Insurance Fraud

Insurance fraud is one of the most common “white collar” crimes – people are tempted to commit it because insurance companies pay out billions of dollars in claims every year. Unfortunately, this can result in unjust prosecutions of innocent people. One of the unique features of the crime of insurance fraud, in Texas as well as elsewhere, is its unusually wide range of penalties. If you have been accused of insurance fraud in Houston, the services of an experienced Houston criminal law attorney could prove invaluable to you.

Legal Definition

The crime of insurance fraud can be broken down into four elements:

Making a false or misleading statement;
that is material (important or significant);
with the intent to defraud or deceive;
in connection with an insurance claim or payment

The prosecutor must prove each of these four elements beyond a reasonable doubt in order to convict you of insurance fraud.

Examples

There are an almost unlimited number of ways that a person can commit insurance fraud. Following are some typical examples:

Faking an illness in order to obtain prescription drugs that will be paid for under an insurance policy
Submitting an insurance claim for a surgical procedures that you did not perform (if you are a doctor).
Exaggerating the damages from an automobile accident in order to collect property or personal injury damages from the other driver’s liability insurance policy.
Forging the death certificate of a living person in order to collect on a life insurance policy (even if you are not the beneficiary).
Burning down your own house to collect on a homeowner’s insurance policy.

Insurance company claims adjustors are typically alert and suspicious whenever a large or unexpected claim arises.

Penalties

In Texas, the penalties for insurance fraud vary greatly according to the amount involved. Insurance fraud of under $50, for example, is a misdemeanor that carries no jail time and involves a fine of no more than $500 (for a first offense, anyway). By contrast, insurance fraud of $200,000 or more is a felony with a maximum penalty of 99 years in prison. Insurance fraud penalties are expressed in ranges of penalties matched with the amount of the fraud (180 days to two years for amounts between $1,500 and $20,000, for example).

Defenses

The main defenses to an insurance fraud claim are simple denials of the prosecution’s claims that raise reasonable doubt as to whether or not the prosecutor has met his burden of proving one of the four elements of the crime. Your defense could be based on a claim that:

The alleged false statement was not false at the time it was made (even if it became false later due to changing circumstances).
The alleged false statement was not inherently misleading, even if the insurance company was in fact misled by it.
The alleged false statement was not material – lying about your cell phone number might not be material, for example, if it had minimal effect on the underlying claim or payment.
You had no intent to defraud or deceive – you simply made an error — for example, by reporting that a fire was accidental when, unbeknownst to you, it was set intentionally by someone else.
Part of the value of your claim was valid, even though the other part was fraudulent (this particular defense will not completely exonerate you, but it could lead to a great reduction in penalties).

Getting Help

Mario Madrid is a prominent white collar criminal defense lawyer with nearly two decades of rich practice experience. As a former prosecutor and judge, he enjoys a multifaceted perspective that few of his peers can match. As a certified specialist in Criminal Law, the depth of his understanding of his field has been recognized by the Texas Board of Legal Specialization.

Insurance Fraud

Insurance Fraud

Legal Definition

Examples

Penalties

Defenses

Getting Help

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