Insurance is a part of everyday life for nearly all citizens of Utah and across America. For most of us, we have multiple forms of insurance, whether they be car insurance, health insurance, life insurance, homeowner’s insurance, or many other types. While paying the monthly premium can seem to be a waste, it can be hugely beneficial if you face an unexpected loss, like a house fire. The large amounts of money available for some claims can give people an incentive to lie, but those that do can be charged with insurance fraud and face serious penalties.
At Overson Law, PLLC, our Utah insurance fraud defense attorneys have years of experience successfully defending clients charged with insurance fraud throughout the state. We understand how troubling and disorienting it can be to be charged with a crime, and our compassionate advocates will be there with you every step of the way to guide you through the process and fight for a successful resolution. For a free consultation, call our firm today at (801) 758-2287.
The Crime of Insurance Fraud in Utah
Insurance fraud can be committed in several different ways and by several different subsets of people. Fraud could be committed by insured individuals against their insurance companies, service providers like doctors against the insurance providers, and insurance providers against clients or service providers. For insured individuals, it occurs most commonly in one of two ways: lying on your application to obtain insurance or making a claim based on false or misleading information. Insurance fraud may be used to obtain money or goods and services of value. For example, lying to your insurance company to receive money to pay for your totaled car would be fraud. However, doing the same thing to obtain repair services paid for by your insurance company is also fraud.
There are other ways that insurance fraud can be committed, however. For example, you can be charged with this crime even if you do not actually receive any money if you aid and abet someone else in committing insurance fraud. On the other hand, you can be charged if you knowingly receive money from an insurance fraud scheme even if you did not take part in its planning and execution.
Insurance providers can also be charged under this section for deceiving customers or not paying out claims that they are required to. Cases against insurance companies can be complex and can result in different types of penalties, such as losing your professional license. It is best to consult with an experienced insurance fraud defense lawyer like those at Overson Law, PLLC who can discuss the unique aspects of a case against an insurance providers. Service providers, such as doctor’s offices or radiology services, can also be charged under this section for claiming money owed from the insurance company for services of procedures that did not actually occur. No matter the circumstances, our Utah insurance fraud defense lawyer is here to help you fight your charges.
Mandatory Reporting of Insurance Fraud in Utah
If an insurer or someone related to the insurance business, such as an auditor, learns of an insurance fraud scheme, they are required by law to report it to the authorities. They must submit a report of the insurance fraud scheme within 90 days of learning about it. The report must be submitted to their supervisors as well as law enforcement. The person required to make the report does not even have to know with 100% certainty that fraud is being committed. Instead, they must have at least a good faith belief that you are committing insurance fraud in Utah. Failure to report could result in penalties for the insurer.
In addition, people who report insurance fraud to the authorities are immune from any civil penalties that would ordinarily be associated with disclosing private information to third parties. Even if the allegations of fraud turn out to be false, the person who made the report is still immune from civil penalties as long as they made the report in good faith. If you are suspected of participating in an insurance fraud scheme, contact our Utah insurance fraud defense attorney for help. We can help you prove you were not involved in an insurance fraud scheme and help you avoid a lengthy legal battle.
Penalties for Insurance Fraud in Utah
The penalties you could face for insurance fraud will depend on the particular circumstances surrounding your case, including how you commit the fraud, who you commit it against, and how much money is involved. For example, lying or misleading on an application in order to procure insurance is charged as a Class A misdemeanor. Class A misdemeanors are punishable by up to a year in prison and up to $2,500 in fines. On the other hand, fraud involving making false claims is punishable by a tiered system dependent on how much was sought to be stolen in the fraudulent scheme.
If the value of the benefits sought or obtained through the fraud was $500 or less, the crime is a Class B misdemeanor punishable by up to 6 months in prison and fines up to $1,000. If the value of the benefits was more than $500 but less than $1,500, the charge will be a Class A misdemeanor, with penalties the same as those described above. If the value of the benefits was $1,500 or more but less than $5,000, the crime is a third-degree felony, with penalties including up to 5 years in prison and fines up to $5,000. Finally, for cases where the value was more than $5,000, you will be charged with a second-degree felony punishable by up to 15 years in prison and up to $10,000 in fines.
Note that the language of the law states only that you must seek to obtain benefits through the fraud, not that you actually receive them. If your fraud is discovered before the money is actually paid out, you still face potential criminal liability under this section. If you are charged with insurance fraud, regardless of whether you obtained a payout, contact our Utah insurance fraud defense attorney.
What Happens When My Insurance Company Pays Me Too Much by Mistake in Utah?
Insurance can be a very complicated business and mistakes have been known to happen. Sometimes people send the wrong information to their insurance company resulting in large payouts or other benefits. Other times the insurance company is the one who makes a mistake and accidentally awards people too much money for their insurance claims. In either case, no insurance fraud has been committed unless the benefiting party fails to correct the mistake after learning about it.
For example, if your insurance company mistakenly sends you $10,000 when they were only supposed to send you $1,000, you are not immediately on the hook for insurance fraud. However, if you immediately realize you have been overpaid but fail to notify your insurance company, you could be charged with insurance fraud. Our experienced Utah insurance fraud defense attorney can help you work things out with your insurance company and hopefully avoid legal action.
The Criminal Process for Insurance Fraud Charges in Utah
Unless you are issued a summons and released, which is unlikely for this crime, you will be arrested and taken to the local police station for the booking process. After you are booked, you will be taken to the holding cell or the local detention center where you will await your arraignment and bail hearing before a judge. The judge will have the option to deny you bail and detain you until the case is over, release you on your own recognizance, or without bail, or set bail. Our bail hearing attorneys at Overson Law, PLLC can work to get you released quickly with little to no bail imposed.
After this, we will assess the evidence and begin discussing a potential plea deal with the prosecutor. If you have no prior criminal history, we may be able to get you into a pre-trial diversion program. If you complete this program successfully, your charges will be dropped and you will not have a criminal record. If the prosecutor is not willing to offer pre-trial diversion, we can try to work out a deal where the charges are downgraded or you agree to plead guilty in exchange for the prosecutor recommending a more lenient sentence. If you do not wish to accept a deal, we are ready and able to fight for your innocence at trial. Call our Utah insurance fraud defense lawyer to help you figure out the best options for your case.
Civil Penalties for Insurance Fraud in Utah
The consequences of insurance fraud go beyond just criminal penalties. In addition to criminal charges, a defendant will have to deal with repaying any money they obtained through insurance fraud and additional fees. A defendant charged with insurance fraud will also face certain civil penalties.
- You pay restitution covering the full amount of the money you fraudulently obtained.
- You must pay the costs and expenses incurred by law enforcement in bringing you to justice. This includes costs of:
- Other public employees
- The court may, in its discretion, make you pay a civil penalty to the state in an amount not to exceed three times the value of money or property fraudulently obtained.
You do not need to face criminal charges or be criminally convicted of insurance fraud in order to face civil penalties. If your case does not result in criminal charges, do not think that you are off the hook. You will have to pay back everything you allegedly obtained through fraud along with hefty penalty fees.
The civil penalties mentioned above are paid to the victim of the insurance fraud. An individual who defrauds their insurance company will have to pay the money back to the insurance company. However, an insurance company that defrauds a customer or client will have to pay the client back any money they were defrauded out of. If you are facing either civil or criminal penalties, or both, please contact our Utah insurance fraud defense attorney for help. We are prepared to assist you through both civil and criminal proceedings.
Call Our Experienced Utah Insurance Fraud Defense Attorneys Today
A conviction for insurance fraud can lead to serious penalties like jail time and hefty fines, especially for fraud schemes involving large amounts of money. Furthermore, a conviction for fraud could make it difficult for you to geta a job in many industries where trust is a key, and in some cases, you could even face losing a professional license. At Overson Law, PLLC, our seasoned Utah insurance fraud defense attorneys will fight to get your charges downgraded or dismissed and to clear your good name. Call us today at (801) 758-2287 for a free consultation.