Fraud Insurance Fraud

Florida’s annual hurricane season makes the state especially prone to fraudulent insurance claims. However, insurance fraud may take place in areas other than real estate. Anyone who insures a product may be the victim of a false claim. Florida law defines insurance fraud as the act of submitting an insurance claim based on false, exaggerated, or deliberate injury or loss. It is also illegal to provide false information on an application for insurance. Even the act of making an exaggerated claim may be considered to be insurance fraud. In some cases, an unscrupulous company may illegally sell customers unlicensed or nonexistent insurance policies, or a broker or representative may illegally divert customers’ premiums for his or her own personal use. In all cases, these charges are very serious, and you need the guidance of an experienced Naples, Broward County or Fort Lauderdale insurance fraud attorney to protect your rights – and possibly your freedom.

Just Arrested?
Do not say anything that might incriminate you. Speak with an attorney first.

Types of insurance fraud

Insurance fraud and related schemes are often categorized as “hard” or “soft.” Hard fraud occurs when someone deliberately fakes an accident, injury, theft, arson, or other loss to file a claim and collect an insurance payout. Perpetrators may act alone or participate in organized crime rings that support each other in committing fraud. Soft fraud occurs when an everyday person exaggerates or makes a comparatively small misrepresentation in the interest of maximizing payout. People often believe soft fraud is harmless; however, it is a criminal offense that has the effect of raising the general cost for others to purchase and maintain insurance. Other specific forms of insurance fraud include:

  • false auto accident claims
  • false slip and falls
  • false disability claims
  • medical providers billing for services they did not provide
  • using some else’s identity to obtain health care services

How it’s detected

Computer programs that analyze claims data often raise initial red flags that cause claims to be investigated for fraud. Once an insurance investigator detects the possibility of fraud, he or she may employ a variety of different tactics to establish a basis upon which to deny the claim or to formally accuse the individual of a criminal act of fraud. Traditional tactics like hiring a private investigator to conduct a stakeout and surveillance of the potentially fraudulent claimant’s activities. For example, if a Fort Lauderdale resident who filed a claim for a back injury is observed training for a marathon, video evidence of the claimant participating in strenuous physical activity may be introduced as evidence in court.

Social media’s role

In recent years, people have become more comfortable with sharing the details of their leisure activities and personal lives on their social media accounts. As a result, social media has become a valuable tool for insurance fraud investigators. Some people are caught committing fraud as a result of sharing contradictory photos and posting updates on their social media accounts that indicate they provided false information. Others may avoid posting potentially incriminating information about themselves directly, but are still caught as a result of family members and friends unknowingly publicly sharing photos and information about the claimant that expose his or her misrepresentation.

How is it proven?

Defense cases against insurance fraud allegations are usually focused on disproving one or more required elements of the crime. To prove insurance fraud and obtain a conviction against the accused, prosecutors must establish the following elements:

  • The defendant intentionally made a false or misleading statement on an insurance claim.
  • The false statement made was in connection with a payment made or set to be made under the terms of the insurance policy.
  • The statement is of material importance to the case.

Possible penalties

Insurance fraud is a federal offense. Soft fraud is usually a misdemeanor in most states. In these states, offenders may be sentenced to up to one year in prison and/or ordered to pay a fines, complete community service, or be put on probation. However, in Florida, most fraud cases are felonies. Therefore, whether a person is convicted of hard or soft fraud, he or she is much more likely to be sentenced to one year or longer in prison and/or ordered to pay a fine of $5,000 or more. An individual who is convicted of hard fraud in Florida may be sentenced to a maximum of 30 years imprisonment and ordered to pay up to $50,000 in fines.

Charged in Ft Lauderdale or elsewhere in Broward County?

People who embellish details on insurance claims are usually unaware that they may be charged with a felony and sentenced to time in prison if they are caught. Anyone who is under investigation for insurance fraud should immediately contact a Naples or Fort Lauderdale defense attorney to discuss the best way to respond to the accusation. Accused claimants should contact an attorney prior to speaking to investigators, if possible, as people often inadvertently reveal information during preliminary conversations that may later be used to obtain a conviction. In cases in which a person is wrongfully accused of insurance fraud, an experienced Broward County insurance fraud defense lawyer can help the individual prove his or her lack of intent to commit fraud. In any case, an attorney can advise the accused party of his or her legal options at every stage of the investigative and criminal court process.