False Claim Against Insurance Company

What is a fraudulent insurance or personal injury claim? 

Fraudulence is legally defined as deliberately trying to profit from a deceitful act. A person can commit insurance fraud by filing a false claim. Filing a claim for compensation for pre-existing or nonexistent injuries is personal injury insurance fraud. 

People can also commit fraud when they have a valid claim. A person can be found guilty of fraud if they claim their injuries are more severe than they are so they can receive a higher settlement.

Types of false claims 

Insurance fraud cases fall into one of the following categories:

• Opportunistic fraud: People who commit opportunistic fraud don’t plan on getting injured or being in an accident. However, when they find themselves in a situation where they can file a claim, they embellish their injuries to receive a higher settlement. 
• Premeditated fraud: Premeditated fraud means committing a deliberate act with the intention of receiving an insurance settlement. A person having financial issues may get rid of their vehicle and claim it was stolen so they can seek compensation. Others may deliberately injure themselves so they can file a personal injury claim.

How common are false personal injury claims?

Somewhere between one in ten and one in five insurance claims are false. False claims can apply to several types of insurance claims, including the following:

• Car accident claims: False car accident claims could include property damage claims after a person stages a car accident or a person filing a claim for a fake injury they say they received in a car accident.
• Life insurance claims: Making untrue statements to receive a life insurance payout is fraud. An example would be falsifying documentation so the reported cause of death qualifies for payment.
• Medicare claims: People may make false statements to medical professionals to receive medical benefits they don’t need. Medical professionals also commit Medicare fraud if they file a claim for tests or services they didn’t provide to their patients. 
• Property claims: People may attempt to claim pre-existing damage when filing a claim for storm damage to their home or vehicle. People may also sell or pretend to lose valuables and file an insurance claim, alleging they were stolen. 
• Slip and fall claims: Slip-and-fall accidents can cause severe injuries, but if a person deliberately slips to file a claim or tries to blame the accident for pre-existing injuries, they’re committing insurance fraud.
• Workers compensation: Workers compensation reimburses employees for medical expenses and lost wages when injured at work. When an employee fakes or embellishes an injury to receive higher benefits, they commit insurance fraud.
• Wrongful death claims: Suppose a person dies after a car accident. They had a pre-existing medical condition that caused their death, but their family members misrepresented the cause and sued the person responsible for the accident. This is another example of insurance fraud. 

Consequences for filing false personal injury claims 

Although an individual may face the consequences of filing false insurance claims, this type of fraud also impacts society as a whole.

Impact on those filing false claims 

When an insurance company determines someone’s filing a false claim, they may deny the person’s claim. Those embellishing a legitimate claim to receive more money may not receive any money for their legitimate injuries or losses.

Sometimes, the insurance company determines a claim was fraudulent after they pay a settlement. They can take legal steps to recover the total payout, the cost of their investigation, and any legal fees incurred. 

Insurance companies may provide information to law enforcement agencies, who may initiate a criminal investigation. Those charged and found guilty of insurance fraud in Nevada may receive a prison sentence of four years or less and a fine of $5,000 or less. Those convicted may also be financially responsible for the cost of the criminal investigation and ordered to repay the insurance company for any funds received from the fraudulent claim. 

Impact on society 

The costs of insurance fraud exceed $300 billion per year. These costs include almost $75 billion in life insurance fraud and approximately $60 billion in Medicare fraud costs. Insurance companies include investigative costs and insurance fraud losses in premiums to all consumers, with families paying up to $700 more per year to cover their insurance company’s fraud-related expenses. 

How can an attorney help you with a false claim against you?

Suppose you’re in a car accident, and someone files a false claim against you. You may be able to recover costs incurred from the false claim. When you hire a car accident lawyer from Adam S. Kutner, Injury Attorneys, we will review accident reports, witness statements, video footage, and other evidence to prove your innocence.