What Is Insurance Fraud?

insurance fraud

Insurance fraud is a criminal act that has severe legal consequences. Specifically, in the state of Florida, insurance fraud is taken quite seriously and is governed by Florida Statute Section 817.234.  

False & Fraudulent Insurance Claims  

Under Florida Statute § 817.234, insurance fraud involves an individual or entity intentionally deceiving an insurance company for financial gain. It can occur in various forms, such as false insurance claims, exaggerating damages or injuries, or misrepresentation of information while buying a policy. 

Consequences of Insurance Fraud Conviction 

Under Florida Statute Section 817.234, insurance fraud is considered a felony. The severity of the charge (first, second, or third degree) depends on the amount of money involved in the fraudulent activity. 

Specifically, if the amount defrauded is less than $20,000, it is considered a third-degree felony punishable by up to five years in prison and a fine of up to $5,000. If the defrauded amount is between $20,000 and $100,000, it is a second-degree felony punishable by up to 15 years in prison and a fine of up to $10,000. If the amount exceeds $100,000, it is a first-degree felony with penalties of up to 30 years in prison and a fine of up to $10,000. 

It is important to note that certain professionals can also face additional penalties. For instance, a licensed healthcare professional can lose their license for five years and may not be reimbursed for personal injury protection benefits for 10 years if found guilty of insurance fraud. Healthcare professionals (as well as lawyers and clinic medical directors or owners) can also be charged with a third-degree felony if they solicit or try to solicit business from those involved in a vehicular accident.  

Types of Insurance Fraud  

There are several types of insurance fraud, including:  

  • Health insurance fraud, which occurs when false or misleading information is provided to a health insurance company, often to receive benefits or payments not entitled to the claimant. 

  • Auto insurance fraud, which can include staging car accidents, exaggerating damage to vehicles, or inflating repair costs to claim higher compensation.   

  • Life insurance fraud, which involves faking death or disability to collect life insurance money. 

  • Property insurance fraud, which includes intentionally damaging property or exaggerating the value of stolen items to claim a higher payout. 

Defenses Against Fraud Claims 

The defense against insurance fraud charges often involves disproving one or more elements of the fraud. This could involve showing that the misrepresentation was not intentional or the defendant did not intend to defraud the insurance company. Other defenses might include a lack of evidence or proving that the insurance company suffered no actual financial loss. 

For example, in a case where an individual is accused of exaggerating damages in an auto accident claim, their defense could argue that the claimant genuinely believed the damage to be as extensive as claimed and there was no intent to deceive the insurance company. 

Call (352) 503-4111 to request a consultation with our white-collar crime defense attorney today.  

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