18-5-211 C.R.S. - Insurance Fraud in Colorado

Updated

18-5-211 C.R.S. is the Colorado law prohibiting insurance fraud. Insurance fraud comprises deliberately making false claims or applying for insurance with false information.

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.

18-5-211 C.R.S. 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[.]

Penalties

It is a class 1 misdemeanor to apply for insurance 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 fraud are class 5 felonies. This carries:

Defenses

An effective defense to 18-5-211 C.R.S. charges is the defendant had no intent to defraud. Defendants may have to return any insurance money they wrongly received. But defendants who unknowingly provided false information broke no law.

In this article, our Colorado criminal defense lawyers will address:

legal document (18-5-211 C.R.S.)
Defrauding an insurer can be a felony or a misdemeanor under 18-5-211 C.R.S.

1. What is insurance fraud under 18-5-211 C.R.S.?

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.

1.1. Insurance fraud by individuals

There are five main ways people defraud insurers:

  1. Applying for an insurance policy. The application has material lies or omissions. And the insurer grants the policy based on this application. "Material" means important or relevant to the insurance policy.
  2. Making a claim for a loss or injury. This claim contains false material information. Or it withholds material information.
  3. Staging a car accident to file a fake claim.
  4. 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.)
  5. Making an oral or written statement in support of an insurance claim. And the person knows it is false or missing material information.

1.2. Insurance fraud by insurance agents

There are two main ways insurance agents defraud insurers:

  1. Presenting a certificate of insurance with false information to any person or entity.
  2. Misappropriating premium funds without authorization or lawful justification1

2. What are the penalties?

Receiving an insurance policy after submitting a fraudulent insurance 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 4 years in prison (with a mandatory 2-year parole period), and/or
  • A fine of up to $100,000

Agents convicted of insurance fraud will lose their professional license as well.2

3. What are common defenses?

A common way to fight insurance 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 insurance 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, insurance companies suspect policyholders staged an accident to get money. In these 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 Liberty Mutual to make a claim. But her agent believes she is lying because her facts keep changing. 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 18-5-211 C.R.S. case is an insurance agent, three potential defenses are:

  1. The agent did realize the insurance certificate was false;
  2. The agent had lawful authority to move the funds; or
  3. The agent did not knowingly misappropriate funds

4. Can the record be sealed?

gavel
Dismissed charges can be sealed immediately.

Insurance fraud 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.

Learn how to seal Colorado criminal records.

5. What are the immigration consequences?

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.

6. Related Offenses

6.1. Health care fraud

Health care fraud generally involves filing false claims with health insurers. It may also involve fraud against a government agency providing health care benefits.

Health care fraud is usually prosecuted as insurance fraud. It may be a misdemeanor or felony.

6.2. Identity theft

Identity theft (18-5-902 C.R.S.) 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

6.3. Forgery

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...

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Call our Denver criminal defense attorneys. Reach us 24/7 at 303-222-0330. We offer free consultations.

Accused of insurance fraud? Being investigated by your insurance company? Contact us at Colorado Legal Defense Group.

Our Denver criminal defense attorneys have decades of experience. We may be able to get the charges reduced or dismissed through negotiation alone. But if you wish, we are ready to take your matter to trial.

Contact us today for a free consultation at 303-222-0330. We are available 24/7.

Arrested in California? Learn about California insurance fraud crimes.

Arrested in Nevada? Learn about Nevada insurance fraud crimes


Legal References

  1. 18-5-211 C.R.S.
  2. Same.
  3. See Hollinger v. Mutual Ben. Life Ins. Co., 192 Colo. 377, 560 P.2d 824 (1977).
  4. See 8 U.S.C. § 1101(a)(43)(M)(i).

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