New York Insurance Fraud Criminal Statutes

New York Penal Law Article 176.05 defines insurance fraud as a fraudulent insurance act committed by any person who, knowingly and with intent to defraud presents, presents to an insurer:

  1. Any written statement in support of an application for the issuance of commercial or personal insurance that he or she knows to:

(a) contain materially false information concerning any fact material; or

(b) conceal, for the purpose of misleading, information concerning any fact material; or

  1. any written statement or other physical evidence as part of the issuance of a health insurance policy or a claim for payment, services, or other benefit pursuant to such policy, contract, or plan that he or she knows to:

(a) contain materially false information concerning any material fact; or

(b) conceal, for the purpose of misleading, information concerning any fact material.

Article 176 defines five degrees of insurance fraud that start with a class A misdemeanor for the basic offense, insurance fraud in the fifth degree. The degrees then become more serious depending on the value of the property that the defendant has taken, obtained or withheld, or attempted to take, obtain or withhold, from an insurance carrier, with the most severe degree of insurance fraud being a class B felony.

The monetary amounts related to each degree of insurance fraud are as follows:

  • Insurance fraud in the fifth degree. This involves a fraudulent insurance act involving $1000 or less.
  • Insurance fraud in the fourth degree. This involves a fraudulent insurance act involving $1000 – $3000.
  • Insurance fraud in the third degree. This involves a fraudulent insurance act involving $3000 – $50,000.00
  • Insurance fraud in the second degree. This involves a fraudulent insurance act involving $50,000 – 1 million dollars.
  • Insurance fraud in the first degree. This involves a fraudulent insurance act involving over a million dollars.

There is also a charge of aggravated insurance fraud when a person charged has been previously convicted within the preceding five years of any offense, an essential element of which is the commission of a fraudulent insurance

Examples of Insurance Fraud Cases

Insurance fraud can take many different forms. Our NYC insurance fraud lawyers usually encounter the following situations that lead to criminal charges:

  • Health Insurance fraud
  • Worker’s Compensation Insurance Fraud
  • Disability Insurance Fraud
  • No-Fault Insurance Fraud
  • Commercial Insurance Fraud
  • Car Insurance Fraud
  • Home owners insurance fraud
  • Life Insurance Fraud

In People v. Abraham, the court found the evidence was sufficient to determine that the defendant committed insurance fraud when took out a large insurance policy on the property shortly before a fire destroyed the property, with the beneficiary of the policy a worthless family-owned entity, coupled with evidence that shortly before the defendant had purchased substantial quantities of the kind of accelerant found at the scene of the fire, and the empty accelerant containers were later found at defendant’s home.

Not all insurance fraud involves intentional damage to property to obtain insurance proceeds.

In People v. Keschner, the defendants created a scheme to utilize health care clinics to fraudulently obtain money from insurance companies by fraudulently billing insurers.

Individuals Charged with Insurance Fraud

There is no single type of person that is charged with insurance fraud. Insurance fraud cases span the gamut from cases involving fraudulent property damage like Abraham to submitting a false claim to auto insurance provider, faking an injury to obtain money or prescription medical, faking a death to obtain life insurance proceeds, or creating a fraudulent scheme to receive insurance proceeds like Keschner.

Potential Penalties for Insurance Fraud

The penalties for insurance fraud depend on the degree of insurance fraud that you are charged with, whether you have been charged with a similar crime or any crimes in the past, and the specific circumstances surrounding the commission of the crime. Potential penalties may range from a lower-grade misdemeanor conviction and restitution payments to felony convictions, probation, and prison time.

Non-citizen defendants convicted of insurance fraud may even be deported from the country based on their convictions.

Defendants who hold professional licenses may be disciplined by their licensing authorities, putting their professional life in jeopardy.

Help for Those Accused of Insurance Fraud in New York

We can help! It is extremely important that you contact an attorney if you are charged or are concerned that you may be charged with any type or degree of insurance fraud as soon as possible. We can help you understand your case, the charges against you, your defenses, advise you of your rights and zealously advocate for you in our criminal justice system.

NYC Insurance fraud lawyers with Joseph Potashnik and Associates have handled numerous insurance fraud cases of all types and levels of complexity in New York criminal courts. We have build a successful track record of success. If you or someone you know have been accused of insurance fraud in NYC, call us today!