CRS 18-5-211 is the Colorado law prohibiting insurance fraud. This is defined as deliberately making false claims or giving false information. The crime can be prosecuted as a misdemeanor or a felony and carries penalties of up to 3 years in prison and fines of up to $100,000.00.
Example: Harold submits a life insurance application with Farmers. Harold lies about being a non-smoker to get a lower premium. Farmers does grant him a policy with a lower, non-smoking premium. Therefore, Harold could be prosecuted for defrauding an insurer.
CRS 18-5-211 also comprises filing untrue car accident claims. The statute states it is illegal when a person:
[w]ith an intent to defraud causes or participates … in a vehicular collision … for the purpose of presenting any false or fraudulent insurance claim[.]
It is a class 1 misdemeanor to apply for coverage by lying. If the defendant receives a policy, the sentence is:
- 6 to 18 months in jail, and/or
- Up to $5,000
All other types of insurance-related fraud are class 5 felonies. This carries:
- 1 to 3 years in Colorado State Prison, and/or
- Up to $100,000
An effective defense to CRS 18-5-211 charges is the defendant had no intent to defraud. Defendants may have to return any money they wrongly received. But defendants who unknowingly provided false information broke no law.
In this article, our Colorado criminal defense attorneys will address:
- 1. What is insurance fraud under CRS 18-5-211?
- 2. What are the penalties?
- 3. What are common defenses?
- 4. Can the record be sealed?
- 5. What are the immigration consequences?
- 6. Related Offenses
Insurance fraud is trying to get undeserved benefits from an insurer. This becomes a Colorado crime when the defendant has the intent to defraud. Mistakenly filing a false claim is no crime.
Insurance fraud can be committed by individuals or by agents.
There are five main ways consumers defraud insurers:
- Applying for a policy. The application has material lies or omissions, such as those that would lower premiums. And the insurer grants the policy based on this application. “Material” means important or relevant to the policy.
- Making a claim for a loss or injury. A fraudulent claim contains false material information, or it withholds material information.
- Staging a car accident to file a fake claim.
- Filing a claim for the payment of a loss. But the loss or damage predates the policy. (An exception is if the policy covers preexisting conditions.)
- Making an oral or written statement in support of an insurance claim. And the person knows it is false or missing material information.
There are two main ways agents defraud insurers:
- Presenting a certificate of being insured with false information to any person or entity.
- Misappropriating premium funds without authorization or lawful justification1
Receiving an insurance policy after submitting a fraudulent application is a class 1 misdemeanor. Penalties include:
- 6 to 18 months in jail, and/or
- A fine of up to $5,000
All other ways of defrauding an insurer are a class 5 felony. (Examples include filing a false claim or staging an accident.) The penalties include:
- 1 to 3 years in prison (with a mandatory 2-year parole period), and/or
- A fine of up to $100,000
Agents face disciplinary actions like losing their professional license as well.2
Note that these cases are typically prosecuted by the Colorado Attorney General’s office – Insurance Fraud Unit.
A common way defense lawyers fight fraud charges is to argue the defendant had no intent to defraud.3 Mistakes and oversights are not criminal:
Example: Kelsey is applying for homeowners coverage from Progressive. On the application, he makes a typo and states that his house is worth $800,000. In fact it is worth only $300,000. But Progressive provides him with the policy worth $800,000. Here, Kelsey committed no crime because he had no intent to defraud. Unless the D.A. can prove intent to defraud beyond a reasonable doubt, criminal charges should not stand.
Sometimes, companies suspect policyholders staged an accident to get money. In these alleged fraud cases, the defense attorney would search for all available evidence to show the claimant’s innocence:
Example: Sheila is the victim of a hit-and-run. She calls her auto coverage company Liberty Mutual to make a claim. But her agent believes she is lying because her facts keep changing. After a fraud investigator and various law enforcement agencies look into the matter, Sheila gets charged with defrauding an insurer for staging an accident.
Sheila’s attorney then hires an accident reconstruction expert. This expert testifies in a deposition that her vehicle’s damage is consistent with a hit-and-run. Sheila’s attorney also hires a medical expert. This expert testifies that it is typical for accident victims to be fuzzy on the facts. In the course of the investigation, Sheila’s attorney also finds surveillance video which shows the car that hit Sheila fleeing the scene. The D.A. eventually realizes that Sheila’s claim is genuine. The charges get dropped.
If the defendant in CRS 18-5-211 case is an agent, three potential defenses are:
- The agent did realize the insurance certificate was false;
- The agent had lawful authority to move the funds; or
- The agent did not knowingly misappropriate funds
CRS 18-5-211 convictions are not sealable in Colorado. Convictions show up on future background checks.
But defendants can seal charges that get dismissed. And there is no wait. But the sealing process takes a few weeks.
Colorado insurance fraud is arguably a crime involving moral turpitude. And in some cases, it may be an aggravated felony. Therefore, non-citizens convicted of it might be deported.4
Aliens facing fraud charges should consult with an attorney immediately. The lawyer can determine whether the charges are deportable. And the prosecutor may be willing to reduce or dismiss the charges.
Learn more about the criminal defense of immigrants in Colorado.
Health care fraud generally involves filing false claims with health insurers. It may also involve fraud against a government agency providing health care benefits.
Identity theft (CRS 18-5-902) is common in the digital age. It is using another person’s information to obtain anything of value. This includes using another’s identity to file an insurance claim.
ID theft is a class 4 felony. Penalties include:
- 2 to 6 years in prison, and/or
- A fine of up to $500,000
Forgery is making or possessing fake documents. A classic example is drawing a fake will. Another is falsifying a tax return. Forgery can be a misdemeanor or felony.
Call us for help…
Accused of insurance fraud in California? Learn about California insurance fraud crimes.
Accused of insurance fraud in Nevada? Learn about Nevada insurance fraud crimes.
- CRS 18-5-211; also see the Colorado Division of Insurance.
- See Hollinger v. Mutual Ben. Life Ins. Co., 192 Colo. 377, 560 P.2d 824 (1977).
- See 8 U.S.C. § 1101(a)(43)(M)(i).