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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.
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:
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.
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:
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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:
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.
