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Insurance Fraud

Insurance Fraud

Insurance fraud is a widespread crime that involves policy holders defrauding insurance companies or insurance agents or agencies defrauding their customers. It can involve people who’ve never committed a crime but who are desperate for money or highly organized groups that systematically commit fraud on a wide scale. If you think you’re being investigated for insurance fraud in the Fort Worth, Texas, area or have been charged with the crime, we may be able to help.

What is insurance fraud?

Insurance fraud is any act done with the intent to collect an improper payment from an insurer or insurance customer. Insurance fraud can be committed by those of us in all walks of life. Doctors, lawyers, business owners, chiropractors, insurance agents and people in positions of trust have all been convicted of the crime.

Because insurance fraud is so common it drives up insurance costs for all of us who buy insurance. It’s been estimated that insurance fraud totals about $150 billion a year. It happens most often when an insured party,

  • Makes a false or exaggerated insurance claim,
  • Seeks compensation for injuries or losses that were not actually suffered,
  • Injuries or losses were suffered but are exaggerated, or,
  • They actually occurred but the reason is fabricated to be covered by an insurance policy.

Consumers can also be the victims of insurance fraud through,

  • The unlicensed sale of bogus insurance coverage, or,
  • An insurance agent, broker or agency embezzles or steals insurance premiums paid by clients.

Insurance fraud scheme generally fall into two categories,

  • Hard fraud: Accidents are faked, injuries are fabricated, something sold is reported as being stolen, property is intentionally destroyed by arson or some other cause to collect on a claim. Those involved may act on their own or schemes by organized crime could steal millions of dollars.
  • Soft fraud: Those who normally are honest tell lies or exaggerations to their insurance company to file or inflate a claim.

How is insurance fraud investigated and prosecuted in Texas?

Insurance fraud is investigated by the Texas Department of Insurance (TDI) Fraud Unit, a state law enforcement agency. The unit employs peace officers, prosecutors, criminal analysts, administrative and support staff. They may also prosecute related crimes such as forgery, engaging in organized criminal activity, money laundering, tampering with governmental records, misapplication of fiduciary property, securing execution of a document by deception and theft.

The TDI published its top cases of insurance fraud for 2017, which include,

  • A Dallas County resident recruited twelve others to get involved in a scheme to burn down residences. He owned a restoration business and used the arson to generate business. He pleaded guilty to engaging in organized criminal activity and was sentenced to six years in prison.
  • A licensed insurance agent in Bexar County used Social Security numbers, dates of birth and addresses to create fictitious people to apply for life insurance policies. The agent collected commissions from the sales and then allowed the policies to cancel. He was sentenced to five years in prison and ordered to pay $52,364 in restitution.
  • A Texas woman ran an internet based business selling fake insurance certificates and other documents. Victims thought they were insured but their premiums were deposited directly into her bank account. She was sentenced to two years in prison.
  • A Tarrant County woman fabricated medical bills and submitted claims for injuries she never suffered. She pleaded guilty to third degree felony insurance fraud and was sentenced to five years of probation and ordered to pay $53,735 in restitution.
  • A Texas man staged an accident by repeatedly hitting a tree then reporting an accident involving an unknown driver who supposedly swerved into his lane and caused him to drive off the road. He and three other people made false claims for injuries. He was sentenced to six years in prison and ordered to pay $9,000 in restitution.

In Texas potential penalties for committing insurance fraud vary depending on the amount or value of the fraudulent claim. If it’s less than $50 there would be a $500 fine. It the value of the fraudulent claim is $200,000 or more this would be a first degree felony, which carries a possible sentence of five to 99 years in a state prison and/or a fine of up to $10,000.

What should I do if I’m being investigated or charged with Insurance Fraud?

As an AV rated attorney, Bruce Beasley has over 25 years of legal experience, both as a former prosecutor and criminal defense attorney. Get the best defense possible from an Insurance Fraud lawyer serving Fort Worth, Texas, the surrounding area, the State of Texas and across the Country.  Attorney Bruce Beasley understands how important it is for our clients to feel comfortable with their attorney, and makes every effort to earn your trust, keeping you informed throughout the process. If you or your company requires an Insurance Fraud criminal defense lawyer, schedule a free consultation with Bruce Beasley by calling us at 817.338.1877, or you may contact the BEASLEY LAW FIRM by filling out our online contact form.