Insurance Fraud Defense Attorney in Naples
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Insurance fraud takes two forms. It either involves a person filing a claim based on false or exaggerated information or an entity selling fake insurance policies to consumers. Most offenses arise from insured parties making false claims or intentionally causing damage to serve as the basis of a claim. Organized groups sometimes conspire to conduct ongoing insurance fraud. Insurance companies and state and federal law enforcement agencies act aggressively to combat these illegal activities. Fines, probation and imprisonment are all possible penalties. For these reasons, anyone accused of this crime should speak to a Naples insurance fraud lawyer.
Hard and soft insurance fraud
Insurance-related offenses fall into the categories of hard and soft. Hard fraud refers to planning and executing schemes for the purpose of illegally collecting insurance payouts or benefits. Deliberately stealing, setting fires, staging accidents and causing injuries define hard insurance fraud. Insurance agents or brokers may also steal premium payments meant for legitimate policies, or unlicensed actors might sell consumers policies that do not exist and cannot provide benefits.
Common approaches to hard insurance fraud are:
- filing claims for false automobile accidents
- faking a slip and fall accident
- making a false disability claim
- billing for fictitious medical services
- stealing someone’s identity for the purpose of accessing health care
- pocketing insurance premiums instead of funding insurance
The soft offenses lack fake or staged events, but they are still motivated by the desire to increase an insurance payout. People who include seemingly minor fabrications on an insurance claim or exaggerate losses are committing soft insurance fraud.
Examples of soft or opportunity insurance fraud include:
- including pre-existing car or home damage on an accident claim
- failing to add new teen drivers to auto policies
- using a different address to get lower rates
State prosecutors often treat soft insurance fraud as a felony. Sentencing may include community service, one or more years in prison and fines up to $5,000. However, hard insurance fraud is a federal offense. Maximum sentences could be as long as 30 years with fines up to $50,000.
The conviction of a Naples man exposed him to a maximum sentence of 20 years along with payment of restitution to the insurers that he defrauded. He worked within a criminal organization that was running an unlicensed chiropractic clinic. Participants in the scheme staged motor vehicle accidents. The fake chiropractor then billed insurers for the alleged injuries in an attempt to collect personal injury protection benefits. Evidence presented at his trial indicated that the group had received over $2 million in auto insurance funds through fraudulent activities.
Do not say anything that might incriminate you. Speak with an attorney first.
Insurance fraud investigations
Insurers collectively process millions of claims, which makes them reliant on computer analyses of claims’ data to monitor for abuses. Internal fraud investigators will take closer looks at claims flagged by the system. They may use private investigators to collect information about people suspected of fraud as they go about their daily lives.
Social media has emerged as a common way for investigators to find evidence about people lying about their injuries or disabilities. Individuals cannot rely on any expectations of privacy about the images and comments that they share on social media platforms, like Facebook or Instagram. Even people who think that they have kept their posts private may have their activities revealed by friends or relatives sharing pictures of them publicly. Pictures of claimants engaging in physical activities might contribute to a disability fraud case. Upon finding sufficient evidence, insurance investigators may alert law enforcement and initiate criminal prosecution.
Because some cases are launched as a result of a computer analysis, the possibility for errors exists. Someone contacted about a suspected fraud case may fail to take it seriously at first, but insurance companies can be aggressive. Asking an attorney for guidance at the first sign of an insurance investigation may stop a case from advancing.
Conviction standards for insurance fraud
The law only supports a conviction when a prosecutor can show that:
- the accused acted intentionally to trick an insurance company into making a payment.
- the accused made false or misleading statements related to the insurance payment.
- the false or misleading information was material to the determination of payment.
Criminal defense attorneys work off this standard when defending clients. Any weak areas of evidence could create opportunities to cast doubt on a defendant’s intention or whether potentially dishonest actions were material to the case.
Legal advice for insurance fraud suspects
All people interact with insurance companies throughout their lives. A mistake or misunderstanding could occur at any time, especially because policies are difficult to understand, and people feel like they should get as much money as possible after years of paying premiums. Fraud investigators are looking for crimes, but not every lead that they follow is valid. The intervention of a knowledgeable insurance fraud lawyer from Joffe Law, P.A. could enable someone to resolve honest errors. Legal representation will be very crucial for those who have been arrested. We have extensive experience with the federal criminal court system and are willing to wage strong defenses meant to minimize penalties.