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Insurance Fraud in California

Reports of insurance fraud have risen substantially across California in recent years. Due to this, state and federal law enforcement have taken steps to aggressively pursue attempts at defrauding insurance companies. Through their vigor, however, these investigators have also caused significant problems for innocent people caught up in a misunderstanding. When this happens, an experienced criminal defense attorney can help that person straighten out the legal issues.

Insurance fraud comes in many different forms. Some involve allegations of fraudulent auto insurance claims. Others can result from a house fire that the police believe was suspicious. Even health insurance has been a target of fraudulent activity. If you are facing any of these types of allegations, attorney Vitaly Sigal could help. Regardless of the circumstances of your case, a call to the Sigal Law Group could put you on the path towards a favorable resolution of your charges.

Elements of Insurance Fraud

The term “insurance fraud” is a broad category that encapsulates a variety of illegal acts. This could lead to prosecutors relying on a variety of federal or state criminal statutes in their case. However, every insurance fraud charge includes similar basic elements. These elements include:

  • An intent to defraud. There is no such thing as accidental fraud. To obtain a conviction, prosecutors must establish you knowingly committed an act in order to defraud an insurance company.
  • A completed act. To convict you of insurance fraud, the prosecutor must show that you completed an act in furtherance of the fraud. This involves more than planning or even making a false statement.

Either the act or the intent alone is not enough to result in a conviction. Fraud only occurs when a person intends to commit fraud and then acts on that intention. It is immaterial whether or not the act was successful, as fraud can occur even if the alleged victim does not suffer any harm.

Classifying Insurance Fraud Charges in California

The specifics of an insurance fraud charge depend on whether the case is brought by state or federal prosecutors. While large fraud prosecutions are commonly handled by federal authorities, the State of California has the right to bring charges as well.

Federal Law Used to Prosecute Insurance Fraud

Federal law does not directly address insurance fraud, as there is no statute that specifically outlaws it. That does not mean the federal government is powerless when fraud occurs. In many cases, the federal government will rely on broad statutes that apply to any alleged fraud in order to prosecute insurance fraud cases.

One statue federal prosecutors often rely on during insurance fraud prosecutions is 18 U.S.C. §1341. The statute, which addresses mail fraud, is commonly used when a person uses U.S. postal services to file a false claim or lie on an insurance application.

Also common is the use of 18 U.S.C. §1343, which is the federal wire fraud statute. Like with mail fraud, prosecutors rely on this statute to charge anyone who fraudulently files a claim using a telephone or other form of wired communication.

Under either statute, a conviction can lead to 20 years behind bars and large fines. However, the use of these statutes is fairly narrow. In situations where these statutes do not apply, state law likely covers any other allegations of fraud.

California State Law on Insurance Fraud

While federal laws might not address insurance fraud directly, the same cannot be said for the laws of the State of California. There are statutes for a wide range of fraud, including medical fraud and unemployment insurance fraud. The most common claims are auto insurance fraud claims, however.

There are several statutes that cover auto insurance fraud. However, the most commonly used is California Penal Code 548. Under this statute, it is a crime to hide, damage, destroy, or abandon a motor vehicle in order to make a fraudulent claim.

There are also statutes addressing health insurance fraud. Attempting to defraud private insurance companies or the state-operated Medi-Cal are governed by California Penal Code 550(a).

Unemployment insurance fraud does not grab as many headlines as other crimes do, but it is still frequently prosecuted under state law. Unemployment insurance fraud occurs when a person attempts to increase or receive unemployment benefits unlawfully. This can occur through collecting benefits in multiple jurisdictions or lying about attempts to find new employment.

Other common types of insurance fraud alleged in California include welfare fraud and workers' compensation fraud. Under any of these statutes, the potential penalties are significant. Working with a seasoned Los Angeles insurance fraud attorney could go a long way towards avoiding those penalties.

Common Defenses

The defenses in an insurance fraud case can vary. However, the elements of the crime itself provide for some of the most potent defenses. Remember, fraud only occurs when there is intent combined with a fraudulent act. If the prosecutors cannot establish fraudulent intent, they cannot prove the crime of fraud. Likewise, even the intent defraud someone is not a crime if it is never acted upon.

A mistake of fact is another common defense. Sometimes, the insurance company just makes a mistake. In other cases, the police might misunderstand the basis of the claim. When these errors occur, establishing proof that the case was a misunderstanding can lead to the dismissal of all charges.

In some cases, the strongest defense is to argue the prosecution has failed to meet their burden of proof. Remember: the burden of proving the case is on the State of California. You do not have to prove your innocence. If the prosecutor cannot make the case that fraud occurred beyond a reasonable doubt, a jury should acquit you.

Discuss your Options with a Los Angeles Insurance Fraud Lawyer

The stress and financial strain that come with fraud allegations can be substantial. Amidst the worry is the very real possibility of a conviction and the jail time that comes with it. However, the right attorney can help you build the strongest defense possible. To learn about your chances of prevailing at trial and avoiding a conviction, contact the Sigal Law Group for a free consultation.