What is Insurance Fraud?
Fraud is
obtain financial or
defrauded, it refers to the activity as “insurance fraud.” People use the term
“insurance fraud” when describing defrauding a person or company related to
insurance. However, if criminal charges are brought, then sometimes the charge
may or may not be listed as Insurance Fraud. In federal court, the charges may be a
conspiracy to commit fraud, or another type of fraud charge.
The fraud is usually alleged to be false claims to insurance companies to obtain payments that are not legitimate. Or the fraud alleged could be a false increase in the
Federal Prosecutions
Prosecutions in federal court for insurance fraud are usually prosecuted as
Conspiracy to Commit Fraud, Mail Fraud, or Wire Fraud. False claims for health
insurance can be prosecuted as Health Care Fraud or Conspiracy to Commit Health
Care Fraud.
Note that federal criminal laws contain prosecutions for false statements to
State Prosecutions
Prosecutions for insurance fraud are common in state court when they involve
claims for homeowner’s insurance or car insurance. This is especially true if the
insurance claim dollar amounts are less then $100,000.00.
In Texas, Insurance Fraud is a specific felony charge with a scale of dollar
amount categories. Here is the Texas charge for Insurance Fraud (in relevant part)
from the Texas Penal Code:
“Title 7, Chapter 35, Sec. 35.02. INSURANCE FRAUD.
(a) A person commits an offense if, with intent to defraud or deceive an insurer, the person, in support of a claim for payment under an insurance policy:
(1) prepares or causes to be prepared a statement that:
(A) the person knows contains false or misleading material information; and
(B) is presented to an insurer; or
(2) presents or causes to be presented to an insurer a statement that the person knows contains false or misleading material information.
(a-1) A person commits an offense if the person, with intent to defraud or deceive an insurer and in support of an application for
an insurance policy:
(1) prepares or causes to be prepared a statement that:
(A) the person knows contains false or misleading material information; and
(B) is presented to an insurer; or
(2) presents or causes to be presented to an insurer a statement that the person knows contains false or misleading material information.
(b) A person commits an offense if, with intent to defraud or deceive an insurer, the person solicits, offers,
(c) An offense under Subsection (a) or (b) is:
(1) a Class C misdemeanor if the value of the claim is less than $100;
(2) a Class B misdemeanor if the value of the claim is $100 or more but less than $750;
(3) a Class A misdemeanor if the value of the claim is $750 or more but less than $2,500;
(4) a state jail felony if the value of the claim is $2,500 or more but less than $30,000;
(5) a felony of the third degree if the value of the claim is $30,000 or more but less than $150,000;
(6) a felony of the second degree if the value of the claim is $150,000 or more but less than $300,000; or
(7) a felony of the first degree if:
(A) the value of the claim is $300,000 or more; or
(B) an act committed in connection with the commission of the offense places a person at risk of death or serious bodily injury.”
Claims
Allegations for fraudulent insurance claims are often those made that increase the damage amount beyond the real damages. Sometimes claims are created when no damage occurred. Fraud can also be based upon false statements to an insurance company when these are additional information to the claim.