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NEW YORK PENAL LAW § 176: Insurance Fraud

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Insurance Fraud | Insurance Fraud Attorneys | Insurance Fraud Law Firm | Insurance Fraud Lawyer

Insurance fraud, as defined under New York Penal Law § 176, is a serious criminal offense that encompasses various degrees of fraudulent activities related to insurance claims and policies. Whether you’re facing allegations of insurance fraud or navigating a complex insurance-related legal issue in Manhattan, having the guidance of a skilled Manhattan insurance fraud attorney can make all the difference.

Related Offenses

Case Example

John, who owns a car insured by XYZ Insurance Company, stages a fake accident. He damages his vehicle intentionally and submits a claim to XYZ Insurance for the repair costs which amounted to $4,000. He provides false accident details and exaggerates the extent of the damage. As a result, XYZ Insurance pays out the sum for repairs based on John’s fraudulent claim.

In this scenario, John could be charged with Insurance Fraud in the Third Degree because he intentionally misrepresented the facts to the insurance company with the intent to defraud, resulting in financial loss to the insurer. The resulting degree is due to the defrauded amount, exceeding $3,000 but not $50,000.

Elements and Definitions of the Offense

In New York, insurance fraud is considered a white-collar crime, and it encompasses various degrees of severity, with different elements that must be proven to secure a conviction.

  • Intent to Defraud: The fundamental element of insurance fraud is the defendant’s intent to defraud an insurance company. This means that the individual knowingly and willfully engages in fraudulent activities to obtain financial benefits to which they are not entitled. This intent to deceive is a critical component of the crime.
  • False Statement or Misrepresentation: To be convicted of insurance fraud, the defendant must have made a false statement, presented false information, or misrepresented material facts to the insurance company. This false statement or misrepresentation can take various forms, such as providing inaccurate information about the extent of damage, falsifying documents, or making untrue statements about the circumstances of a claim.
  • Materiality: The false statement or misrepresentation must be material, meaning that it has the potential to influence the insurance company’s decision-making process. In other words, it must be a significant factor in the insurer’s determination of whether to approve or deny a claim. Minor or inconsequential misrepresentations may not meet the materiality requirement.
  • Benefit Obtained: The defendant must have received a financial benefit as a result of their fraudulent conduct. This benefit could come in the form of an insurance payout, reduced premiums, or some other financial gain. Establishing a link between the fraudulent act and the financial benefit obtained is necessary.
  • Knowledge and Willfulness: The defendant must have acted with knowledge and willfulness, meaning they were aware of the false nature of their statements or misrepresentations and willingly engaged in the fraudulent conduct. Proving that the defendant acted knowingly and willfully is crucial for securing a conviction.

In New York, insurance fraud is categorized into different degrees, with fifth-degree and first-degree being the least and most severe, respectively. The severity of the offense charged depends on the value of the fraudulent claim. The specific elements and penalties vary depending on the degree of the offense, with higher degrees carrying more significant penalties.

Penalties

The penalties for Insurance Fraud (NYPL § 176) in New York vary depending on the value of the fraudulently obtained benefits:

If the value of the fraudulent claim exceeds $1,000,000, the offense is a class B felony, carrying a potential prison sentence of up to 25 years. Penalties can also include the payment of a fine and up to 5 years probation.

For claims between $50,000 and $1,000,000, the offense is a class C felony, with a possible prison term of up to 15 years.

If the value of the fraudulent claim is between $3,000 and $50,000, the offense is a class C felony, punishable by up to 7 years in prison.

Fraudulent claims valued at more than $1,000 but less than $3,000 constitute a class D felony, carrying a maximum sentence of 7 years in prison.

Fraudulent claims valued at less than $1,000 constitute a class A misdemeanor, carrying a maximum sentence of a year in prison and a potential probation term of up to three years.

Regardless of the severity of the charge, working with a skilled attorney is important to protect your rights and safeguard your interests.

Defenses

Defendants facing charges under New York Penal Law § 176 may have several legal defenses. If the defendant can show that they did not intend to defraud the insurance company, this could be a valid defense. For example, if they unintentionally include previous damage to a vehicle into a claim for a more recent accident, they may not be charged with Insurance Fraud.

In addition, in the cases of healthcare providers such as doctors and other medical professionals, human errors committed in filing a claim would not be considered an offense as it would not satisfy the level of intent to defraud required in this charge.

Insurance Fraud (New York Penal Law § 176)

A fraudulent insurance act is committed by any person who, knowingly and with intent to defraud presents, causes to be presented, or prepares with knowledge or belief that it will be presented to or by an insurer, self-insurer, or purported insurer, or purported self-insurer, or any agent thereof:

  1. any written statement as part of, or in support of, an application for the issuance of, or the rating of a commercial insurance policy, or certificate or evidence of self-insurance for commercial insurance or commercial self-insurance, or a claim for payment or other benefit pursuant to an insurance policy or self-insurance program for commercial or personal insurance that he or she knows to:
    1. contain materially false information concerning any fact material thereto; or
    2. conceal, for the purpose of misleading, information concerning any fact material thereto; or
  2. any written statement or other physical evidence as part of, or in support of, an application for the issuance of a health insurance policy, or a policy or contract or other authorization that provides or allows coverage for, membership or enrollment in, or other services of a public or private health plan, or a claim for payment, services or other benefit pursuant to such policy, contract or plan that he or she knows to:
    1. contain materially false information concerning any material fact thereto; or
    2. conceal, for the purpose of misleading, information concerning any fact material thereto.

Working with a Top-Rated Manhattan Insurance Fraud Attorney from Lebedin Kofman LLP

In the complex legal landscape of Manhattan, where insurance fraud allegations can carry serious consequences, having a skilled Manhattan insurance fraud attorney from Lebedin Kofman LLP by your side is crucial. Our experienced legal team is committed to safeguarding the rights of individuals facing insurance fraud charges. We understand the nuances of New York’s insurance fraud laws and are dedicated to providing personalized and aggressive representation. 

When you choose us, you’re choosing unwavering advocacy, meticulous legal strategies, and a relentless pursuit of justice on your behalf. With Lebedin Kofman LLP, you don’t have to face these charges alone; we’re here to protect your rights and fight for your future.

Schedule a free consultation with one of our attorneys today by calling (646) 663-4430. Our Manhattan and Nassau County, Long Island offices are conveniently located to serve you.

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