Every crime in California is defined by a specific code section. Our attorneys explain the law, penalties and best defense strategies for every major crime in California.
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The punishment for California insurance fraud can range from probation to five years in prison, as well as fines, community service, and restitution.
Insurance fraud charges are usually the result of either making a fraudulent insurance claim or from the destruction of insured property.
A Fraudulent Insurance Claim under California Penal Code 550 PC occurs when:
Fraudulent Destruction of Insured Property under California Penal Code 548 PC occurs when:
A fraudulent insurance claim can be charged as either a felony or a misdemeanor depending on the type and amount of the claim made to the insurance company. As a felony, the punishment is:
As a misdemeanor the punishment for a fraudulent insurance claim can be up to:
If the fraudulent claim involves health care benefits in an amount less than $950, the offense is a misdemeanor punishable by:
Fraudulent Property Damage of Insured Property is a felony. A felony conviction is punishable by:
Restitution must be ordered in all insurance fraud cases, such as paying back any wrongfully received insurance payments.
Defenses to insurance fraud can include:
The California Department of Insurance investigates insurance fraud and has identified more than 60 types of insurance fraud. See http://www.insurance.ca.gov/0300-fraud/0100-fraud-division-overview/05-ins-fraud/
Most insurance fraud in California occurs in one of four areas:
A Fraudulent Insurance Claim under California Penal Code 550 occurs when:
Destruction of Insured Property claims under California Penal Code section 548 occur when:
An insurance claim means that a person claims, makes, or presents a request for payment under a contract of insurance for a loss, injury, or healthcare benefit.
Intent to defraud occurs when someone intends to deceive another person to cause:
Please note that federal insurance fraud cases can also be filed. In federal court, the crime of insurance fraud is usually prosecuted as mail fraud, criminal racketeering or other federal offenses.
A fraudulent insurance claim in California can be either a felony or a misdemeanor depending on the type and amount of the claim. Actual loss is not needed so long as the suspect has committed an act and had the intent to commit the crime.
Insurance fraud is a specific intent crime. This means the district attorney’s office must prove that the person involved:
For insurance fraud as a felony, the punishment is:
If the claim involves health care benefits fraud over $950, the offense is a “wobbler,” punishable as either a felony or a misdemeanor. As a felony the punishment can be:
As a misdemeanor the punishment could be up to:
If the claim involves health care benefits fraud less than $950, the offense is a misdemeanor punishable by:
Destruction of Insured Property is a felony and punishable by:
Sentence enhancements and additional punishment can be added if an accused has:
Please note that a person with one or more prior insurance fraud convictions is ineligible for probation.
Restitution must be ordered in every insurance fraud case.
Because insurance fraud is a specific intent crime, there are various defenses that can be raised by an experienced criminal defense attorney. These include:
Another defense is that the law enforcement agency committed misconduct, such as coercing a confession.
Call our law firm for help. We offer free consultations in Los Angeles County and throughout the state of California. We can speak by phone or at one of our California law offices.
Also see the California Insurance Code.
A former Los Angeles prosecutor, attorney Neil Shouse graduated with honors from UC Berkeley and Harvard Law School (and completed additional graduate studies at MIT). He has been featured on CNN, Good Morning America, Dr Phil, The Today Show and Court TV. Mr Shouse has been recognized by the National Trial Lawyers as one of the Top 100 Criminal and Top 100 Civil Attorneys.