Insurance Fraud

As economic times become more difficult, the more likely it is for citizens to look for ways to alleviate their financial grief. Insurance fraud can take many forms and is considered a white collar crime. Generally, insurance fraud involves making false statements or intentional misrepresentations to deceive an insurance carrier.

The most common types of insurance fraud include:

  • Auto insurance fraud
  • Medicaid/Medicare fraud
  • Property and home insurance fraud
  • Health insurance fraud
  • Life insurance fraud

So, for example, very simply, if you slip on something that spilled inside a store and make a claim against the insurance company for a broken leg, but your leg wasn’t really broken, you are committing insurance fraud.  Insurance fraud can be as simple as that example or as complicated as a scheme in which a medical clinic hires people to recruit patients after, for example, car accidents – real or staged - or falls.  The clinic then bills the insurance company or Medicaid/Medicare for procedures that were not done or overbills for procedures that were done.  The clinic sometimes also recruits attorneys to file claims for these patients.

If you or someone you know has committed insurance fraud, it is important that you seek legal representation.

Defense Attorneys for Insurance Fraud in New York

A person charged with insurance fraud may have to face felony charges. When looking for an attorney, you want someone who has years of experience who can put your interests first. The attorneys at Law Office of Rochelle S. Berliner are skilled and specialized in criminal defense under New York law.

Law Office of Rochelle S. Berliner is ready to protect your freedom. Our attorneys care about each case, and regard our clients with the utmost care. We have the legal background and knowledge to attack any type of insurance fraud. With efficient planning and investigation, our attorneys can help you obtain the best possible result. The attorneys at Law Office of Rochelle S. Berliner are proudly members of several attorney organizations such as the National Association of Criminal Defense Lawyers (NACDL), and the New York State Association of Criminal Defense Lawyers (NYSACDL).

The attorneys at Law Office of Rochelle S. Berliner represent those accused of insurance fraud throughout Queens, Manhattan, The Bronx, Brooklyn, Nassau and Suffolk.

Take the first step to your defense today. Call 718-261-5600 or submit an online contact form for your free consultation.

Overview for Insurance Fraud in New York


Insurance Fraud Defined under New York Law

Under New York Penal Law § 176.05 insurance fraud is defined as an fraudulent act committed with the intent to defraud with the belief that it will be presented to an insurer, self insurer, or any insurance agent.

A few examples of insurance fraud in New York include:

Acts that are considered fraudulent under New York law include:

  • Any written statement as part of, or in support of, an application for the issuance of or rating of a commercial insurance policy. This includes any written statement that is an certificate of self insurance for commercial insurance, or commercial self insurance, a claim for payment pursuant to an insurance policy or self insurance program for commercial or personal insurance that he or she knows which:
    • Contains materially false information concerning any material fact; or
    • Conceals, for the purpose of misleading, any information concerning any material fact.
  • Any written statement or other physical evidence as part of, or in support of, an application for the issuance of a health insurance policy. It can also consist of a policy or contract or other authorization that provides or allows coverage for, membership or enrollment in, or other services of a public or private health plan. This includes a claim for payment, services, or other benefit pursuant to such policy, contract or plan that he or she knows which:
    • Contains materially false information concerning any material fact; or
    • Conceals, for the purpose of misleading, information concerning any material fact.

Insurance Fraud Terms Defined in New York 

The laws surrounding insurance fraud are complex and contain many legal terms. The following are definitions that are applicable to the laws and regulations regarding insurance fraud.

  • Insurance Policy – An insurance contract by New York Insurance Law §1101 (a), which includes reinsurance contracts, purported insurance policies, and purported reinsurance contracts.
  • Statement - Includes, but is not limited to, any notice, proof of loss, invoice, bill of lading, estimate of property damages, account, bill for services, prescription, diagnosis, hospital or doctor records, x-rays, test result, or other evidence of injury, loss, or expense.
  • Personal Insurance – Refers to a policy of insurance which insures a natural person against any of the following circumstances:
    • Loss or damage of real property which is used predominantly for residential purposes. Additionally it consists of not more than four dwelling units, other than hotels, motels, and rooming houses;
    • Loss or damage to personal property which is not used to conduct business;
    • Other liabilities for loss of, damage to, or injury to persons or property, not arising from the conduct of business;
    • Death, death by personal injury, continuation of life, personal injury by accident, sickness, or disease.
  • Commercial Insurance – Refers to insurance other than personal insurance, and can include insurance that provides disability benefits, insurance providing workers with compensation benefits, and any program of self insurance which provides similar benefits.

Penalties for Insurance Fraud in Queens County, NY

The legal consequences for insurance fraud range from a Class A misdemeanor to a Class D felony. Penalties for insurance fraud depend on the amount which is wrongfully taken. The following are the different legal repercussions one can face if he or she commits the act of insurance fraud.

  • Insurance Fraud in the Fifth Degree – Any person, who commits a fraudulent insurance act, is considered guilty of insurance fraud. This is a Class A misdemeanor, and the penalties include:
    • A possible fine of up to $1,000; and
    • Possible jail term for up to one year.

  • Insurance Fraud in the Fourth Degree – A person commits the act of insurance fraud and wrongfully takes, obtains, withholds, or attempts to wrongfully take property with a value of $1,000. This is a Class E felony, and the penalties include:
    • A possible fine up to $5,000; and
    • Possible prison sentence up to four years.

  • Insurance Fraud in the Third Degree – A person is considered guilty of third degree insurance fraud if he or she commits a fraudulent insurance act and unlawfully obtains, takes, withholds, or attempts to take property with a value in excess of $3,000. This is a Class D felony. The maximum penalties for a Class D felony include:
    • A possible fine up to $5,000; and
    • Possible prison sentence up to seven years.

  • Insurance Fraud in the Second Degree – For a person to be convicted of second degree insurance fraud, he or she must commit a fraudulent insurance act and illicitly obtains takes, withholds, or attempts to take a property with a value in excess of $50,000. This is a Class C felony, and the maximum penalty includes:
    • A possible fine determined by the court; and
    • Possible prison sentence of up to seven years.

  • Insurance Fraud in the First Degree – any person, who commits a fraudulent insurance act and wrongfully takes, obtains, withholds, or attempts to wrongfully take a property with a value in excess of $1,000,000. This is a Class B felony, and the maximum penalties includes:
    • A possible fine determined by the court; and
    • Possible prison sentence of up to 25 years.

  • Aggravated Insurance Fraud –Any person who commits a fraudulent insurance act and was previously convicted within the last five years of any offense that involves insurance fraud. This is a Class D felony, and the maximum penalty include:  
    • A possible fine determined by the court; and
    • Possible prison sentence up to seven years.

Additional Resources 

New York Insurance Fraud Law § 176.00 – Visit the official website for New York's laws and regulations. See more regarding the statute's specifics, penalties, and what is considered an admissible defense. Read more regarding the terminology, conditions, and the other fraud offenses under New York law.

Insurance Fraud Bureau – Visit the official website for the State of New York. Find more information regarding the Insurance Frauds Bureau which is a part of the FFCPD's Criminal Investigations Unit. It is responsible for the detection and investigation of insurance and financial fraud.


Queens Lawyers for Insurance Fraud in New York

Are you currently being investigated for insurance fraud in the state of New York? Have you found yourself at a loss of what to do? You must be updated and aware of what will happen next in court. Any person, who has been charged with insurance fraud in New York, should contact a criminal defense attorney.

The attorneys at Law Office of Rochelle S. Berliner are professional and proficient at practicing law. We have handled many cases involving fraudulent activity in New York courts. Our mission is to be compassionate with clients and aggressive in the courtroom. Every attorney at Law Office of Rochelle S. Berliner understands the legal repercussions from insurance fraud. We will exhaust every possible resource to get you the best possible results for your case.

Stay ahead of your case. Law Office of Rochelle S. Berliner represents those accused of insurance fraud throughout Queens, Brooklyn, Manhattan, The Bronx, Nassau and Suffolk.  

Dial 718-261-5600 or schedule an online appointment for a free consultation today.


This article was last updated on November 2, 2018.

 

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Rochelle Berliner
Rochelle Berliner

Rochelle Berliner grew up in Queens, NY. She started New York Law School in January 1989 and graduated in June 1991. Immediately after law school, she started working at the New York County District Attorney’s Office, where she stayed for approximately 14 years...

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