Many people in California feel pressure to get fair compensation after an injury. Some may be tempted to exaggerate how severe their injuries are. However, this can lead to serious criminal charges under state law. When dealing with mounting medical bills, it can be easy to blur the lines to secure a higher payout. Understanding where a valid claim ends and a criminal offense begins is vital to protecting your freedom and your future.
What qualifies as insurance fraud in California?
Insurance fraud involves knowingly making false claims to receive money or benefits. In California, making your injuries seem worse than the actual harm suffered can qualify as fraud. Under state law, lying about an injury to claim benefits is a felony if the amount is more than $950. This also applies if an individual claims injuries that do not exist or blames old injuries on a new accident.
What evidence do insurers look for?
Insurance companies closely examine claims that seem suspicious. Investigators look for differences between what you report and what your doctors document.
Investigators may also review statements made throughout the claims process. Changes in how you describe pain or physical limits can raise red flags if they are inconsistent or if they clash with your medical files. In some cases, surveillance footage may be used to see whether certain activities conflict with your reported injuries.
What happens if insurers believe there is fraud?
If a review suggests fraud, insurance companies may deny your claim or stop paying benefits. Oftentimes, insurers ask for the money back.
A fraud finding can also start a criminal investigation. California law requires insurers to report suspected fraud to the California Department of Insurance Fraud Division and local police. Criminal fraud charges can result in fines and possible jail time. After a fraud conviction, itcan be difficult to get insurance coverage later on.
How to avoid fraud charges
Honesty is the best protection when filing insurance claims. Provide clear and accurate information about your injuries and limits. If the insurer raises questions about your claim and threatens to turn your file over to the police for a criminal review, consider seeking legal representation. A knowledgeable advocate can help you understand the situation and how to respond to investigators.
