False Insurance Claims Hurricane.

The submission of false information, through misrepresentation, fabrication, omission, or a combination of these methods, in order to obtain insurance proceeds to which the applicant or policyholder is not legally or contractually entitled is commonly referred to as insurance fraud. With regard to false hurricane claims, this can take several forms:

Claiming Damages That Did Not Occur

If you (or anyone else on your behalf) seek insurance benefits for damage related to a hurricane that never occurred, this is considered a clear instance of insurance fraud. This may violate applicable state law and, depending on the circumstances, federal law. The most common examples of this type of insurance fraud, known as “hard fraud,” include deliberately damaging property, fabricating insurance losses in a covered event, or fabricating the event itself in order to seek compensation.

If you or anyone else is facing allegations of deliberately fabricating hurricane-related insurance losses, our team can get to work reviewing your claim in order to determine why it has raised the concerns it has and how to assert your rights to seek insurance compensation for the actual (if any) damages that occurred.

Exaggerating Actual Hurricane-Related Damages

A legitimate hurricane-related insurance loss can also become fraudulent. This is when damage is claimed that is grossly exaggerated or intentionally mischaracterized in order to secure insurance proceeds that are not legally owed. For example, a property owner who seeks insurance coverage for the costs of replacing hurricane-damaged materials but also requests reimbursement for entirely new materials that exceed those that need to be replaced would be committing insurance fraud.

A common form of “soft fraud” is the exaggeration of property or other financial losses or other circumstances that are otherwise covered under an insurance policy. For example, this may involve:

• Claiming that a loss was caused by the hurricane when in fact the loss resulted from other causes
• Attributing preexisting damage to the hurricane in order to seek compensation from insurance
• Requesting compensation for personal property damaged in a storm that never belonged to the policyholder
• Inflating the value of goods or services damaged in a storm in order to claim a higher reimbursement from insurance
• Requesting reimbursement for goods and services that were not purchased or were not damaged by the storm

How Should You Challenge an Investigator’s Inaccurate Account of Your Hurricane Damage?

An investigation into allegations of hurricane insurance fraud can begin well before prosecutors file criminal charges. Depending on whether a claim is being scrutinized, insurers may refer suspected fraud cases to the Department of Justice or other federal authorities. Even if charges have not yet been filed, challenging the investigator’s findings as soon as possible is essential. If an investigation reveals that a claim is not legitimate or that a claimant is seeking funds to which they are not entitled, criminal charges may follow. With this in mind, it is critical to challenge any inaccuracies that may lead to allegations of insurance fraud or that may lead to a criminal conviction or other penalties in a civil proceeding.

What Is the Scope of an Investigation Into a Suspected False Hurricane Insurance Claim?

When insurers suspect that a hurricane damage claim is false or exaggerated, they typically engage investigators to examine the claim and the underlying policy. Insurers may hire licensed private investigators, including former federal agents and prosecutors, to conduct interviews, gather documentation, and examine insurance applications. In many cases, forensic accountants are used to analyze the financial extent of the alleged insurance fraud as well.

These investigators look for any possible evidence of a false hurricane damage claim. This may involve reviewing the information provided in insurance applications and other claim-related documents in order to determine if any material information was knowingly omitted or if an application mischaracterizes information regarding an event that is believed to be fraudulent.

For example, you may have submitted a claim for property damage, but an investigator claims that you left out information about preexisting damage to your property. Or, you may have made a billing mistake that made it appear as if you were claiming coverage for materials or services that were not actually provided. While a mistake could warrant a correction rather than a criminal referral in some circumstances, investigators may view any omission as evidence of intent to defraud.

Do I Have to Provide Information or Statements to a Claims Investigator?

In many cases, you will need to provide a statement to a claims investigator during the insurance company’s investigation. However, if a claims investigator is working with federal authorities, it is imperative to carefully consider how to respond. You may have to answer certain questions, but you may be able to answer others in writing, or you may need to rely on a third-party to help you communicate with the claims investigator.

If you need a third-party to assist you with responding to a claims investigator’s questions about an alleged false hurricane claim, reach out to Spodek Law Group immediately.

The attorneys at Spodek Law Group carry more than fifty years of combined experience between them.

Can a Falsely Blamed Hurricane Insurance Claimant Sue the Person Who Made the Accusation?

Yes, if you are being falsely accused of insurance fraud, you may be able to sue the person who made the accusation. However, before taking legal action, it is essential to understand your rights and have a clear strategy for your defense. To start, the consequences of getting caught committing insurance fraud can be severe. In many cases, the case could involve not just criminal charges, but a civil lawsuit seeking repayment of all money that was obtained through fraudulent conduct as well. But, even if you are not the party that sought the insurance benefits, you can still face allegations. Many cases involve third parties who may have received some benefit from the fraudulent conduct, even if they were not directly responsible for filing a false claim.

While insurance fraud is a crime in all 50 states, the presence of false information alone does not prove criminal liability. To establish that someone has committed insurance fraud, the prosecution must prove that the defendant’s conduct satisfied all of the relevant statutory elements. This includes showing that the defendant’s conduct was intentional and resulted in a loss for the insurance company or an undue financial gain for the defendant.

Many cases involving suspected false hurricane claims end up getting referred as cases of mail fraud, wire fraud, or healthcare fraud. While these are all distinct offenses, proving any of them requires satisfying all relevant legal elements. For example, proving a case of insurance fraud does not satisfy the elements of mail fraud or wire fraud, and showing evidence of a false claim will not establish liability for healthcare fraud either.

Although many states use the term “insurance fraud,” the penalties associated with a conviction vary widely. In some states, the potential penalties include a criminal record, fines, loss of license, and loss of the ability to work in certain professions. However, none of these penalties are universal, and while they might be the same across various state-level insurance fraud cases, this does not necessarily mean they also apply to federal cases as well.

Which Criminal Penalties Apply to a Hurricane Insurance Claim That Is Treated as Fraud?

While all states have various insurance fraud statutes, the penalties for a conviction range considerably. Below are some examples of insurance fraud statutes in Florida, New Jersey, and Massachusetts. If you are currently facing allegations of filing a false hurricane insurance claim, it is important to determine what laws apply to your case. In many cases, your defense will begin with establishing that your conduct does not trigger the law under which you have been charged.

Insurance Fraud in Florida

Florida’s statutes describe the crime of insurance fraud as follows:

Florida Statutes § 817.234(1)(a) provides that a person commits insurance fraud, with the intent to injure, defraud, or deceive an insurer, by engaging in specified conduct

with the intent to injure, defraud, or deceive any insurer

Subsection 817.234(1)(a) enumerates four numbered acts, with the third act divided into subparagraphs 3.a and 3.b.

presents or causes to be presented a statement containing false, incomplete, or misleading information concerning any fact or thing material to the claim

b. Falsifying or concealing information from an insurance company in order to seek a payment.

c. Making claims for property damage or losses that never occurred.

d. Making claims that are grossly exaggerated in order to seek reimbursement.

e. Attributing preexisting damage to an event covered by an insurance policy.

f. Falsifying claim documents.

g. Claiming coverage for materials or services that were not delivered or were delivered incorrectly.

h. Attempting to get reimbursement from a third-party insurer after getting reimbursement from their own insurer.

Insurance Fraud in New Jersey

New Jersey has classified insurance fraud as a criminal offense by defining “criminal insurance fraud” in its statutory materials as:

New Jersey defines the crime of insurance fraud in N.J. Stat. Ann. § 2C:21-4.6(a) as knowingly making or causing a false, fictitious, fraudulent, or misleading statement of material fact, or omitting a material fact, in a record, bill, claim, or other document connected with an insurance transaction.

Insurance Fraud in Massachusetts

Massachusetts has several laws that address insurance fraud. Chapter 266, Section 10, defines burning insured property with the intent to defraud as a criminal offense and provides for imprisonment in the state prison for not more than five years or in a jail or house of correction for not more than two and one-half years.

If You Want Someone to Look at Your Case

Reading about a charge is not the same as having someone read your file. Spodek Law Group keeps an attorney on call around the clock, and the first consultation costs nothing and runs as long as your questions do. The number is 888 348 8028.