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Insurance Fraud Defense Lawyer in San Diego

In the state of California, insurance fraud is considered a very serious offense. Not only will a guilty verdict deal a blow to your reputation and criminal record, you could find yourself serving time in jail or prison, paying heavy fines and restitution, or even being deprived of the opportunity to get an insurance policy in the future. If you are facing charges, I encourage you to contact me for insurance fraud defense in San Diego.

Unlike many other white collar crimes, insurance fraud can be prosecuted at both the state and federal level. Though federal legislation does not distinctly govern insurance fraud, the Violent Crime and Law Enforcement Act of 1994 allows federal prosecutors to claim jurisdiction in cases that effect interstate commerce. If charged as a felony at the state level in California, insurance fraud is punishable by up to 5 years in prison and a fine of $50,000. In some federal cases, violators can be sentenced up to 20 years in federal prison and face fines as high as $250,000.

Don’t wait to start fighting your case. Call me today at (619) 202-5583 to get started.

Types of Insurance Fraud

Each type of insurance has nuances and specifics relating to how fraud can be perpetrated. For example, filing a false claim relating specifically to mold damage is unique to property insurance, while suspicious slip and fall claims are unique to medical insurance.

Auto Insurance Fraud

One of the more common ways that auto insurance fraud is perpetrated is by filing a false claim. This could be as simple as padding numbers or exaggerating damage on paperwork.

Other forms of auto insurance fraud include, but are not limited to:

  • Staging a car accident
  • Deliberately damaging an insured vehicle
  • Charging a customer for auto repairs that is excessive of the original estimate

For the most part, auto insurance fraud is charged as a felony, meaning that you could spend anywhere from 16 months to 5 years in prison and have to pay a fine of up to $50,000 or twice the amount of the total that was defrauded (whichever figure is higher). Misdemeanors can land you in jail for up to a year and have you paying a fine of up to $1,000.

Unemployment Insurance Fraud

Both employees and employers can be charged with unemployment insurance fraud depending on the circumstances of the case.

Employees can be investigated based on a number of reasons, such as:

  • Collecting benefits in a state in which you do not reside
  • Falsely claiming to seek new employment
  • Attempting to collect unemployment benefits from two or more states

An employer, on the other hand, may be investigated for providing false information regarding why an employee was terminated or for willfully obstructing an employee’s right to unemployment benefits.

Regardless of whether you are employer or employee, a guilty verdict in a case involving unemployment insurance fraud could lead to 3 years in prison along with a fine of up to $20,000.

Health Insurance Fraud

Health insurance fraud (sometimes referred to as Medi-Cal fraud) can be summarized as knowingly submitting an insurance claim that contains incorrect information with the intent to defraud an insurance company.

For a felony conviction, the penalties include 2-5 years in prison and a fee of up to $50,000 or twice the total sum of money that was gained through fraud. For a misdemeanor conviction, you can expect up to a year in jail, a fine of up to $10,000, or both. These crimes are considered wobblers, meaning that the prosecution has discretion over filing the charge as a felony or misdemeanor.

Workers’ Comp Fraud

A felony conviction can get you two, three, or five years in prison. Those convicted will also need to pay fines as high as $150,000. The consequences of a misdemeanor are considerably more lenient with a maximum of a year in jail.

Workers’ comp fraud can be charged for a variety of reasons, including:

  • Knowingly helping a person commit fraud
  • Making numerous claims for the same injury
  • Submitting false information for the purpose of either obtaining or denying an employee from receiving workers’ comp benefits

Regardless of the details of your case, my firm is ready to provide you with qualified legal representation.

Defense Against Insurance Fraud Charges

Though being charged with insurance fraud can be intimidating, there are defensive strategies that my firm can take on your behalf.

Insurance fraud is considered an “intent crime,” meaning that the prosecution must prove beyond a reasonable doubt that you not only committed fraud, but that you intended to do so. Both must be proven—the intent to commit fraud without perpetrating on its own is not sufficient evidence for a guilty verdict. Intent is famously difficult to prove, and the burden of proof is on the shoulders of the prosecution. This is one of the most common defenses against insurance fraud charges.

Another defense for insurance fraud is mistake of fact. Sometimes insurance companies and investigators make errors in analyzing claims and cases, meaning that you could be dragged into a stressful legal situation without having committed any crime. Likewise, the idea that one could make an error on a form is completely reasonable. Remember, without intent, you cannot be charged with insurance fraud.

Further, the statute of limitations for insurance fraud is very short. It is three years at the state level and five years at the federal level. The gears of law, bureaucracy, and litigation all turn slowly. Combined with the fact that white collar crimes generally take a long time to investigate, you may be able to avoid charges altogether.

If none of these options work for your case, I will work diligently to negotiate with the prosecution regarding a plea deal or outright dismissal of the case. We all make mistakes, and the full extent of legal consequences is not always necessary to convince others that you acknowledge and have learned from your mistake.

If you need an insurance fraud defense lawyer in San Diego, I am here to help. At Kern Law, APC, I fight for my clients relentlessly and do everything I can to reach a favorable outcome.

I would love to hear more about your case. Please give me a call at (619) 202-5583 or contact me online. I look forward to meeting you.