering, Mortgage Fraud

FOOTNOTES
[1] California Penal Code 548 PC
[2] Judicial Council of California Criminal Jury Instruction (“CALCRIM”) 2004 – [Auto] Insurance Fraud
[3] Insurance Code 1871.4
[4] Penal Code 550
[5] Penal Code 549
[6] Penal Code 549