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Insurance fraud is the act of filing false claims to health, life, property, workers’ compensation, automobile or any other type of claim. Insurance fraud is categorized as criminal activity and is therefore regulated by both the federal and state laws. The laws that regulate insurance fraud are meant to protect both insurance companies and consumers from any fraudulent activities.
Insurance fraud is also categorized as either hard or soft. Cases of hard insurance fraud involve a thoughtful plan to claim an insurable loss, for instance, theft, car accident, or fire to get compensated by the insurance company for the supposed loss.
Soft insurance fraud is also referred to as opportunity fraud, and it involves the exaggeration of a legitimate claim by a policyholder to get a higher compensation. For instance, a person involved in a car accident can claim for serious injuries than they sustained. This is often meant to claim for a larger settlement. Misrepresentation of other preexisting conditions when purchasing an insurance policy to obtain a policy that would normally be declined or to receive a larger payout later is also considered as soft insurance fraud.
Federal and state laws outlaw both hard and soft insurance fraud. Because insurance fraud is one of the most favorable schemes of organized crimes, it has been criminalized. Each state in the U.S now classifies cases of insurance fraud as criminal activities. The federal government has also put in place laws that criminalize insurance fraud and created sentences for those who participate in schemes that result in either death or injury to other human beings.
Insurance fraud has become a big problem today, and that is why 41 states have created insurance fraud bureaus to fight illegal insurance activities. These bureaus are law enforcement agencies that have been given the jurisdiction of investigating any suspicious insurance fraudulent insurance claims.
Insurance fraud is often punishable depending on the value of the claims obtained or attempted to be reimbursed from an insurance company. In case you attempt to defraud an insurance company for property worth less than $300, this is regarded as a Class A offense and it is punishable by having to pay a fine of $2,500 or imprisonment of not less than one year. Defrauding an insurance company for property worth between $300 and $10,000 is classified as a Class 3 crime and is punishable by paying a fine of $25,000 and a jail term of two years minimum and a maximum of five years. If the insurance fraud exceeds an amount of $100,000, it is then considered as a Class 1 felony. These are serious crimes and are punishable by paying a fine of not less than $25,000 and a jail term of not less than four years and not exceeding fifteen years.
You should keep in mind that with any felony or misdemeanor conviction, the conviction will go on your record which is visible to schools, employers, military institutions, employers, and others. This means that a felony or misdemeanor conviction will have serious effects on your employment future.
You should never take an insurance fraud charge lightly. There are several channels to defend you if you are charged with such crimes. However, the type of defense you choose will mostly depend on your case. Some of the potential defenses that are used on insurance fraud charges include:
The absence of intent– You will only be charged for engaging in fraudulent activities if you knowingly obtain insurance reimbursements dishonestly. This means that if you unknowingly filed for insurance claims, you won’t be convicted.
Insufficient evidence– The prosecutor in charge of your case has the responsibility of proving all aspects of the fraudulent crimes committed. Therefore, if your attorney can prove reasonable doubt in the case by providing crucial evidence missing in your case, you won’t be convicted.
Lack of fraud– It is not always that statements provided can lead to a fraud case. This means that merely expressing yourself when filing for insurance claims should not always be regarded as fraudulent. For your charges to be dropped, your attorney will have to prove that the allegedly deceptive claim isn’t based on a fraudulent intent.
Your criminal defense lawyer will begin by reviewing the circumstances surrounding your insurance fraud case and create a strong defense with the information gathered. Your attorney may attempt to fight the charges during the early stages to prove lack of sufficient evidence and have your case dismissed. However, in some other cases, your attorney may try and negotiate for minimal sentence and a lower charge if you plead guilty. If your case proceeds to trial, your attorney will produce exculpatory evidence that can help you get exonerated.
It is advisable that you pursue legal assistance immediately after you are charged with insurance fraud to enable your attorney to gather evidence and mount an effective defense on your case during the early days. The decision you make during such a time may mean the difference between the dismissal of your case or prison time and hefty fines.
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