J. Gordon Dees, Attorney At Law - A Professional Corporation

Types of Insurance Fraud

There are numerous types of insurance fraud. Insurance fraud encompasses fraudulent claims made by the defendant with the specific intent to defraud the insurer. Some of the types of fraud claims include:

  • Property fraud claims.
  • Automobile fraud claims.
  • Life insurance fraud claims.
  • Healthcare fraud claims.

Property Fraud Claims

The defendant may file a property insurance claim if the property that she owns has been damaged or destroyed. With respect to fraudulent claims, arson is a big area that is often found in conjunction with fraudulent claims made to property insurers. Arson is one of the most heavily prosecuted offenses in conjunction with fraudulent insurance claims. There are many reasons why arson is heavily prosecuted. First, there is real danger to human life involved in any arson situation. If it is determined that arson occurred, any person who stood to profit from the destruction of the property is a suspect in the arson investigation. Second, insurers concentrate their investigatory budgets on arson because of the prevalence of the crime along with the savings that the insurers may realize as a result of discovering that arson occurred.

Often times the defendant is charged with arson and insurance fraud. Arson is a felony in all jurisdictions, whereas insurance fraud is not a felony in all jurisdictions.

Automobile Fraud Claims

Insurance fraud with respect to automobile claims is widespread. Automobiles are supposed to be insured in the United States and most individuals keep their automobiles insured. There are numerous types of automobile fraud claims that one may make. Some of the types of claims include:

  • Filing a false theft report.
  • Filing a false injury report.
  • Filing a false accident report.
  • Filing a false damage report.
  • Filing a claim that the automobile was wrecked.

In addition to individuals filing fraudulent automobile claims, others may also be involved in filing false claims. Insurance adjusters, repair shops, dealerships, and other co-conspirators may be involved in filing automobile fraud claims.

Life Insurance Fraud Claims

The most prevalent type of insurance fraud claims involves life insurance. Some cases also involve murder, kidnapping, assault, and other charges. Fraudulent life insurance claims are made in an attempt to collect the proceeds of another's life insurance policy although the beneficiary is not actually entitled to the proceeds. Insurers spend a lot of money investigating suspicious life insurance claims in attempt to avoid paying on any fraudulent claims. As with other insurance fraud claims, the defendant may also be charged with other offenses other than simply with the fraud offense.

Healthcare Insurance Fraud Claims

Healthcare fraud claims are also commonly prosecuted fraud claims. The defendant commits healthcare fraud when either the defendant submits a fraudulent claim or the defendant attempts to have services covered which otherwise would not be covered by insurance. For example, if a medical office billed a procedure under one code when it actually should have been billed under a different code, which would not have been covered by the patient's insurance, the medical office may be prosecuted for filing a fraudulent claim.

Copyright 2010 LexisNexis, a division of Reed Elsevier Inc.

Areas of Practice

  • Assault
  • Criminal Conspiracy
  • Criminal Fraud
  • Criminal trials and investigations including Grand Jury investigations in all Texas State and Federal Courts in criminal matters including Homicide Murder
  • Defense of Claims by State and Federal Regulatory Agencies and Defense of White Collar Crimes
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