Insurance Fraud

When the masses think of Insurance Fraud, generally they think of someone burning a house to collect insurance funds, faking a car crash to collect a check, or at its worst, ending the life of another in order to obtain life insurance policy proceeds. Insurance fraud is generally prosecuted under a number of other, more easily provable fraud charges like mail fraud, wire fraud, or healthcare fraud. Insurance Fraud is considered a white collar crime where one defrauds an insurance company by making a false claim, gives false information in order to get an insurance payout unjustly. Though in theory, a fraud of this variety seems simple, because it often is prosecuted as a Federal crime, it is very complex and involves a very high volume of business documents to review. As with other fraud allegations, at the heart of an allegation that one has committed insurance fraud is the undertone of theft. Due to this the severity of any potential sentence is primarily going to be determined by the value of the amount alleged to have been taken under Federal Sentencing Guideline 2B1.1 all while considering specific offense characteristics. Because no Federal criminal case is simple, let alone a white collar crime allegation, it is imperative to retain an experienced Federal criminal attorney. Federal criminal lawyer Jason Mayberry is routinely in our Federal courts and has the experience and dedication to earn you the best possible result on your case.

What is Fraud?

Though there is no specific insurance fraud statute in our Federal system, an allegation that an insurer has been defrauded can be summed up as one’s scheme to defraud an insurer by using false or fraudulent pretenses, representations, or promises regarding a material fact; that those pretenses, representations or promises were in fact material to the scheme; and that the individual intended to defraud the insurer. Though this definition is rather generic, this would be the essence of an allegation, though the means to get to the end could be through an alternate type of fraud allegation.

Not all insurance fraud is committed by a policy holder. In all actuality the most common kind of insurance fraud occurs through a scheme called premium diversion. In a premium diversion scheme an insurance agent accepts a premium paid by a policy holder and fails to forward it on to the underwriter. The agent would then use the premium money for personal use, thereby defrauding both the insurer and insured.

At the highest level, an asset diversion scheme can involve a takeover of a fledgling insurance company and misappropriating its assets. In this scheme, insurance company “A” will borrow funds in order to obtain control of insurance company “B.” After insurance company “A” purchases insurance company “B,” insurance company “A” uses the assets of newly acquired insurance company “B” to pay off insurance company “A’s” debt. The remaining assets of insurance company “B” are then diverted to insurance company “A” generally leaving insurance company “B” to go out of business, thereby damaging shareholders and others involved with the company.

How can We Help?

Regardless of whether you are a policy holder accused of fraud associated with an insurance company, an agent accused of diverting premium funds, or an insurance executive charged with conspiring to divert corporate assets after a merger, Tampa insurance fraud attorney Jason Mayberry has the skills and dedication necessary to defend you against your Federal criminal allegation. With any fraud there is the potential for a good faith defense, depending on the facts. For a free evaluation of your case contact Jason Mayberry today at 813-444-7435 or at 727-771-3847.