Insurance policies are intended to provide policyholders with protection from financial loss. Whether it is home, auto, health, or some other kind of insurance, consumers are expected to be honest when submitting their initial paperwork and any subsequent claims.
In some cases, policyholders may exaggerate or completely fabricate losses or damages they sustained in an effort to financially profit from their claims. When policyholders allegedly lie about the information in an insurance application or claim, they can face very serious criminal charges.
Lawyer for Insurance Fraud in San Antonio, Texas
If you think that you are currently under investigation or have already been arrested for allegedly submitting a fraudulent insurance application or claim, we suggest you immediately retain legal counsel. Goldstein & Orr has been defending clients accused of insurance fraud and other white collar offenses throughout Bexar County since 1968.
Gerry Goldstein and Cynthia Orr are San Antonio criminal defense attorneys who are both dual Board Certified in Criminal Law and Criminal Appellate Law by the Texas Board of Legal Specialization. Call (210) 226-1463 or submit an online contact form right now to receive a complete evaluation of your case during a free, confidential consultation.
Overview of Insurance Fraud in Bexar County
- How can a person be charged insurance fraud?
- What Are the Different Types of Insurance Fraud?
- What are the consequences if an alleged offender is convicted of this crime?
- Where can I find more information about insurance fraud in Texas?
Alleged offenders will be charged with a state jail felony if they, with intent to defraud or deceive an insurer and in support of an application for an insurance policy, do either of the following:
- Prepare or cause to be prepared a statement that they know contain false or misleading material information and was presented to an insurer; or
- Present or cause to be presented to an insurer a statement that they know contains false or misleading material information.
Criminal charges become more serious when, with intent to defraud or deceive an insurer, the alleged offenders do any of the following:
- In support of a claim for payment under an insurance policy, they prepare or cause to be prepared a statement that they know contain false or misleading material information and was presented to an insurer;
- In support of a claim for payment under an insurance policy, they present or cause to be presented to an insurer a statement that they know contains false or misleading material information; or
- They solicit, offer, pay, or receive a benefit in connection with the furnishing of goods or services for which a claim for payment is submitted under an insurance policy.
In any of these cases, the classification of the crime depends on the value of the claim. If the value of a claim is not readily ascertainable, the value of the claim will either be the fair market value, at the time and place of the offense, of the goods or services that are the subject of the claim or the cost of replacing the goods or services that are the subject of the claim within a reasonable time after the claim.
Depending on the value of the claim, the crime will be classified as follows
- Class C Misdemeanor if the value of the claim is less than $100;
- Class B Misdemeanor if the value of the claim is $100 or more but less than $750;
- Class A Misdemeanor if the value of the claim is $750 or more but less than $2,500;
- State Jail Felony if the value of the claim is $2,500 or more but less than $30,000;
- Third-Degree Felony if the value of the claim is $30,000 or more but less than $150,000;
- Second-Degree Felony if the value of the claim is $150,000 or more but less than $300,000; or
- First-Degree Felony if the value of the claim is $300,000 or more, or if the alleged act was committed in connection with the commission of the offense places a person at risk of death or serious bodily injury.
Types of Insurance Fraud
Generally, a person commits insurance fraud when they lie or misrepresent facts for some type of financial gain. Listed below are common insurance fraud schemes commonly prosecuted in both State and federal courts.
- Unlicensed Insurance— Selling insurance policies without a valid license is a criminal offense. These companies rarely meet the State’s required financial criteria and usually don’t have the money to provide payouts to claims. Unlicensed insurance companies will collect premiums and sometimes provide small payouts to minor claims. However, once an expensive claim arises, the company will be unable to provide coverage.
- Health Care Provider Fraud – Over-billing an insurance company for provided services is another common type of fraud. Often this occurs when a doctor or hospital asks for payments for services they never provided, unnecessary tests, and/or procedures.
- Life Insurance Fraud – Due to their vulnerability, seniors are often targeting of life insurance fraud. Those who target these individuals tend to use high-pressure tactics, will urge the person they are talking to cash in their existing insurance, or they may contact the victim unsolicited.
- Auto Accident Fraud – One of the most common types of insurance fraud is related to auto accident policies. An individual may paddle their claim or file a claim for an accident or theft that never occurred. In some cases, individuals will even create a collision in order to receive a payout.
- Mortgage Fraud – Using misleading or false statements to obtain a mortgage loan is referred to as mortgage fraud. That includes diverting escrow funds at settlement.
If alleged offenders are convicted of an attempt to defraud an insurance company, they can face stiff maximum sentences under state law. Depending on the value of the claim allegedly involved, the possible consequences of a conviction for insurance are as follows:
- Class C Misdemeanor — Fine of up to $500;
- Class B Misdemeanor — Up to 180 days in jail and/or a fine of up to $2,000;
- Class A Misdemeanor — Up to one year in jail and/or a fine of up to $4,000;
- State Jail Felony — Up to two years in jail and/or a fine of up to $10,000;
- Third-Degree Felony — Up to five years in prison and/or a fine of up to $10,000;
- Second-Degree Felony — Up to 20 years in prison and/or a fine of up to $10,000; or
- First-Degree Felony— Up to 99 years or life in prison and/or a fine of up to $10,000.
It is important to remember that in order for a person to be convicted of defrauding or attempting to defraud an insurance company, a prosecutor will need to prove beyond a reasonable doubt that the alleged offender knowingly intended to deceive the insurer. An experienced attorney will know how to investigate your case and may be able to present evidence that the errors in your case were the result of an honest mistake.
Texas Department of Insurance (TDI) | TDI Fraud Unit — The stated mission of the TDI is to “protect insurance consumers by regulating the insurance industry fairly and diligently, promoting a stable and competitive market, and providing information that makes a difference.” The TDI Fraud Unit employs peace officers, non-commissioned investigators, prosecutors, and criminal analysts to work on a variety of cases. On this website, you can find fast facts about the Fraud Unit, learn more about insurance fraud cases, and read recent news updates.
Coalition Against Insurance Fraud — This alliance of consumers, insurance companies, government agencies, and others “empowers consumers to fight back, helps fraud fighters better detect this crime and deters more people from committing fraud.” On this website, you can find fraud news, stats, and videos as well as scam alerts. You can also learn more about the impact of fraud and why you should worry about it.
Texas Laws for Insurance Fraud — Visit the official website for the Texas Penal Code to learn more about the various laws regarding insurance fraud. Access the site to learn more about the elements of insurance fraud, penalties, admissible defenses, and other important information.
Lawyer for Insurance Fraud in San Antonio, TX
Have you been arrested or do you think that you could be the target of an investigation for allegedly defrauding an insurance company in Texas? You may be able to get these criminal charges reduced or dismissed by having skilled legal representation.
Goldstein & Orr serves clients throughout the greater Bexar County area. Our proven criminal defense attorneys in San Antonio can review your case as soon as you call (210) 226-1463 for a free consultation.