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When are insurance fraud offenses prosecuted?

On Behalf of | Jul 19, 2023 | Federal Criminal Defense, State Criminal Defense

Consumers acquire insurance for many reasons. Its sole purpose is to provide a specific level of protection against costly damages, such as with health or auto insurance coverage. However, some individuals could take advantage of these products and fraudulently file claims or collect benefits, also known as insurance fraud.

This type of fraud is a serious concern because it could lead to billions of losses, affecting taxes, insurance premiums and prices. Specific types of fraud, including staged motor vehicle accidents or inappropriate medical treatments, could endanger innocent and unsuspecting victims, risking fatalities and physical harm.

Authorities could charge violators with felony charges for severe cases of insurance fraud. However, they can only prosecute if the following factors exist:

  • Evidence must show the suspect’s specific intent to defraud.
  • The suspect behaved or acted unlawfully, such as committing misrepresentation or false statements.
  • The suspect’s intent reconciled with how they behaved or acted.
  • The offense resulted in potential or actual loss.

With insurance fraud, loss is not a requirement for prosecution. If the intent existed, authorities could go after the suspect. Still, the case details could affect various aspects of the case. These elements could require supporting evidence to make the offense valid.

Victimizing vulnerable individuals

Out of all consumers, vulnerable groups tend to suffer the most from insurance fraud. Sometimes, perpetrators target seniors, immigrants and businesses that rely on their insurance coverage for security. Its damages could accumulate to around $15 billion annually.

Whether a lone perpetrator or a widescale organization, insurance fraud suspects could face severe punishments, including fines, restitution and imprisonment. Authorities take these offenses seriously, investigating any suspected insurance fraud cases and prosecuting them as needed.