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3 Types of Insurance Fraud

Insurance Fraud

What is Insurance Fraud?

Insurance Fraud involves the submission of fraudulent insurance claims in order to gain monies or property. The methodology employed by fraudulent insurance claims can utilize either fabrication or exaggeration in their respective nature. The intention to defraud the insurance company is the focus of this type of crime.

While the prospect exists that an insurance claim can be reported in a fallacious nature absent of the intention to commit fraud, Insurance Fraud investigations maintain a rigorous and thorough process and procedure that is utilized to not only determine the validity of any and all insurance claims, but also to study patterns and trends latent within insurance claims with the hopes of apprehending individuals attempting to commit acts of Insurance Fraud.

Types of Insurance Fraud

The following are the most common types of Insurance Fraud:

1. Health Insurance Fraud is considered to be the submission of a fraudulent insurance claim with regard to the health, wellness, or medical malady attributed to an individual. Health Insurance Fraud can take place within the following methods:

• Exaggerated or fabricated injuries reported to an insurance company
• Falsified medical documents, which can include medical reports or medical bills reported to the insurance company
• Falsification of the events that had taken place resulting in an injury, which are reported to the insurance company.

2. Life Insurance Fraud is the attempt to collect on a life insurance policy as a result of spurious, illegal, and unlawful intention. Life Insurance Fraud can consist of the following:

• The falsification of death records or death notices reported to the insurance company
• The murder of an individual in order to collect the life insurance policy belonging to them
• Fallaciously marrying an elderly individual or an individual at a high risk for death in the attempt to collect their life insurance policy.

3. Government or Administrative Insurance Fraud is the intentional defrauding of the Federal Government in order to receive payments in the form of monetary grants, loans, or assistance. This can include the following:

• The submission of fraudulent financial reports in order to collect welfare or government assistance
• The submission of fraudulent employment claims in order to unlawfully receive unemployment benefits
• The submission of fallacious reports of pregnancy in order to unlawfully receive maternity benefits
• The submission of fraudulent claims with regard to an injury sustained in order to unlawfully collect worker’s compensation.

Arrest Process for Insurance Fraud

Individuals who have been served documentation in the form of an arrest warrant displaying an Insurance Fraud charge, or have already been arrested by law enforcement agents, are encouraged to cooperate with the arresting officers regardless of personal belief with regard to the charges. Individuals under arrest will be given the opportunity to consult with legal specialists subsequent to the arrest process. Resisting or fleeing from an Insurance Fraud arrest can result in harm, injury, and additional penalties. Upon arrest, an individual should be made aware of the following in order to prevent any further complication(s):

• Habeas Corpus
• Due Process
• The Presumption of Innocence.

Upon the arrest for an Insurance Fraud charge, this is the standard arrest protocol that must be upheld by any and all arresting officers. Miranda Rights include the Fifth Amendment, which states that an individual retains the right to remain silent in order to avoid incriminating themselves. This is also known as ‘pleading the Fifth’. In addition, Miranda Rights also guarantee the following rights with regard to an arrest:

a. The right to remain silent
b. The right for any words spoken during the arrest to be admissible during a trial
c. The right to consult with an attorney regardless of financial stature
d. The acknowledgement that the individual arrested for the Insurance Fraud charge understands the aforementioned rights.

The Preparation of an Insurance Fraud Defense

Individuals are encouraged to consult with attorneys specializing in criminal law and, if possible, those who focus on Insurance Fraud legality, criminal law, and defense. In the construction of a defense, the individual may be asked to provide the nature of the Insurance Fraud in question, any included threats, the biographical information with regard to any and all victims, any previous arrests and/or convictions, evidence and witness testimony, full account of the details surrounding the event in question, and the arrangement for bail or bond.

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