Best Insurance Fraud Lawyers in Florida

About Insurance Fraud Law in Florida, United States

Insurance fraud involves any act committed with the intent to obtain an improper payment or benefit from an insurance provider. In Florida, insurance fraud covers a range of activities such as staging automobile accidents, inflating damages, submitting false claims, or deliberately misrepresenting facts on applications or claims. Both individuals and professionals, such as contractors or medical providers, can be involved in insurance fraud cases. Florida is known for having one of the highest rates of insurance fraud in the nation, making law enforcement and regulatory agencies especially vigilant about investigating and prosecuting these offenses.

Why You May Need a Lawyer

Legal issues involving insurance fraud can be complex and carry significant criminal and civil penalties. You may require the help of an attorney in several common situations:

• You are under investigation or have been charged with insurance fraud by the authorities
• Your insurer has accused you of submitting a false or exaggerated claim
• You are a medical provider or business owner accused of participating in fraudulent billing or claims
• Your claim has been denied or delayed due to a suspected fraud investigation and you believe it is unjustified
• You need help understanding your rights or the insurance policy language in relation to fraud allegations
• You wish to report suspected fraud committed by another party and require legal guidance

Because the consequences can include jail time, heavy fines, restitution, loss of professional licenses, and a permanent criminal record, having a knowledgeable lawyer can help protect your legal rights and advocate for the best possible outcome.

Local Laws Overview

Insurance fraud in Florida is governed by several statutes, most notably Florida Statutes Section 817.234. This law makes it illegal to knowingly submit false, incomplete, or misleading information to an insurer for purposes of obtaining payment or benefits. The penalties for insurance fraud vary depending on the amount involved and the specific circumstances but can range from misdemeanors to first-degree felonies.

Key local law points include:

• Even attempting to commit insurance fraud or conspiring with others can lead to charges
• Penalties increase with the value of the fraud - for example, fraud involving more than $100,000 is a first-degree felony
• Certain types of insurance fraud have special attention under Florida law, such as automobile insurance (personal injury protection, or PIP fraud) and health care billing fraud
• The Florida Division of Investigative and Forensic Services (DIFS) actively investigates insurance fraud cases
• Whistleblower provisions may reward individuals who report insurance fraud leading to successful prosecutions
• Convictions can result in loss of business licenses for professionals and restitution orders for losses suffered by victims

Frequently Asked Questions

What is considered insurance fraud under Florida law?

Insurance fraud includes knowingly providing false, inaccurate, or misleading information to an insurer with the intent to gain a financial benefit or advantage not entitled under the policy. This can include making false claims, inflating damages, staging accidents, or intentionally omitting material facts.

What are the penalties for insurance fraud in Florida?

Penalties vary depending on the amount of money involved. For fraud involving less than $20,000, it is usually a third-degree felony, punishable by up to 5 years in prison. From $20,000 to $100,000, it becomes a second-degree felony with up to 15 years in prison. Over $100,000 is a first-degree felony, carrying a maximum of 30 years in prison. Fines, restitution, and professional consequences may also apply.

Who investigates insurance fraud cases in Florida?

The Florida Department of Financial Services, specifically the Division of Investigative and Forensic Services, investigates insurance fraud. Law enforcement agencies and prosecutors may also be involved.

Can an insurance company deny my claim if they suspect fraud?

Yes, insurance companies can deny a claim if there is evidence of fraud. They may also refer the case to law enforcement for further investigation.

What should I do if I am accused of insurance fraud?

If you are accused of insurance fraud, do not make statements to investigators or the insurance company without consulting an attorney. A lawyer experienced in insurance fraud defense can help you understand your rights and develop a strategy to protect you.

Is it insurance fraud to exaggerate damages or losses?

Yes, exaggerating damages or losses in an insurance claim is considered insurance fraud, even if you suffered a legitimate loss. All claims must reflect accurate and truthful details.

Can someone be charged for accidentally providing wrong information?

Insurance fraud in Florida requires intent. Honest mistakes or clerical errors, without intent to deceive or gain unjust benefit, are generally not prosecutable as fraud. However, thorough investigations may occur to determine intent.

Are business owners at special risk for insurance fraud accusations?

Yes, businesses, especially in the medical, automotive, and construction fields, are often scrutinized for billing or claim-related fraud. Accurate records and compliance with all laws are vital for business owners to protect themselves.

What is PIP fraud in Florida?

PIP fraud concerns Florida’s Personal Injury Protection insurance for auto accidents. This includes cases where individuals, clinics, or medical providers inflate or falsify treatment costs and accident-related injuries to receive higher payments.

Can I report suspected insurance fraud anonymously?

Yes, Florida has mechanisms for anonymous reporting of suspected insurance fraud, including hotlines operated by the Department of Financial Services. You may even be eligible for a reward if your tip leads to a conviction.

Additional Resources

• Florida Department of Financial Services - Division of Investigative and Forensic Services
• Florida Department of Law Enforcement
• Florida Office of Insurance Regulation
• National Insurance Crime Bureau (NICB)
• Your local county or circuit court’s self-help office
• Florida Bar Association lawyer referral service
• Legal aid organizations throughout Florida specializing in financial crimes defense

Next Steps

If you are facing an insurance fraud investigation or have concerns about a claim or policy, it is important to act quickly. Take the following steps:

• Do not speak with investigators or insurance company representatives about the allegations without legal counsel
• Collect all documents, records, and correspondence related to the claim or policy
• Contact an attorney with experience in Florida insurance fraud cases for a confidential consultation
• Follow your attorney’s advice carefully and avoid discussing your case with others
• If you wish to report suspected fraud, reach out to the Florida Department of Financial Services or a qualified legal representative for guidance

A knowledgeable lawyer can evaluate your situation, explain your rights and options, and help you navigate the legal process to secure the best possible outcome.