New York Insurance Fraud is an all-encompassing term that covers a wide range of white-collar criminal conduct that is aggressively prosecuted by Assistant District Attorneys all across New York State. If you believe that you are under investigation for committing New York Insurance Fraud, it is essential that you consult an experienced criminal defense attorney for assistance as soon as practicable. These types of cases can not only result in substantial civil fines and penalties, but also in felony charges being filed against you.

What Are Examples of New York Insurance Fraud?

Common examples of cases that are prosecuted as New York Insurance Fraud include:

  • Falsifying health information to qualify for insurance,
  • Obtaining fraudulent loans,
  • Falsifying a death to collect life insurance proceeds,
  • Reporting a car stolen, when in fact it has been sold to a “chop shop” to commit fraud against the insurance company,
  • Staging car accidents in order to recover damages for alleged bodily injuries,
  • Medical providers billing for services that were never provided,
  • Falsely claiming property damage to collect home insurance,
  • Faking a disability and collecting Workers Compensation.
  • Claiming to be out of work to collect unemployment benefits, while working “under the table.”

What Criminal Law Charges Apply to New York Insurance Fraud?

Under New York Penal Law, there are six different charges that apply to Insurance Fraud. Specifically, they are:

Insurance Fraud in the First Degree is the most serious of these charges, while Insurance Fraud in the Fifth Degree is the least serious. Additionally, the Aggravated Insurance charge can be filed against individuals who has committed another fraudulent act in the past 5 years. Nonetheless, prosecution for any of these charges can subject you to a permanent criminal record. The difference in these charges is explained in greater detail below, but generally depends on the value of the dollar amount obtained through the fraud.

New York Insurance Fraud in the Fifth Degree

Insurance Fraud in the Fifth Degree is codified in NY Penal Law Section 176.10. Under this statute, a person is guilty of Insurance Fraud in the Fifth Degree when s/he commits a fraudulent insurance act.

What is considered to be a Fraudulent Insurance Act?

The term “Fraudulent Insurance Act” has a legal definition, which is codified New York Penal Law § 176.05. It is an act, which is committed by any person who “knowingly and with intent to defraud presents, causes to be presented, or prepares with knowledge or belief that it will be presented to or by an insurer” and includes the following:

  1. Any written statement as part of, or in support of, an application for the issuance of, or the rating of a commercial insurance policy, or certificate or evidence of self insurance for commercial insurance or commercial self insurance, or a claim for payment or other benefit pursuant to an insurance policy or self insurance program for commercial or personal insurance that s/he knows to:
    1. contain materially false information concerning any fact material thereto; OR
    2. conceal, for the purpose of misleading, information concerning any fact material thereto; OR
  2. Any written statement or other physical evidence as part of, or in support of, an application for the issuance of a health insurance policy, or a policy or contract or other authorization that provides or allows coverage for, membership or enrollment in, or other services of a public or private health plan, or a claim for payment, services or other benefit pursuant to such policy, contract or plan that he or she knows to:
    1. Contain materially false information concerning any material fact thereto; OR
    2. Conceal, for the purpose of misleading, information concerning any fact material thereto.

Simply put, a fraudulent insurance act is any act which is involves the filing of a false written document with the intent to deceive

Sentencing and Penalties for Insurance Fraud in the Fifth Degree

Insurance Fraud in the Fifth Degree is a Class “A” misdemeanor. As such, this charge is punishable by up to 1 year in prison. With that being said, many of these cases resolve without any jail time. Payment of restitution, or money wrongfully obtained may be required as part of a resolution of the case.

New York Insurance Fraud in the Fourth Degree

New York Insurance Fraud in the Fourth Degree is codified in New York Penal Law Section 176.15. Under this statute, a person is guilty of Insurance Fraud in the Fourth Degree when s/he

  1. Commits a fraudulent insurance act AND
  2. Thereby wrongfully takes, obtains or withholds, or attempts to wrongfully take, obtain or withhold property with a value in excess of one thousand dollars.

Simply put, this charge requires an individual to commit Insurance Fraud of the Fifth Degree and the value of the property must exceed $1,000.

Sentencing and Penalties for Insurance Fraud in the Fourth Degree

Insurance Fraud in the Fourth Degree is a Class “E” non-violent felony. As such, this charge is punishable by up to 1 1/3 to 4 years in prison. However, conditional discharges, probation, split sentences (up to 6 months jail, rest of the time on probation) are legal sentences for this New York Insurance Fraud charge.

New York Insurance Fraud in the Third Degree

Insurance Fraud in the Third Degree is codified in New York Penal Law Section 176.20. Under New York Law, a person is guilty of Insurance Fraud in the Third Degree when s/he:

  1. Commits a fraudulent insurance act AND
  2. Thereby wrongfully takes, obtainsor withholds, or attempts to wrongfully take, obtain or withhold property with a value in excess of three thousand dollars.

Similar to New York Insurance Fraud in the Fourth Degree, this charge requires the commission of New York Insurance Fraud in the Fifth Degree and the value of the property exceeding $3,000.

Sentencing and Penalties for Insurance Fraud in the Third Degree

Insurance Fraud in the Third Degree is a Class “D” felony. As such, this charge is punishable by up to 2 1/3 to 7 years in prison. Importantly, this charge can

New York Insurance Fraud in the Second Degree

(NY Penal Law Section 176.25)

§ 176.25 Insurance fraud in the second degree.

A person is guilty of insurance fraud in the second degree when he
commits a fraudulent insurance act and thereby wrongfully takes, obtains
or withholds, or attempts to wrongfully take, obtain or withhold
property with a value in excess of fifty thousand dollars.

Sentencing and Penalties for Insurance Fraud in the Second Degree

Insurance fraud in the second degree is a class C felony.

New York Insurance Fraud in the First Degree

(NY Penal Law Section 176.30)

A person is guilty of insurance fraud in the first degree when he
commits a fraudulent insurance act and thereby wrongfully takes, obtains
or withholds, or attempts to wrongfully take, obtain or withhold
property with a value in excess of one million dollars.

Sentencing and Penalties for Insurance Fraud in the First Degree

Insurance fraud in the first degree is a class B felony.

New York Aggravated Insurance Fraud

(NY Penal Law Section 176.35)

§ 176.35 Aggravated insurance fraud.

A person is guilty of aggravated insurance fraud in the fourth degree
when he commits a fraudulent insurance act, and has been previously
convicted within the preceding five years of any offense, an essential
element of which is the commission of a fraudulent insurance act.

Sentencing and Penalties for Aggravated Insurance Fraud

Aggravated insurance fraud in the fourth degree is a class D felony.

Which Agencies Investigate New York Insurance Fraud?

Insurance companies have private investigators who work for them to investigate the claims. Accountants investigate unusual spending.

How Are New York Insurance Fraud Investigations Handled?

What Should I Do If I Accidentally Committed Insurance Fraud?

WHAT CAN I DO IF I’M INVESTIGATED FOR INSURANCE FRAUD IN NYC?

The first thing to remember is not to speak with investigators. If they come to you with questions, you can assume that they already know most answers. Don’t make it worse by making statements that will incriminate you. Besides, it won’t even help you to “spill” everything to the investigators.

The way to handle it is to ask for the investigator’s contact information and tell them (politely but firmly) that you will speak with your attorney first and the attorney will get back to them.

We’ve had countless cases where we intervened on behalf of our clients early in the process and were able to prevent arrest and prosecution. There were so many cases where our clients were already arrested but the outcome was much better than it could have been.

Contact Top Rated New York Insurance Fraud Defense Attorneys

If you suspect that you are under investigation for New York Insurance Fraud, you need to consult a top rated New York Insurance Defense attorney as soon as possible. We have defended many Insurance Fraud cases both in New York State and federal courts and look forward to sharing our knowledge with you. Contact us today to schedule your initial consultation.