Insurance fraud is a serious crime that the state of Idaho takes very seriously. Strict laws and penalties are in place for those found guilty. If you are facing an insurance fraud charge in Idaho, it is crucial to understand the offense, its consequences, and your legal rights. This post will give you an overview of Idaho's insurance fraud offense, its elements, and what to do if you are facing a charge.
Idaho Insurance Fraud Laws
Idaho Code § 41-293 defines the offense of insurance fraud as knowingly and willfully providing false or misleading information to an insurance company with the intent to receive benefits, compensation, or indemnification to which the person is not entitled. Specifically, under this statute, insurance fraud occurs when a person with the intent to defraud or deceive:
- Assists, abets, conspires with, or solicits another person to make a false statement to any insurer.
- Employs a runner with the intent of having them submit a false claim or a claim containing false information
- Makes a false statement to obtain, increase, or extend their workers’ compensation benefits.
- Presents (or influences the presentation of) any statement as part of a claim for payment or other benefits to any insurer knowing that the statement contains false information concerning any material fact.
- Presents an insurance package to a claimant and takes their premium money while being aware that the coverage plan will not be affected.
- Presents an insurer with a false or altered statement concerning their insurance case/transaction.
- Transacts insurance of any kind or character or transmits for another person an application for a policy of insurance without proper licensing
This offense is a felony and a person can be charged with separate offenses for each violation of this law. To prove the crime of insurance fraud, the prosecution must establish four elements:
(1) the defendant made a false or misleading statement or omitted material information to an insurance company;
(2) the defendant did so knowingly and willfully;
(3) the defendant intended to receive benefits or compensation to which they were not entitled; and
(4) the defendant's false statement or omission was related to a material aspect of the insurance claim. If any of these elements are missing or not proven, the prosecution may not be able to secure a conviction.
Types of Insurance Fraud
Here are common schemes and acts that are considered types of insurance fraud:
- Staged car accidents are a common form of insurance fraud where those involved purposely crash collide two or more cars and then file false insurance claims for the damages. The people involved will usually recruit ‘victims’ to be involved in the accident and will collect money for their role in the staged collision.
- Reimbursement for items not covered by the policy is when individuals submit applications for reimbursement from their insurer that aren’t covered under their policy provisions, resulting in them receiving fraudulent payments from the insurer.
- Personal injury fabrications involve filing fraudulent reports related to injuries sustained during accidents that never occurred, allowing perpetrators to collect large sums of money in return for these inaccurate reports.
- Not disclosing existing medical conditions is another form of insurance fraud where individuals neglect to reveal pre-existing medical conditions so they can get coverage without having those conditions factored into their rate calculations by insurers at the time of purchase.
- Inflated auto repair costs involve making fraudulent changes to vehicle estimates and invoices in order to report higher repair costs than actually necessary for a legitimate repair job.
- False information on an insurance application involves individuals lying about their health status, age, or other details in order to receive lower rates on life or health insurance policies or make fraudulent claims against the insurers who granted them coverage under false pretenses.
- Fake medical claims involve submitting false information about an illness or injury as part of an insurance claim. This can range from exaggerated symptoms and treatments to completely inventing a medical history.
- Claiming a theft that never occurred involves falsely claiming that property was stolen when it wasn’t, in order to cash out on an insurance policy or collect money through reimbursements from false claims of missing items.
- Burning homes is another form of insurance fraud where someone intentionally sets their house on fire and then submits a claim for damage from an ‘accidental’ fire when, in reality, they are attempting to defraud the insurer.
- Accidental damage misrepresentation occurs when claimants misreport how certain damages were incurred, leading insurers to pay large sums as compensation even though there was no actual incident related to those damages.
How Much Jail Time Can You Receive for Insurance Fraud?
As we mentioned, insurance fraud is a felony offense. This offense is punishable by up to 15 years of imprisonment and a fine of up to $15,000.
In addition to criminal penalties, a conviction for insurance fraud can also lead to civil penalties, such as restitution, fines, and damages. Moreover, a conviction of such a crime can hurt your reputation, employment prospects, and personal relationships.
What to Do If You’re Being Investigated or Are Under Arrest for Insurance Fraud
Being investigated or arrested for insurance fraud can be frightening, especially if you don’t know what to do. Here are a few tips to keep in mind if you are under investigation or have been arrested for insurance fraud:
- Remember you have the right to remain silent. If you are under arrest or being investigated, it's essential to avoid making any incriminating statements to the police or investigators. It's your constitutional right to remain silent, and you should exercise that right. Anything you say can and will be used against you in court, so it's best to say nothing at all until you have spoken to an attorney.
- Consult with an attorney. As soon as possible, you should contact a criminal defense attorney who has experience in handling insurance fraud cases. They can guide you through the legal process, protect your rights, and work to achieve the best possible outcome for your case. Your attorney can also negotiate with the prosecutors to reduce the charges or penalties, or even get the case dismissed.
- Work to develop a case strategy and evidence. With your attorney, you can determine what your case strategy should be, and you will need evidence to support your defense. Therefore, it's important to gather all relevant information that may help your case. This evidence could include documents, witnesses’ statements, and video or audio recordings. Your attorney can use this evidence to challenge the prosecution's case and show that you are not guilty of insurance fraud.
- Stay calm and adhere to your attorney’s instruction/counsel. Being charged with insurance fraud is a stressful and challenging experience. However, it's vital to remain calm and not panic. You are innocent until proven guilty, and your attorney will work tirelessly to ensure your rights are protected. It's important to follow your attorney's advice and trust in their experience and knowledge of the legal system.
Trusted White Collar Crime Attorneys
If you've been accused of a white-collar crime in Idaho, you need the legal expertise of May, Rammell & Wells. We have over 70 years of combined experience and a deep understanding of state and federal fraud laws. Let us investigate your case, gather evidence, and create a personalized defense strategy for you. With your freedom and reputation on the line,
We are familiar with the judges and courts and can work tirelessly to obtain the best possible outcome for you. Contact our firm online or via phone at (208) 623-8021 to schedule a consultation today.