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Insurance fraud covers a range of dishonest acts intended to obtain payment or benefits from an insurance company to which a person is not entitled. In Nashville - which sits in Davidson County, Tennessee - insurance fraud can involve false accident claims, staged collisions, exaggerated medical injuries, falsified property damage, submission of fake documents, or dishonest conduct by insurance agents and medical providers. Insurance fraud matters may trigger criminal charges, civil claims by insurers, and administrative actions against licensed professionals.
Insurance fraud matters often involve overlapping legal risks - criminal prosecution, civil repayment or lawsuits, and professional discipline for license-holders. You may need a lawyer if you are:
- Being investigated by a prosecutor, state fraud unit, or law enforcement agency for suspected fraud.
- Charged with an insurance fraud crime in municipal, county, or state court.
- Facing a civil demand for repayment, a lawsuit by an insurer, or a subrogation action.
- An insurance agent, broker, or medical provider under regulatory scrutiny by the state insurance regulator or facing license suspension or revocation.
- Unsure how to respond to requests for statements or documents from investigators or insurers and want to protect your rights and limit exposure.
Experienced counsel helps at every stage - from pre-charge investigations to trial, plea negotiations, civil defense, administrative hearings, and appeals. A lawyer can evaluate evidence, advise on whether to give statements, negotiate with prosecutors or insurers, and seek to limit penalties or avoid conviction when possible.
Key legal aspects particularly relevant in Nashville and Tennessee include:
- Criminal elements - Prosecutions typically require proof that the defendant knowingly made a false statement or acted dishonestly with the intent to obtain an insurance benefit or payment. Both individual claimants and professionals who assist or orchestrate schemes can be charged.
- Range of offenses - Conduct leading to charges can include filing false claims, arson for insurance proceeds, staged auto accidents, agent embezzlement, false medical billing, and conspiracy to commit fraud. Charges may be brought as misdemeanors or felonies depending on factors such as the amount involved and whether the conduct was part of an organized scheme.
- Civil liability - Insurers can deny claims, seek repayment of paid benefits, and sue for fraud, breach of contract, or unjust enrichment. Civil exposure exists even if there is no criminal conviction.
- Administrative and licensing consequences - Insurance agents, adjusters, health care providers, and attorneys who engage in fraudulent conduct may face disciplinary action by state licensing boards, including fines, license suspension, and revocation.
- Local enforcement and prosecution - Investigations and prosecutions may be handled by local law enforcement, county prosecutors - including the Davidson County District Attorney General - the Tennessee Department of Commerce and Insurance fraud investigators, and state law enforcement when larger or organized schemes are involved.
- Evidence and procedure - Investigations may include subpoenas for records, search warrants, recorded interviews, and collaboration with insurers. Criminal cases are handled through the Tennessee court system, with initial hearings often in general sessions court and felonies proceeding to the appropriate criminal court in Davidson County.
Insurance fraud generally means knowingly making a false statement or concealment to obtain insurance proceeds or benefits. Examples include staging accidents, exaggerating injuries, submitting false repair or medical bills, falsifying property damage, and agents diverting premiums or falsifying policy records.
Seriousness depends on the facts - the amount of money involved, whether it was part of a larger scheme, and whether the defendant has prior convictions. Penalties can include fines, restitution to insurers, probation, community service, and jail or prison time. Administrative sanctions for licensed professionals can be severe.
Yes. An insurer can deny a claim and pursue civil remedies while criminal investigators or prosecutors pursue criminal charges. Civil and criminal actions are separate - a criminal conviction is not required for a civil suit or for license discipline.
You have the right to remain silent when facing criminal investigation. It is usually wise to consult an attorney before giving recorded statements or extensive documentation to insurers or investigators. Saying too much can create evidence that may be used in a criminal or civil case.
Remain calm. You can ask whether they have a warrant. If they do not have a warrant, you may politely decline consent to search and ask to speak with a lawyer. If you are under arrest, you must be informed of the reason - exercise your right to consult counsel before answering substantive questions.
Defenses depend on the case but can include lack of intent - showing a mistake rather than purposeful deception - lack of materiality, mistaken identity, unreliable evidence, or lawful conduct by an agent or provider. A skilled lawyer will assess the evidence and build defenses tailored to the facts.
Agent misconduct is treated seriously. You could face criminal charges, civil suits from insurers and policyholders, and administrative discipline. Protect your license and legal rights by seeking counsel experienced in regulatory and criminal defense, preserving records, and cooperating strategically.
Court-ordered restitution requires the defendant to repay the amount the insurer lost because of the fraud. Restitution obligations can extend beyond fines and may be enforced through collection actions if unpaid.
Expungement rules vary by offense, the sentence imposed, and Tennessee law. Some convictions may be eligible for sealing or expungement after successful completion of sentence and waiting periods, while others may not. Consult an attorney to determine eligibility and how to proceed.
Look for attorneys with experience in white-collar criminal defense, insurance defense or plaintiff work, and administrative licensing cases. Ask about courtroom experience in Davidson County, familiarity with local prosecutors, track record with similar cases, fee structure, and whether the lawyer will handle your case personally or pass it to another attorney.
Resources that can help someone needing legal advice or reporting suspected fraud in Nashville include local and state agencies, professional organizations, and nonprofit legal services. Useful contacts typically include the state insurance regulator and its fraud investigation unit, the Davidson County District Attorney General or local prosecutor, and law enforcement agencies. National organizations that track insurance crime and provide education may also be helpful. If you cannot afford a private attorney, consider contacting the local public defender office or legal aid organizations that provide criminal or civil defense guidance.
If you suspect you are under investigation, have been accused of insurance fraud, or need help responding to an insurer or regulator, follow these steps:
- Pause communications - Avoid giving detailed statements to insurers or investigators until you have legal advice. Do not post about the situation on social media.
- Preserve evidence - Save all documents, receipts, correspondence, photos, medical records, and policy information related to the claim or matter.
- Get legal help - Contact a lawyer experienced in insurance fraud, criminal defense, or administrative law. If you cannot afford a private lawyer, contact the public defender or legal aid organizations for guidance.
- Prepare for initial consultation - Bring copies of any correspondence, subpoenas, notices, or charge documents and a timeline of events. Ask about the attorney's experience with similar cases, strategy options, likely outcomes, and fee structure.
- Understand your options - A lawyer will explain the possible defenses, negotiation strategies with prosecutors or insurers, and whether alternatives such as diversion, pretrial resolution, or civil settlement make sense.
- Follow counsel - Follow your attorney's guidance about statements, evidence production, court appearances, and potential plea or settlement negotiations.
Facing an insurance fraud matter is stressful, but timely action and informed legal representation can significantly affect outcomes. Seek advice early so you understand your rights, obligations, and possible paths forward.
