Providing the Best California Insurance Fraud Attorney Representation
In the sections below, we will break down the intricacies of insurance fraud, including the various types, the laws that govern it, and what you need to know if you’re facing charges. For a free consultation with a California honest services fraud defense Lawyer, call (619) 794-0451.
Common Types of Insurance Fraud in California
California insurance fraud charges can result from a number of different scenarios. Here are some of the most common types:- Medical/healthcare insurance billing fraud;
- Auto accident and property damage claim fraud;
- Workers’ compensation fraud;
- Arson for insurance proceeds;
- Fraudulent insurance applications;
- False insurance claims.
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Some of the most common types of insurance fraud include:
- Auto Insurance Fraud: Often includes staging accidents, falsifying damage claims, or reporting a vehicle as stolen when it wasn’t;
- Health Insurance Fraud: Often includes billing for services not rendered, upcoding to more expensive procedures, or using someone else’s insurance information;
- Property Insurance Fraud: Often includes arson for profit, inflating the value of stolen items, or falsely claiming damage from natural disasters;
- Workers’ Compensation Fraud: Often includes knowingly making false statements to collect workers’ compensation benefits or submitting a claim for healthcare treatment when the purported injury was never treated by a medical professional;
- Life Insurance Fraud: Often includes faking one’s death to collect benefits or taking out policies on non-existent people.
California Penal Code § 548(a)
This law applies to willfully damaging or destroying insured property with the intent to defraud.
The law states that, “Every person who willfully injures, destroys, secretes, abandons, or disposes of any property which at the time is insured against loss or damage by theft, or embezzlement, or any casualty with intent to defraud or prejudice the insurer, whether the property is the property or in the possession of that person or any other person, is punishable by imprisonment pursuant to subdivision (h) of Section 1170 for two, three, or five years and by a fine not exceeding fifty thousand dollars ($50,000).” That is, anyone found guilty under California § 548(a) may face a two, three, or five year prison sentence in addition to a $50,000 fine. Additionally, under California § 548(a) states that, “… anyone who has a prior conviction… shall receive a two-year [sentencing] enhancement for each prior conviction.”
California Penal Code § 549
This law addresses the solicitation or referral of business with intent to defraud an insurer.The law states that, “Any firm, corporation, partnership, or association, or any person acting in his or her individual capacity, or in his or her capacity as a public or private employee, who solicits, accepts, or refers any business to or from any individual or entity with the knowledge that, or with reckless disregard for whether, the individual or entity for or from whom the solicitation or referral is made, or the individual or entity who is solicited or referred, intends to violate Section 550 of this code or Section 1871.4 of the Insurance Code is guilty of a crime, punishable upon a first conviction by imprisonment in the county jail for not more than one year or by imprisonment pursuant to subdivision (h) of Section 1170 for 16 months, two years, or three years, or by a fine not exceeding fifty thousand dollars ($50,000) or double the amount of the fraud, whichever is greater, or by both that imprisonment and fine.”
That means that anyone found guilty under California § 549 may face a jail sentence of up to one year or a prison sentence of 16 months, two years, or three years. A fine of up to $50,000 or double the amount of the fraud may also be imposed.
California Penal Code § 550
This comprehensive law covers various fraudulent acts, including making false claims, multiple claims for the same loss, and knowingly causing auto accidents for insurance money. California § 550 is considered a “wobbler” law, meaning it can be charged as either a felony or misdemeanor.Anyone found guilty under California § 550 may face a prison sentence of up to five years as well as substantial fines which are dependent upon the amount of the fraud.
Differences Between State and Federal Insurance Fraud Prosecutions
Although many insurance fraud cases are handled at the state level, it’s a mistake to assume that federal prosecutors won’t get involved in your case. Federal cases typically involve larger-scale fraud or crimes that cross state lines. They often come with additional charges and can lead to more severe penalties.
Federal prosecutors have substantially more resources at their disposal when compared to state prosecutors, and penalties can be much higher depending on the amount of loss attributed to the crime.
In federal court, examples of the aforementioned additional charges that may be applied to your case include conspiracy or illegal financial gain. Even without additional charges, however, federal convictions often result in longer prison sentences and larger fines compared to state-level convictions for similar crimes.
McKenzie Scott’s insurance fraud lawyers are experienced in successfully defending cases in California State and federal courts.
How Insurance Fraud Cases are Prosecuted
Prosecuting insurance fraud cases typically involves several key elements:- Proving Intent: For an act to be considered fraudulent, the prosecution must prove specific intent to defraud. This means they need to demonstrate that the accused knowingly committed the act with the purpose of defrauding the insurance company. It’s worth noting that this can be challenging, as intent is not always clear-cut.
- Using Financial Transactions as Evidence: Financial records often play an important role in these cases. Once a transaction has taken place, it can be used as evidence by prosecutors to imply intent if the defendant received a financial benefit.
- Using Forensic Accounting in Investigations: Both state and federal prosecutors employ financial specialists who analyze bank records, credit card statements, and other financial documents in an effort to prove potential fraud.
If you’re facing insurance fraud charges, understanding your options for a successful defense is critical.
An experienced insurance fraud defense attorney can have a significant impact in the outcome of your case. Securing legal representation from attorneys who understand the nuances of insurance fraud law and can build a strong defense strategy is essential.
Some common insurance fraud defense strategies include:
- Lack of intent: To commit insurance fraud, you must have intended to submit/communicate a false claim;
- Lack of knowledge: To commit insurance fraud, you generally must have known that your actions were false;
- Entrapment: If the criminal intent originated with law enforcement, and you would have otherwise not committed the fraudulent act, an entrapment defense may be warranted;
- Mistaken identity: Often used as a defense when an application or other type of paperwork is filled out by another individual, mistaken identity can be claimed whenever someone else could have committed the insurance fraud;
Possible Outcomes: Dismissal, Acquittal, or Reduced Charges
Depending on the strength of the evidence and skill level of your defense attorneys, successful outcomes can range from complete dismissal of charges to reduced penalties. Securing a successful outcome in an insurance fraud case requires a strategic and aggressive defense. This may include filing motions to dismiss.
Motions to dismiss your insurance fraud case can have a number of bases:
- Failure to present evidence on a necessary element of the crime;
- Failure by the prosecution to bring charges within the statute of limitations;
- Failure to show probable cause during the preliminary hearing.
Additionally, McKenzie Scott’s San Diego insurance fraud defense attorneys commonly file motions to dismiss an improper charge, to suppress illegal evidence, or to prevent prosecution testimony on behalf of clients in these types of cases.
If your case goes to trial, our elite attorneys will present evidence, call key witnesses, and provide the best possible legal defense to fight all charges.
Insurance fraud is a complex area of law with severe penalties. If you’re facing charges or are under investigation, it’s imperative to secure legal representation immediately. Remember, anything you say can be used against you, so exercise your right to remain silent and consult with a McKenzie Scott insurance fraud attorney before speaking to investigators.
Frequently Asked Questions About California Insurance Fraud
Call McKenzie Scott, Insurance Fraud Attorney : (619) 794-0451.
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