A New York City Defense Lawyer Explains Insider Fraud Crimes
Insurance fraud exists whenever an insurance provider is asked to pay out claims that should not be covered under policy terms. False a
nd inflated claims can lead to insurers suffering losses and policyholders and others involved in the frauds scheme being unjustly enriched.
Insurance fraud is a crime. Depending upon the type of fraudulent actions taken, those involved in a fraud scheme may be charged with a state offense or a federal offense. Fraud schemes may actually result in multi-count indictments or multiple criminal charges. This is especially true when insiders who work for the insurance company participate in a fraud scam.
Bukh Law Firm, PLLC provides legal representation to insurance agents, insurance brokers, claims adjusters, insurance companies, policyholders, and others accused of involvement in a scam to defraud an insurance company. Give us a call if you have been accused of insider fraud so we can get started helping you make a case and fight for your freedom.
What is Insider Fraud
Insider fraud is fraud committed by someone who is on the “inside.” In the case of insurance fraud, the insider may be an insurance broker, a claims adjuster, or anyone else who is employed by the insurance company and who uses his or her privileged position as an employee to help perpetrate a fraud scheme.
A person involved in insider fraud may not be the one who actually submits claim paperwork to the insurance company asking for a claim to be paid. However, the insurer’s employee helps in some way to get that false claim submitted or processed.
The key question as to whether insider fraud occurred is whether false statements, misrepresentations, artifice, or material commissions were used as part of an effort to take assets from an insurer or policyholder and/or to enrich the insider or co-conspirators.
Types of Insider Fraud?
There are many different kinds of insider fraud including:
- Insurance company employees falsifying policy payments
- Insurance company employees falsifying claim settlements
- Redirecting legitimate payments to participants in a fraud scheme
- Doing business with suppliers that an employee has a private interest with
- Colluding with policyholders to make false claims
An insurance claims processor may convince co-conspirators to purchase policies and make false claims for losses that the insurer then has the company pay out. An insurance agent may convince policyholders to buy policies for the purpose of making fraudulent claims. An appraiser for an insurer may inflate the value of losses and get a kickback from the policyholder when money is paid out that is greater than the value of actual losses.
These are just a few of many examples of insider fraud. Insider fraud can sometimes be difficult for an insurance company to detect and hard for a prosecutor to prove beyond a reasonable doubt. If you can raise questions in the minds of jurors about whether fraud occurred in complicated transactions, you shouldn’t be found guilty.
Penalties for Insider Fraud
An insurance company insider could be charged with myriad criminal offenses, including embezzlement, theft, insurance fraud, and general fraud offenses. Under New York laws, the penalties for insurance fraud, larceny, and similar crimes become more serious when larger amounts of money are at stake. For example, while insurance fraud involving less than $1,000 is a misdemeanor under New York Penal Law Section 176.10, it becomes a felony once more than $1,000 in false claims is made.
The penalties for larceny also become significantly more serious once the $1,000 threshold is crossed. Petit larceny is a Class A misdemeanor with a maximum penalty of a year in jail under NY Penal Law Section 155.25, but taking more than $1,000 becomes a felony offense with a possible sentence of up to four years imprisonment. Higher amounts of theft or higher value fraudulent claims lead to progressively longer jail terms and progressively more serious felony charges.
Contact a NY Insider Fraud Attorney
A NY insider fraud attorney can help you try to raise defenses or make a jury doubt guilt so you can avoid being convicted of insurance fraud. In some cases, negotiating a plea agreement to try to reduce the charges or lessen your sentence is a better choice. You need to make strategic decisions as you handle your case, and an attorney will help every step of the way.
Bukh Law Firm, PLLC has provided legal representation to many clients accused of insider fraud. Give us a call to learn how our New York insurance fraud lawyers can represent you.
