What is the Penalty for Insurance Fraud?

Posted June 26th, 2021 by .

Categories: Criminal Defense.

Insurance fraud occurs when an individual intentionally deceives the insurance company intending to receive financial gain. It is a crime punishable by the law in all 50 states in America. Unfortunately, the company could accuse you of insurance fraud for a misunderstanding or a mistake when filing the claim. That is why you need a legal representative to protect your rights in such charges. This article discusses insurance fraud in details, including the penalty for such charges:

What are the elements of insurance fraud?

For an accused to be found guilty of insurance fraud, the prosecutor must prove some elements beyond a reasonable doubt. Failure to this, the judge automatically acquits the defendant.


1. Knowingly making a misleading statement.

Like any other fraud case, the defendant in an insurance fraud charge must have knowingly offered a misleading or false statement to the insurance company for additional gains. Therefore, they must have been aware, or the case will be invalid otherwise. Insurers have a legal duty to inform the insurance company of any mistake made when filing the claim immediately.

2. The statement has a connection to the payment or claim

The second condition is that both parties must have a connected statement reflecting payment made or intended to be made by the insurance company. That includes false statements by medical providers to insurers regarding the nature of services performed.

3. Statement is material

The false statement must also have a potential bearing on the investigation’s outcome, or otherwise, the case is invalid. In other words, the statement is material. Therefore, any individual who lies to the insurance company by making statements that do not affect the settlement from their case is not guilty of insurance fraud.

Insurance fraud penalty

If the prosecutor proves to the court all the three elements, the court finds the accused guilty of insurance fraud and offers the appropriate sentence. The nature of punishment differs according to the type of fraud. They include:

  • Felony: If the accused is guilty of a felony, they are likely to receive a two, three, or five-year jail term or a fine of $50000.
  • Misdemeanor: The punishment for this type of insurance fraud is a one-year jail term or a $10000 fine.
  • Health care benefit: This type of insurance fraud receives a punishment of six months jail term or a $1000 fine if the amount was $950 or less.
  • Property damage: Insurance fraud involving property damage results in up to five years in prison or a $50000 fine.

Defense for insurance fraud

The lawyer defends his client by proving to the court that the false statement was a mistake, there was no intent to defraud, or the statute of limitation for insurance fraud charges has expired.

Why the Law Offices of Anthony Carbone

Our expert at the Law Offices of Anthony Carbone has over 30 years of experience dealing with insurance fraud and related cases. Therefore, you can be assured that the chances of having your charges dismissed are high.  To get legal advice from a Bayonne Personal Injury Attorney or a representative to begin your defense and avoid a wrongful conviction, call the offices today at 201-829-3805.

Call Today! (201) 963-6000

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