I’ve Been Charged with Insurance Fraud–What Do I Do? 

Understanding what Fraud is, the Penalties for Committing Fraud, and How You Can Defend Yourself 

First, Understand what Fraud Is and what Fraud Is Not

Fraud occurs when someone knowingly lies to obtain a benefit or advantage to which they are not otherwise entitled or someone knowingly denies a benefit that is due and to which someone is entitled. In the state of New Jersey, insurance fraud is considered a third degree felony which can result in a sentence of 3-5 years in prison and up to $15,000 in fines, depending on the offense. 

Insurance fraud can be committed in many forms; usually the fraud exists because of a false statement or omission of information. 

Let’s review the most common types of fraud, so you can better understand how the law categorizes these actions. 

Common Types of Insurance Fraud

  • Automobile Insurance 
  • Health Care Insurance
  • Disability Insurance 
  • Unemployment Insurance 
  • Life Insurance
  • Worker’s Comp. Insurance 
  • Homeowner’s Insurance
  • Medicaid Insurance 

So these are the broader categories of fraud, but what about the actions that might occur within those categories that constitute potential acts of fraud. 

In New Jersey, there are 5 Elements of Fraud under common law, 

(1) A material misrepresentation of a presently existing or past fact

(2) Knowledge or belief by the defendant of its falsity

(3) An intention that the other person rely on it

(4) Reasonable reliance thereon by the other person

(5) Resulting damages. 

These elements must be proven beyond a reasonable doubt for a fraud conviction to be substantiated. 

Penalties for Committing Fraud in New Jersey 

New Jersey is unique in that the State Attorney General’s office houses its own insurance fraud agency, rightly named Office of the Insurance Fraud Prosecutor (OIFP). 

The Office of the Insurance Fraud Prosecutor (OIFP) is responsible for investigating, prosecuting, and deterring insurance fraud and serves as the statewide coordinator for all anti-insurance fraud efforts in New Jersey. With more than 50 detectives and 20 prosecutors, OIFP investigates a wide range of insurance fraud schemes and serves as a clearinghouse for cases referred by the public, insurance companies, the Medicaid Program, and other law enforcement agencies. 

Some fraud crimes that have lower monetary rewards for the person committing the fraud are considered disorderly persons offenses and receive lower fines and only months long jail sentences. 

However, other insurance fraud convictions can carry fines from $15,000 to $150,000 depending on the specifics of the crime. Prison sentences can be anywhere from 18 months to 10 years, also depending on the crime. 

Defense Strategies Against Fraud Charges 

The key word that the prosecution has to prove in any insurance fraud case is Intent. It must be proven that the accused knowingly committed the fraud with the intent to reap benefits from a false statement or omission of information considering the insurance. 

The prosecution must also prove that it was in fact the accused who committed the fraud. Do they have the correct person who is responsible for the fraud? 

It must also be proven that the person accused of the insurance fraud made the decision themself to commit the act of fraud. Were they misled into committing an act of fraud? 

Another thing to consider is how the evidence proving the fraud was collected. Were proper warrants issued for the evidence? Was the accused notified of their rights?

The most important thing to consider in the defense of a fraud charge is choosing who will represent you in your case.

Why You Need an Attorney to Represent You If You are Facing an Insurance Fraud Conviction

An insurance fraud conviction can change the path of your life forever. A conviction could mean a permanent criminal record, sizable fines, prison time, and affect your ability to get a job. 

Securing an experienced, loyal attorney to help you through the process of your defense is the most important step in protecting the life of yourself and the lives of your family. Having a lawyer on your side who knows the ins and out of the legal process is undoubtedly an advantage to your defense. 

If you find yourself in the position of being accused/charged with insurance fraud, contact an experienced criminal defense attorney at the Law Offices of Robert J. DeGroot. With over 50 years of experience in criminal defense in New Jersey, they will protect you and your rights. 

Contact us today for your confidential consultation!