Insurance Fraud

When an individual files a claim for insurance benefits, the insurance company will conduct an investigation into the claim. If an insurance company determines that the claim was fraudulent, it will frequently report the claim to law enforcement as attempted fraud. This reporting can lead to criminal penalties under the California Insurance Code. Any kind of claim can result in a criminal prosecution if the insurance company decides it was made fraudulently – auto collision, fire damage, stolen property, or any other claim for insurance. The Goldstein Law Group has a history of defending individuals charged with insurance fraud. If you have been charged with insurance fraud, call our law firm to review the details and legal options. Below are the most common types of insurance fraud cases in Los Angeles County.

California Penal Code Sections 548 thru 551 – Auto Insurance Fraud

Auto insurance fraud under California Penal Code Section 548 means you knowingly made a false statement involving a car with the specific intent to receive an insurance payment. Under California law, you commit automobile insurance fraud when you:

  • Make a false claim to an insurance company about an incident involving your car, such as damage sustained in an accident or theft
  • Intentionally damage or abandon your car in order to collect insurance money
  • Submit multiple insurance claims for the same incident
  • Knowingly participate or create a car accident to collect insurance money
  • Present a written or oral statement to an insurance carrier to obtain car insurance that you live in California, but you live in another state.

In Los Angeles County, there are many common ways people commit car insurance fraud. For example, someone abandons their care and then tells the insurance company it was stolen. Another example is situations where someone falsely tells their insurance company they were involved in an accident, but there was no accident. Yet another example is situations where someone was involved in an accident that only caused minor damage, but they claim major damage and they spent much more money on repairs. Finally, one more example is a situation where someone intentionally slams on their breaks to cause an accident in order to receive an insurance payment.

As you see above, California laws deal mostly with presenting false auto insurance claims with a specific intent to defraud an insurance company. It’s important to note here that it’s not legally required that the targeted insurance company actually suffers some type of financial loss. Just the attempt is sufficient to face charges. The legal penalties for a conviction of automobile insurance fraud include jail time, heavy fines, restitution, and probation. In most cases, the Los Angeles County prosecutor will file an auto insurance fraud case as a felony offense. Legal defenses typically include you had no intent to defraud the insurance company or there is insufficient evidence to convict you. If you are facing allegations of auto insurance fraud, contact a Los Angeles criminal defense lawyer at out law firm to review the details.

California Penal Code Sections 550 – Health Insurance Fraud

Healthcare fraud normally involves making false statements or deceptive acts with the specific intent to receive money from a healthcare provider or a government agency. Healthcare fraud typically involves private insurance companies, but also includes Medicare and Medicaid, where it’s the government that is defrauded. In Los Angeles County, the most common examples of healthcare fraud include situations where you:

  • Billed an insurance company for services that were not performed
  • Overcharged an insurance company for services actually performed
  • Submit multiple insurance claims for the same incident

A conviction for violation of California Penal Code Section 550, a felony crime, includes up to 5 years in a state prison and a fine up to $50,000, or double the amount of the fraud, whichever is greater. However, some healthcare fraud cases are wobblers, meaning the Los Angeles County prosecutor can file the case as either a misdemeanor or felony crime.

Our Los Angeles criminal defense attorneys can use a wide range of potential legal defenses to defend you against accusations of healthcare fraud. For example, our lawyers might be able to argue the injury or loss which the prosecutor is claiming is fraudulent, is in fact legitimate. We might able to prove this using medical records or the testimony of a medical expert. Call our Los Angeles criminal defense law firm for more information.

California Penal Code Sections 549 thru 550 – Workers’ Compensation Fraud

Workers’ compensation fraud is covered under California Insurance Code 1871.4 and Penal Code Sections 549-550. Workers’ compensation is a form of insurance that pays an employee for an injury or a disability that happened at work. This means workers’ compensation fraud can be committed when you receive payment, or attempt to receive payment, for which you were not entitled to receive. In Los Angeles County, the most common examples of workers’ compensation is committed when you:

  • Knowingly make false statements with the intent to receive workers’ compensation benefits
  • Encourage others to make false statements about a worker’s compensation claim
  • Submit a claim for treatment of an injury, when you were not actually treated
  • Submit multiple claims for the same injury
  • Claim you were injured at work, but it was actually not work related
  • Exaggerate the extent of your actual injury

Workers’ compensation fraud is known as a “wobbler,” meaning you could be charged with either a misdemeanor or felony offense, based on circumstances of your charges and criminal history. If convicted of a misdemeanor violation of workers’ compensation fraud, the legal penalties include up to one year in jail, a fine up to $150,000, or two times the amount of fraud, and restitution.

Common Legal Defenses for Insurance Fraud

The experienced Los Angles criminal defense lawyers at the Goldstein Law Group can use many different legal defenses to help you avoid a conviction. The most common defenses include the following:

Lack of Knowledge: In order for the Los Angeles County prosecutor to obtain a conviction for insurance fraud, they must be able to prove you knew what you were claiming was false. If we can cast some reasonable doubt that you didn’t know your claims were false, you can probably avoid a conviction. For example, if you made a claim on insurance paperwork based on the fact another person told you the claim was true, and then we could argue you did not knowingly make a false claim.

Lack of Intent: Likewise, in order to be found guilty of insurance fraud, the prosecutor has to prove you intentionally submitted a false claim. In some case, our attorney’s might be able to argue it was an accident or an honest mistake. In most fraud related cases, intent is the absolute key element of the crime. If we can cast some doubt about your actual intent, you stand a good chance of avoiding a conviction.

If you have been accused of any type of insurance fraud, contact the Goldstein Law Group to closely review the details of your case and legal options moving forward. Call our law firm at 323-461-2000.