Insurance Fraud Defense Attorney
in Fort Myers
David Joffe has 35+ years of defending cases involving fraud
Virtually every industry uses insurance to minimize financial loss. Insurance fraud can take many different forms. Fraudulent schemes can involve an individual policyholder, or they can involve entire criminal organizations. An accusation of involvement in fraud can destroy a working professional’s reputation and employment prospects. A knowledgeable Fort Myers insurance fraud defense lawyer can help individuals who are under investigation protect their reputation and protect their rights throughout the criminal court process.
Auto insurance fraud
Florida is a no-fault state. Therefore, all drivers are required to carry Personal Injury Protection (PIP) as part of their auto insurance policies. PIP coverage provides up to $10,000 in insurance benefits to people who are involved in car accidents and other covered accidents. PIP benefits are available to policyholders without regard to whether they were at fault in the accident that caused their injury. Because this type of insurance does not involve a thorough investigation process, fraudsters eventually learned that they could stage accidents and receive compensation. In more elaborate PIP insurance schemes, fraudsters work with chiropractors, massage therapists, clinics, physicians, and unscrupulous lawyers to make the policyholder’s accident and injury seem authentic and ultimately defraud the car insurance company.
Homeowner insurance fraud
Floridians pay the highest homeowner insurance premiums in the U.S. High rates of litigation and fraudulent claims are the driving factor behind steadily increasing insurance premiums. In response, law enforcement agencies investigate suspicions of insurance fraud rings, which often leads to suspected fraudsters facing serious state and federal criminal charges.
Similar to auto accident fraud, homeowner insurance fraud can also involve staged accidents on the policyholder’s property. Common schemes involve a staged flood or fire. Crime rings may stage multiple accidents over the span of several years. They get caught when insurers review the policyholder’s policy history. Even if a policyholder switches insurance providers, insurers use complex software that performs cross-checks to identify suspicious patterns. Red flags that may indicate fraud include:
- a history of multiple checks performed on the same policyholder
- several claims made out to the same address
- a policyholder claimed storm damage occurred on a day when the weather was clear
- signs of fraudulent activity on the policyholder’s social media accounts
Do not say anything that might incriminate you. Speak with an attorney first.
Hurricanes and insurance fraud
After hurricanes, insurance scams seem to emerge overnight. Some home repair companies seek to fraudulently persuade homeowners to sign documents assigning their benefits to the construction company. In exchange, the company promises immediate repairs. Assigning benefits allows construction companies to claim benefits from the homeowner’s insurer that are above the value of the repair work the company performs.
Unauthorized companies and individuals falsely offer claims adjustment services to homeowners. Only a licensed claims adjuster can determine liability and settlement amounts.
Life insurance fraud
Most people imagine a policyholder faking his or her death when they think of life insurance fraud. However, there are other more subtle ways fraudsters operate, including:
- providing false information on an application
- withholding medical history
- tampering with someone else’s insurance policy
Insurance professionals are also sometimes involved in fraudulent practices. Agents commit fraud by:
- pocketing premiums
- churning or convincing policyholders to purchase additional policies they don’t initially want or need
- steering clients toward pricier policies for the sake of profit
Fort Myers life insurance forgery cases
Individuals may become victims of insurance fraud if their policies are taken over by fraudsters. Insurance forgery occurs when someone other than the policyholder changes the beneficiary on a policy without authorization. Forgery may be committed by the insurance agent, family members, insurance agents, and identity theft rings.
Insurance agents are prohibited from depositing money collected from policyholders into their own personal accounts. Premium diversion occurs when an agent pockets a policyholder’s insurance premiums instead of sending the premiums to the insurance company. To cover up the scheme, the agent may send the policyholder false documents to make it appear as if the insured has a valid policy. In reality, there may not be a policy. Diversion most often occurs in smaller communities in which residents have established a trusting relationship with the agent. Instead of directing payment to the insurance company, policyholders are often encouraged to write checks to the insurance agent.
Workers’ compensation insurance fraud
There are several ways employees can commit workers’ comp fraud. Examples include:
- filing a claim for a false injury
- exaggerating the extent of an injury to adjusters and doctors
- working another job while collecting workers’ comp benefits
Insurance companies are always on the lookout for fraudulent claims. If the insurance company detects irregularities in a workers’ comp claim, the company may report the employer to a government agency. At that point, employers typically opt to conduct their own investigation of the employee who made the claim for the injury.
Workers’ compensation fraud committed by businesses
Companies that have employees are required by law to carry workers’ comp insurance. Some employers go to great lengths to give the impression that they are complying with state law by carrying the required insurance coverage. In addition to not carrying workers’ comp coverage at all, not carrying enough workers’ comp coverage is also an act of insurance fraud. Companies seeking to save money sometimes intentionally purchase a workers’ comp policy that only offers limited coverage.
Expert representation in Fort Myers insurance fraud cases
Insurance fraud cases are complex and may be difficult for the state to prove in many cases. Nevertheless, individuals who are accused of insurance fraud may be required to face federal and state prosecutors. These cases tend to have high stakes; therefore, no one should face an insurance fraud charge without qualified legal representation. Our Fort Myers criminal defense attorney represents defendants in insurance fraud cases. Whether you are under investigation, facing charges, or even if you have been convicted, we will review your case and offer you advice that may help you achieve a more favorable outcome. We will leverage our knowledge, expertise, and professional resources to defend you in court.
Contact us today to learn more about how we can potentially help you devise a solid legal defense against a state or federal fraud charge. Our courteous, professional team offers free, confidential case evaluations.