Insurance fraud

PITTSBURGH INSURANCE FRAUD ATTORNEY
HOW IS INSURANCE FRAUD DEFINED IN PENNSYLVANIA?

Section 4117 of the Crimes Code outlines the crime of insurance fraud, which in its entirety lays out 12 different ways by which someone can commit insurance fraud. Those ways can be summarized like this:

• Knowingly presenting a false, incomplete, or misleading document to a state or local government agency, with the intent to defraud, which is “material to the agency’s determination in approving or disapproving a motor vehicle insurance rate filing, a motor vehicle insurance transaction, or other motor vehicle insurance action”;

• Knowingly presenting a false, incomplete, or misleading statement to any insurer or self-insured, with the intent to defraud, that’s material to a claim (and assisting, abetting, soliciting, or conspiring with another to do the same);

• Engaging in unlicensed agent, broker, or unauthorized insurer activity with the intent to defraud an insurer, a self-insured, or the public;

• Knowingly benefiting (directly or indirectly) from proceeds derived from a violation of Section 4117 due to the assistance, conspiracy, or urging of another;

• An owner, administrator, or employee of a health care facility knowingly allowing the use of such facility by another to further a scheme or conspiracy to violation Section 4117;

• Borrowing or using another’s insurance identification card, or permitting the same, knowingly and with intent to present a fraudulent claim to an insurer;

• Soliciting (directly or indirectly) any person to engage, employ or retain themselves or another for purposes of adjusting or prosecuting a claim for damages for negligence, personal injury, or death;

• Knowingly filing an application for insurance containing any false information, or concealing information for purposes of being misleading, to any insurance company, self-insured, or other person.

There are additional provisions within Section 4117 which pertain specifically to lawyers and health care providers, who compensate or give anything of value to another for recommending the lawyer’s or provider’s services (i.e. referral fees). These provisions are covered under Section 4117(b), and they are graded as first-degree misdemeanors.

HOW SERIOUS IS INSURANCE FRAUD?

In most cases, insurance fraud is a third-degree felony except as noted above.

CAN INSURANCE FRAUD BE RESOLVED PRETRIAL?

Within Section 4117(f) itself, the prosecuting attorney is given the authority to enter into “a written agreement in which [the accused] does not admit or deny the charges but consents to payment of [a] civil penalty.”

WHAT IS THE STATUTE OF LIMITATIONS?

A prosecution for insurance fraud must be commenced within five years after it is committed.