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Insurance Fraud Taking a Personal Approach to Law

​SAN DIEGO INSURANCE FRAUD ATTORNEY

Strong Defense for Insurance Fraud California

Insurance fraud reportedly costs California over $15 billion each year, and according to the National Insurance Crime Bureau, other than tax evasion, insurance fraud is the second most costly crime in the country. Based on these stats, it’s no surprise that insurance fraud is treated as a serious crime by state and federal authorities.handcuffs - insurance fraud california

If you have recently been accused of insurance fraud in California, you are probably wondering what the implications are and what options are available to you. Insurance fraud is a serious crime – don’t waste time when it comes to protecting yourself and your legal rights. Similar charges have torn lives apart in the blink of an eye and it’s critical you recognize everything at risk.

The choices you make now will impact your future in a powerful and lasting way; do what you can to safeguard yourself and your reputation

Contact our San Diego insurance fraud lawyer so you know what to do regarding these accusations!

What is Considered Insurance Fraud in California?

The state of California defines insurance fraud as the filing of a false insurance claim to illegally extract benefits from an insurance company.

The law covers all types of insurance claims, including auto insurance, life insurance, health insurance, property insurance, and more. Although the definition is simple, the law is broad and covers a range of offenses. Exaggerating property damage, staging the theft of an insured item, and filing misleading claims are a few examples of what the state can try to prosecute an individual for.

The Insurance Fraud Business

The defense of insurance fraud cases is complex and unique among criminal offenses. Many think of insurance fraud as a white-collar crime similar to many other fraud or financial crimes. The main difference in how these cases are prosecuted is the resources a prosecutor has available.

There are agencies in California that are funded at the State and local level whose sole purpose is to look for fraudulent insurance claims. State agencies under the direction of the Attorney General’s office have detectives, attorneys, and special prosecutors who investigate thousands of insurance fraud claims. Long before a criminal case is brought to the district attorney there has been a long investigation by public and private officers.

The work of a San Diego insurance fraud attorney involves more than knowing how to defend and win a case. Knowing the motivations of prosecutors and insurance companies is key to success in these cases.

Insurance fraud claims can stem from any scenario where there is an insurance contract. This includes homeowners’ insurance, auto insurance, health insurance, or other loss coverage. Anyone who files a claim for loss or damage under his or her insurance coverage is under scrutiny.

Multiple departments within any insurance company always review claims of injury from an auto accident or damage to a vehicle. For example, someone who has in the past made multiple claims on their auto insurance could be flagged as a potential fraudulent claimant. Even without any other indications that a claim is false, the insurance company places the insured into a fraud review.

Suspicious claims for theft or damage to items in a home or business are a big problem for insurance companies. Insurance fraud adds up to millions in lost profits for insurers every year. These companies spend a lot of money on investigators and law enforcement to check up on every large claim of loss to avoid fraudulent claims. Insurance companies also lobby and help fund State-run organizations that are tasked with investigating insurance fraud.

These agencies employ sworn officers who have the same authority to investigate and arrest crimes as any police force. Long before a case comes to the desk of a prosecutor these officers have created files on false claims that are thousands of pages.

What Happens When an Insurance Company Accuses You of Fraud?

As an honest citizen, you pay your monthly premiums and only file claims if you’ve experienced a covered event. You are likely asking yourself why you should be concerned about insurance fraud. The government estimates this crime costs almost $40 billion in lost compensation, and your insurance bill increases each time a scammer plays the system. To avoid losing money, insurance companies will often pursue possible fraud cases relentlessly. You don’t want to be caught in the crossfire.

Because the laws related to insurance fraud are broad, one mistake is all it takes to get you into trouble. It’s not uncommon for people to misunderstand their policy and find themselves in hot water. Some individuals can clear everything up, but not everyone is that lucky. Unless you want to gamble with your future, these situations will demand your immediate and full attention.

California Fraud Investigations

If an insurance company feels that you have committed fraud, they will launch an investigation to collect as much information as possible. The nature of the policy, the date of the accident, and the police report are a few things they will take into consideration. The insurance company can investigate suspects before identifying the situation so that they can build a strong case. When this happens, the odds will be stacked against you making it much more difficult to protect yourself.

California Insurance Fraud Charges

Insurance fraud in California is generally charged as two offenses for each fraudulent claim. The penal code does not distinguish between the type of insurance claim made if an investigator or prosecutor believes there was criminal conduct. A charge of insurance fraud includes CA PC 550(a) which relates to presenting or making a false claim to an insurer. CA PC 550(b) relates to the actual statement, writing, or other action taken by an individual in support of the fraudulent claim.

Is Insurance Fraud a Felony?

Yes, typically insurance fraud cases are charged as felonies. The possible penalty for a conviction includes not only fines and serious jail time but also restitution. For the prosecutor, the goal is always an admission of guilt and getting money back to the insurance companies who covered any claims.

Common Forms of Insurance Fraud

Auto Insurance Fraud

Here are some primary examples of auto insurance fraud:

1. Vehicle Dumping: When an owner disposes of his or her vehicle by leaving it somewhere, burning it, putting it in a lake, or selling it in an untraceable way and then claiming someone stole the car.

2. Registering: Drives may have to pay higher premiums for insurance because they live in a place where cars are regularly stolen, or because they live in an expensive part of the country. As a result, some people register their vehicles in other areas of the country to save money.

Home Insurance Fraud

Common examples of home insurance fraud include:

1. Exaggerating Values: When a house is broken into or damaged and the homeowner inflates the cost of the goods stolen or damaged.

2. Intentional Destruction: When a property owner intentionally damages their property so that they can collect on the insurance money.

3. Double Claiming: Making a second claim on a loss that was already paid by another insurer or through a prior claim.

Life Insurance Fraud

Primary examples of life insurance fraud include:

1. Application Fraud: When someone knowingly puts incorrect information on an application. Common frauds under this umbrella include: denying a smoking habit, hiding a disease, and lying about plans.

2. Selling fake policies: When someone poses as an insurance agency and scams people into buying fake life insurance policies.

Health Insurance Fraud

Common examples of health insurance fraud include:

1. Fraudulent Billing: When a doctor or medical facility bills people for treatments that they never received.

2. Medical Identity Theft: When someone steals the medical identity of someone else to receive healthcare.

3. Intentional Misdiagnosis: When a doctor intentionally misdiagnosis someone to make money.

What Do All Insurance Schemes Have in Common?

All insurance schemes have one thing in common; they can all lead to criminal charges. Those convicted of insurance fraud crimes may face fines, jail time, or both punishments given the circumstances of the case.

However, criminal charges are not the same as convictions, and you can defend yourself against accusations.

From small fraud charges at the state level to felony fraud charges at the federal level, attorney George Gedulin can help you make your case. Attorney Gedulin has experience handling massive fraud cases in California; in one such case, attorney Gedulin got 22 counts of insurance fraud dismissed for one client, reducing his potential sentence from 22 years to 2 years.

Consequences of Insurance Fraud in California

The insurance fraud statutes permit a Judge to sentence someone found guilty of the crime up to 5 years in State Prison. There is always a sentencing range for insurance fraud cases between two and five years. Insurance fraud can also be charged as a misdemeanor which usually eliminates the potential for jail time.

Time can be added to the sentence if the amount of loss to the insurer was significant. Losses exceeding $500,000 can potentially add another five years on top of the original sentence.

If someone is convicted of an insurance fraud felony, he may face serious consequences such as:

  • Imprisonment for two, three, or five years; and
  • A fine not exceeding $50,000, or double the amount of the fraud, whichever is greater.

Suppose someone didn’t commit fraud but assisted or conspired with someone to commit fraud.

In this scenario, the conspirer may face the following consequences:

  • Imprisonment for two, three, or five years; or
  • A fine not exceeding $50,000, or double the amount of the fraud, whichever is greater; or
  • Both the imprisonment and fine; or
  • Imprisonment in a county jail for less than one year; or
  • By a fine of not more than $10,000; or
  • Both the county jail sentence and the fine of not more than $10,000.

For many defendants the prospect of being convicted for any fraud offense is unthinkable. Those with professional licenses or working in the finance industry know how devastating a fraud conviction can be. Even a finding of guilt for misdemeanor insurance fraud is not an option.

Those defendants in the United States on a visa or green card can face deportation and exclusion from the United States for an insurance fraud conviction. Insurance fraud falls into the category of “moral turpitude” crimes which are a serious category for the immigration services.

You could be facing multiple years in prison and tens of thousands of dollars in fines if you are found guilty of your fraud charges, but help is just a phone call away with our San Diego insurance fraud attorney!

Charges of Fraud & Embezzlement for Insurance Fraud

Criminal cases of insurance fraud that involve losses over $65,000 can trigger very serious charges. If the allegedly fraudulent claims are over this amount the State can ask a judge to impose additional jail time for anyone who is convicted. Even when an insurance company paid nothing on a claim, the question is “what was the value of the potential claim?” Often fraudulent insurance claims for home damage or expensive items can exceed $100,000.

If it is proven at trial that someone committed a pattern of false claims that rise to the level of a felony, then years can be added to a sentence.

Insurance Fraud California Penal Code

Someone facing criminal charges for insurance fraud should know the specific type of crimes that can be charged:

  • CA PC 550(a)(1) is the crime of presenting a false claim for loss under an insurance policy. This offense requires some proof that the claimed incident or loss never actually occurred. Also, this can be charged if the person making a claim changes the facts of an incident. These incidents can include misstating who was driving a car during an accident. Often an insured includes damaged items in a claim to the insurance company that was not damaged.
  • CA PC 550(b)(1) is a more specific insurance fraud crime that deals with statements or writings made by a defendant. When fraud investigators speak to defendants, they will usually record the phone call or meeting. While the statements are not always made under penalty of perjury, they are recorded to ensure that the insurance company has a record. Statements made which are intentionally false can trigger this criminal section. Written statements related to an incident such as theft or property damage can also be used under this law.
  • CA PC550(b)(2) – “Prepare or make any written or oral statement that is intended to be presented to any insurer or any insurance claimant in connection with, or in support of or opposition to, any claim or payment or other benefits pursuant to an insurance policy, knowing that the statement contains any false or misleading information concerning any material fact”
  • CA PC 550(b)(3) is the making of written or verbal statements to conceal or mislead about the facts of an event. Knowingly making false statements about an event or failing to disclose information necessary for the claim can be considered a Felony. Like any insurance fraud crime, the prosecutor must be able to prove intent and a desire to mislead for fraudulent purposes. The mistake of facts and lack of intent do not amount to a criminal offense.

Most criminal defense lawyers do not handle complex matters like insurance fraud. Our San Diego insurance fraud lawyers are highly experienced with these types of cases. A defendant should know that if their career and livelihood are on the line that their defense attorney has experience presenting such a case to a jury.

Insurance Provider Fraud Punishment in CA

California Penal Code 548 states that those who are convicted of insurance fraud can face fines of up to $50,000, up to five years behind bars, and an additional two years for every repeat offense. But you don’t even need to commit insurance fraud to find yourself on the wrong side of the law.

As an insurance provider, if you are aware of a client who plans to commit insurance fraud, the state can charge you with solicitation for accepting that client’s business or for referring that client to someone else. If a jury finds you guilty of solicitation, you could face up to three years in prison. Even if you do not know the client’s intent to commit fraud, there is no way to ensure that the authorities won’t view you as a suspect in the case.

Although insurance companies occasionally pursue misdemeanor charges, this is rare. You can expect to face felony charges by the time that you are forced to stand before the judge and jury. In addition to prison time, a felony charge will strip you of many of your rights; you will no longer be able to own a firearm, vote, or serve as a member of a jury.

A felony charge will stop you from collecting government benefits and enlisting in the military. For anyone who has a felony conviction, life will never be the same, you don’t want to fall into this trap.

The Long-Term Impact of Insurance Fraud Arrest

Insurance fraud is aggressively prosecuted in the state by special divisions of the DA’s office. These departments work differently than other criminal divisions because their goal is to support the interests of private businesses like insurance companies. Recovery of funds paid for fraudulent claims or investigation is often what drives these cases.

If you are facing criminal prosecution speak immediately with an insurance fraud attorney in San Diego who has years of experience successfully defending insurance fraud and white-collar fraud cases.

How is Insurance Fraud Handled in Court in California?

Most of the crimes relating to insurance fraud are found in Penal Code 550(a) and 550(b). These statutes cover many of the felony crimes relating to insurance fraud. These can include allegations of one false claim or multiple claims over a period. Regardless of the insurance fraud stemming from an auto accident, theft, or destruction of property the law is very similar.

Most fundamental to an allegation of criminal conduct is the element of intent. The State must be able to prove that someone presented a false claim to an insurance company, and they did so know the claim was false when it was made. The most important aspect of the crime is intent.

These cases come down to what a person knew when they made statements to an insurance company and what was the intent behind presenting that information. For example, claiming a homeowner’s policy for damage to items in a home from burglary requires several things. The insurance company would expect receipts, photos, or other proof that these items were in the home at the time of the loss and that they belonged to the insured.

Making statements to an insurance company that multiple expensive computers and cameras were stolen from the home when they in fact never existed can be considered a criminal act. The intent can be innocent, however, which is why a defense attorney is so important in these cases. Explaining a situation to a Judge at a critical hearing against relentless investigators and DA’s can be daunting even for experienced counsel.

Often an innocent claim with legitimate loss is wrongly flagged as fraudulent. The sad example of a wife whose wedding ring goes missing from the home. The family files a police report and cannot find the ring despite a diligent search. The husband isn’t sure the ring is missing or stolen since his wife has lost it many times in the past.

One month after filing the claim for loss with insurance the husband finds the ring in the home. The husband informs the company that the ring was found, and he can withdraw his claim. Was there ever any intent to make a false claim?

The insurance company never paid out any loss on the ring, however, a claim was presented. Did the wife or husband intend to present false information for financial gain? These cases are complicated and even experienced insurance fraud investigators get it wrong.

Restitution for Insurance Fraud in CA

The penal code also requires that a guilty defendant pay back any restitution demanded by the insurance company. If a false claim was paid out the exact amount can be made part of the criminal judgment. In addition, the insurance company can claim restitution for the time spent by its investigators who investigated the fraudulent claims. The investigation costs can also run into thousands of dollars.

What is difficult for many defendants to understand is that no money needs to have been paid by the insurance company to constitute a crime. Where there was the intent, and a false claim was made this is enough to raise criminal charges.

What Do Prosecutors Need to Argue for a Successful Conviction?

First, prosecutors must prove that the accused knowingly committed the alleged criminal act. Insurance is confusing, and if someone accidentally gives false information or claims a benefit he or she didn’t qualify for, the accused’s ignorance could be a viable defense.

Therefore, the prosecution must attempt to prove beyond a reasonable doubt that the accused knew what they were doing when he or she “committed” the alleged fraud.

Second, prosecutors must attempt to prove that the accused committed fraud against an organization or business. There are many kinds of fraud, so prosecutors will have to key in on the specific method of fraud that the accused “committed” to obtain a successful conviction.

Common forms of fraud include:

  • Creating false documents;
  • Planning a fraud with another party (car theft for auto insurance, burglary for home insurance, an auto accident for personal injury insurance, etc.)
  • Faking injuries from an accident;
  • Submitting a health care claim for services that never occurred;
  • Submitting multiple applications for the same issue.

There are many steps that prosecutors can take to attempt to prove fraud, but there are also many defenses an experienced fraud attorney can make on your behalf.

Insurance Fraud Defenses in California

San Diego insurance fraud attorney, George Gedulin, on how he defends insurance fraud cases, “My goal in all of these cases is to safeguard my client against claims of criminal wrongdoing when they did nothing wrong. The insurance and claim system can be complicated and making statements under oath and providing letters often puts our clients in jeopardy of criminal prosecution without them knowing.

The crucial part of any criminal case is that the prosecution must prove intent. To prove that someone acted criminally in an insurance fraud case there has to be evidence that a claim made with the insurer was false and that some statement or writing was made to support this false claim.”

The mistake of information and inadvertent misstatements should never be the basis for a criminal insurance fraud case. One of the most common cases that an attorney will defend is where a defendant is accused of presenting multiple claims to an insurer for damage to their home or vehicle. Often, a husband and a wife will call an insurer to make a claim not knowing the other has already done so. Strictly under the law, a prosecutor can charge Insurance Fraud under CA PC 550(a)(2). This occurs more often than most of the public imagines. Where a person has multiple insurance carriers it is not beyond reason that multiple claims can be made to different insurers.

Insurance fraud cases, like all white-collar crime defenses, require meticulous attention to detail and experience defending complex fraud allegations. Most white-collar crime cases relating to fraud, like tax fraud or insurance, require time and a details-driven San Diego insurance fraud attorney who can parse through thousands of pages of discovery.

Personalized Approach to Insurance Fraud Defense

When an insurance company charges you or a loved one with insurance fraud, take the correct steps towards protection. You don’t want to lose years of your life behind bars or have your life turned upside down with a felony charge. By enlisting the services of an aggressive insurance fraud lawyer in San Diego, you are taking a big step in securing your future. The Law Office of George Gedulin has the experience and training to give you the most success. We will work hard to let you know you are in good hands.

We acknowledge that laws and policy limits can be a challenge to understand, and we firmly believe that one mistake should not ruin a person’s life. Once you decide to team up with The Law Office of George Gedulin, we will promptly get to work looking at the details so that we can build a solid defense.

Our personalized approach to criminal defense will ensure that all aspects of your case and background are considered. When you let us worry about the legal aspects of these accusations, you can focus on getting your life back under control.

Pick up the phone to contact us today at (858) 281-4605.

Successful Defense Cases

  • Felony Gun Possession, Felony Child Abuse Charges Dismissed

    Client charged with felony gun possession and endangering life of a child being in illegal possession of loaded weapons in the home. Potential 6 year Prison sentence. Child endangerment charges dismissed, NO Custody.

  • 16 Counts, Unlawful Sexual Intercourse with a Minor Sentence Reduced, All Other Charges Dropped

    Client charged with multiple sexual assault offenses, facing 16 years in prison. Convicted of One Count of Sex with a Minor, 2 years Jail, All other charges dismissed.

  • 24 Count, Insurance Fraud Conspiracy, Grand Theft in excess of $250,000 Reduced Sentence, Other Charges Dropped

    Client charged as head of conspiracy to present false claims to insurance companies, losses over $250,000. Client facing 22 years in State Prison. Convicted of two counts of insurance fraud, sentenced to 2 years in jail, remaining charges dismissed.

  • Felony Domestic Violence Arrest All criminal charges dismissed

    After arrest, defense investigation reveals that spouse was aggressor and caused harm to client, all criminal charges dismissed.

  • Restraining Order, Accusations of Sexual Assault Case Dismissed

    Defense Victory at trial for restraining order, Judge dismissed complaint against client, finding victims allegations and testimony not-credible.

  • Possession of 5KG of Methamphetamine while Armed with Loaded Gun Probation and Other Charges Dismissed.

    Client facing 4 counts of possessing large quantity of Methamphetamine for sale and a loaded gun with no serial number. District Attorney offer of 6 years in State Prison. Ultimate resolution was a plea to gun possession only, probation and credit for time served with no additional jail time. All other charges dismissed.

  • Shoplifting from Naval Commissary Case Dismissed

    Case Dismissed, record sealed in Federal Court

  • Assault with semi-automatic Firearm, Criminal Threat, Domestic Violence Dismissed Charges

    Charges exposed client to 8 years in State Prison and two serious strike felonies. Court dismisses all gun related charges at preliminary hearing, client pleads to domestic violence charge only, no custody.

  • Burglary, Theft, Identity Theft Not Guilty. Case Dismissed.

    Client was charged with criminal Burglary, Grand Theft and Identity Theft from local retailers. Defense investigation revealed client was not individual shown on security cameras

  • Restraining Orders Order Granted

    Clients filed for restraining order(s), preventing former pastor from coming within 100 yards of church or making any disparaging comments about the Church on Social Media.

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