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New York Insurance Fraud Lawyer

March 21, 2024 Uncategorized


New York Insurance Fraud Lawyer

Insurance fraud is a serious issue that affects consumers and insurance companies in New York. This article provides an overview of insurance fraud laws in New York, common types of insurance fraud, and how an experienced New York insurance fraud lawyer can help.

New York Insurance Fraud Laws

There are several key laws in New York that address insurance fraud:

  • New York Penal Law Article 176 – Defines insurance fraud crimes and penalties
  • New York Executive Law Article 36-A – Establishes the Motor Vehicle Theft and Insurance Fraud Prevention Board
  • New York Insurance Law Section 409 – Requires insurers to file fraud prevention plans

Under New York Penal Law Article 176, it is illegal to knowingly make false statements or representations to an insurer to obtain insurance coverage or benefits. This covers acts like inflating claims, staging accidents, or providing false information on an insurance application. Insurance fraud crimes can range from misdemeanors to felonies under Article 176.

New York Executive Law Article 36-A established the Motor Vehicle Theft and Insurance Fraud Prevention Board to coordinate statewide efforts to combat auto insurance fraud. The Board releases an annual plan to reduce motor vehicle theft and insurance fraud in the state.

Under New York Insurance Law Section 409, insurers writing over $1 million in premiums must file an annual fraud prevention plan with the state Department of Financial Services. This includes establishing a Special Investigations Unit (SIU) to detect insurance fraud.

Common Types of Insurance Fraud

Some of the most common insurance fraud schemes in New York include:

  • Staged auto accidents – Organized groups intentionally cause car crashes and file injury claims.
  • Premium diversion – Insurance agents pocket premium payments instead of sending them to the insurer.
  • Worker’s compensation fraud – Employees fake injuries to collect benefits.
  • Life insurance fraud – Policyholders lie about pre-existing conditions or continue paying premiums for deceased relatives.
  • Health insurance fraud – Doctors bill for services not performed or patients share insurance cards.

Insurers often detect fraud through data analytics, anonymous tips, and SIU investigations. But many cases also rely on whistleblowers coming forward or getting caught in undercover sting operations.

How a New York Insurance Fraud Lawyer Can Help

Working with an experienced New York insurance fraud attorney is important for several reasons:

  • They understand complex insurance regulations and policies.
  • They can evaluate the strength of the insurer’s fraud accusations.
  • They know how to build a strong defense to fight the charges.
  • They can negotiate reduced penalties or alternative resolutions when appropriate.
  • They have experience representing clients in fraud investigations.
  • They can guide clients through the legal process and protect their rights.

An attorney can also advise clients on steps to take if they suspect insurance fraud. This includes proper documentation and deciding whether to report it to the insurer or regulators.

Defending Against Insurance Fraud Charges

There are many possible defenses against insurance fraud charges. A knowledgeable lawyer can pursue strategies like:

  • Contesting intent – Arguing the client did not “knowingly” commit fraud.
  • Challenging materiality – Questioning if false statements were significant enough to constitute fraud.
  • Disputing investigation methods – Claiming insurer relied on deception or coercion.
  • Raising contractual issues – Identifying ambiguities in policy terms or claims procedures.
  • Presenting mitigating circumstances – Explaining reasons for client’s actions, like financial distress.
  • Seeking prosecutorial discretion – Leveraging client’s cooperation to avoid criminal prosecution.

An attorney can also scrutinize if the insurer followed proper protocols during its fraud investigation and notify regulators of any misconduct.

Negotiating Reduced Penalties for Insurance Fraud

Rather than taking a case to trial, a lawyer may be able to negotiate with prosecutors for reduced penalties such as:

  • Lesser charges – Conviction on a misdemeanor instead of a felony.
  • Pre-trial diversion – Charges dropped after completing probation and restitution.
  • Avoiding license suspension – For professionals accused of insurance fraud.
  • No incarceration – Sentencing limited to fines and community service.

This depends on the circumstances of the case and the client’s criminal history. But an experienced negotiator can often work out deals that minimize damage to the client’s career and reputation.

Reporting Suspected Insurance Fraud

Those who uncover potential insurance fraud should proceed carefully in reporting it. Things to consider include:

  • Documenting evidence – Keep detailed records of observations and documents.
  • Seeking legal advice – Consult an attorney to understand rights and risks.
  • Anonymity – Request confidentiality when reporting fraud to the insurer or regulators.
  • Anti-retaliation laws – New York law prohibits insurers from retaliating against whistleblowers.
  • Rewards – Some insurance companies offer rewards for reporting fraud.

Having an attorney’s guidance can be invaluable in safely bringing fraudulent activity to light.

Choosing an Insurance Fraud Lawyer

When selecting legal representation for insurance fraud matters, key credentials to look for include:

  • Insurance expertise – Extensive experience in insurance law and regulations.
  • Fraud focus – Specific experience handling insurance fraud cases.
  • Trial record – A proven ability to take cases to court if needed.
  • Negotiation skills – A track record of favorably resolving cases through settlements.
  • Industry connections – Relationships with insurance company decision-makers.
  • Resources – The ability to invest in investigating complex insurance fraud schemes.

It’s also important to choose an attorney you feel comfortable with and who will protect your interests. Meet with potential lawyers to discuss your case details and evaluate whether they are the right fit.

Dealing with accusations of insurance fraud can be stressful. But the right New York insurance fraud lawyer can help clients understand their rights, build an effective defense, and achieve the most favorable outcome possible.


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