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Insurance Fraud in California

There are many different types of insurance fraud. Insurance fraud involves any type of fraudulent activity involving insurance companies, claims, or coverage. This could involve fraud involving a person's own insurance company, another individual's insurance company, or fraud within the insurance company. Insurance fraud can involve a single individual or it could involve a complex scheme involving multiple parties across the country.

Types of Insurance Fraud in California

Any type of insurance is subject to potential fraud. The most common types of insurance fraud in California include:

  • Auto Insurance Fraud
  • Health Care Fraud
  • Life Insurance Fraud
  • Unemployment Fraud
  • Home Insurance Fraud
  • Workers' Compensation Fraud
  • Renter's Insurance Fraud

Insurance Fraud Investigations

It is not only police and law enforcement who go after people for insurance fraud. The insurance companies can be very aggressive in investigating, identifying, and reporting possible fraud to law enforcement. There are a number of red flags which alert insurance adjusters and investigators to potential fraud.

Events or indicators of suspicious insurance activity may include:

  • Obtaining insurance coverage shortly before filing a claim
  • Policyholder asks hypothetical questions about a similar type event before the damage occurs
  • Claimant filing a claim is in financial stress with high debt
  • Increasing insurance coverage shortly before reporting damage or theft
  • Claimant has a history or similar losses or claims
  • Fire damage with the presence of combustible materials and multiple starting points
  • Work injury shortly after disciplinary action or workplace argument
  • Inconsistent stories and no witnesses to an accident
  • Claimant pushes for a quick settlement and is willing to accept a smaller settlement than wait for a full claim

Insurance Fraud Criminal Penalties

The penalties for insurance fraud depend on the type of insurance fraud, the value of fraud involved, whether anyone was injured in the fraud, and the defendant's criminal history.

Health Insurance Fraud

Fraud involving healthcare or health insurance can be charged as a misdemeanor or a felony in California. If health insurance fraud is charged as a felony, the penalties could include imprisonment for 2, 3, or 5 years and a fine of up to $50,000 (or double the amount of fraud).

Auto Insurance Fraud

Some of the most common auto insurance fraud involves filing false claims. It is unlawful to present a false or fraudulent claim for payment of a loss or injury under an insurance contract; present multiple insurance claims for the same loss or injury; or participate in a car accident for the purpose of filing a false claim. The penalties for this type of fraud includes up to 5 years in prison, and a fine of up to $50,000, or double the amount of the fraud, whichever is greater.

Auto insurance fraud involving intentionally damaging an insured vehicle is punishable by imprisonment of up to 5 years and a fine of up to $50,000. A second or subsequent conviction carries a two-year enhancement.

If a company or individual does business with someone who intends to participate in insurance fraud, they may be punished by up to three years in prison and a fine of up to $50,000, or double the amount of the fraud, whichever is greater.

Workers' Comp Fraud

Workers' compensation fraud generally involves making false statements or claims in order to obtain workers' compensation for an injury. A conviction for workers' comp fraud can result in up to 5 years in jail and fines of up to $150,000, or double the fraud, whichever is greater.

Unemployment Insurance Fraud

Unemployment insurance fraud involves making false statements or claims to the California EDD. The penalties for a conviction for unemployment insurance fraud can result in up to 3 years in prison and a fine of up to $20,000.

Insurance Fraud Defenses

Many people are falsely accused of insurance fraud when they've done nothing wrong. To make matters worse, many of these people are trying to file legitimate insurance claims or recover from accidents when they are accused of fraud and facing criminal charges. Innocent people even plead guilty to avoid a prison sentence just to avoid the threat of going to jail. Before you plead guilty to any insurance fraud, talk to your experienced East Bay attorney about your case.

There are a number of possible defenses available to insurance fraud charges. Fraud generally requires an intent to defraud. Filling out insurance forms and claims can be confusing or complicated. It is easy to make an error or mistake with insurance claims. Making a mistake in filing an insurance claim may not be considered fraud.

In many cases, the prosecutor does not have enough evidence to prove their case beyond a reasonable doubt. This is often why the prosecutor offers a plea deal. An experienced criminal defense attorney can highlight the lack of evidence and break down the prosecutor's case to show the jury that the defendant is not guilty of any criminal charges.

Experienced Criminal Defense Attorney Representation

Lynn Gorelick has more than 30 years of criminal defense experience and understands the penalties involved with insurance fraud, including felony fraud charges. She understands how to approach the individual facts of each case for the greatest chance of success, keeping her clients out of jail with a clean record. Whether you are arrested in Oakland, Richmond or anywhere else in Contra Costa or Alameda Counties, contact Lynn Gorelick understands you do not have to plead guilty just because you were arrested.

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