Experts estimate that insurance fraud costs the industry about $30 billion annually. With losses like these, insurance companies are relentless in finding and prosecuting those who submit claims for losses that never actually happened, inflate real claims, falsely report facts about an actual loss, intentionally damage property and stage car accidents.
Insurers have aggressive special investigative units that act as high-powered anti-fraud teams. The companies also work closely with state and local police, government investigators, private investigators and federal law enforcement, including the FBI, to identify and arrest people involved in insurance fraud.
Additionally, insurers use sophisticated data analysis to single out any claims that don’t fit established patterns and might be suspicious. Many of them use a list of suspicious loss indicators developed by the National Insurance Crime Bureau to red-flag those who might be submitting false claims. The result of this proactive vigilance by insurers is that you are more likely than ever to be questioned or arrested for insurance fraud. It’s critical that you have an experienced attorney who is very knowledgeable about insurance fraud law to represent you.
What is Insurance Fraud in the State of Pennsylvania?
- Knowingly and with intent to defraud a government agency, present or file documents that contain false, incomplete or misleading information concerning the agency’s determination to approve or disprove a motor vehicle insurance action.
- Knowingly and with intent to defraud any insurer or self-insured, present an insurer with statements that have false or misleading information concerning any facts material to the claim.
- Knowingly and with intent to defraud any insurer or self-insured, assist, abet, solicit or conspire with another person to prepare or make any statements that have false or misleading information concerning any facts material to the claim, including information that documents or supports an amount claimed in excess of the actual loss sustained by the claimant.
- Knowingly engage in unlicensed agent, broker or unauthorized insurer activity with the intent to defraud an insurer, a self-insured or the public.
- Knowingly benefit, directly or indirectly, from the proceeds derived from the activities described above due to the assistance, conspiracy or urging of another person.
- Be the owner, administrator or employee of any health care facility and knowingly allow the use of that facility by any person to further the activities described above.
- Knowingly borrow or use another person’s financial responsibility or other insurance identification card, or permit someone’s financial responsibility or other insurance identification card to be used by another, with intent to present a fraudulent claim to an insurer.
- Directly or indirectly hire someone to engage, employ or retain either themselves or someone else to manage, adjust or prosecute any claim or cause of action against anyone for damages for negligence or, for financial gain for himself or another, directly or indirectly solicit other persons to bring causes of action to recover damages for personal injuries or death.
Insurance Fraud Penalties
Depending on the circumstances of your case, you can be charged with a felony of the third degree punished by up to seven years in prison, or a misdemeanor of the first degree punished by up to five years in prison. You may also be ordered to pay restitution.
An insurer can also sue you in a civil court to recover compensatory damages, which may include reasonable investigation expenses, costs of the suit and attorney fees. The insurer can recover triple damages if the court determines that you have engaged in a pattern of insurance fraud.
Charged? Contact a Pittsburgh Insurance Fraud Lawyer Today – Free Consults!
For crimes like insurance fraud, typically you are not just issued an arrest on the spot. Instead, it’s usually a charge where the local, state, and/or federal government is looking into your activities and financial transactions. They may stop by and ask you questions, or they might start interviewing your friends, family, and coworkers. If this is the case, you’re likely getting nervous. You could be charged under both state and federal law depending on the circumstances, which could mean life-changing consequences if you’re convicted – losing your rights, tarnishing your reputation, putting your family at risk for financial duress, and more. If this is the case and you have not yet been charged, please contact me. You need an experienced defense attorney who has handled cases at all levels and understands what is truly at stake. This is not the time to go it alone or cut corners.
If you have already been charged, you have no time to waste. Make sure you hire an attorney immediately.