What should I do if accused of lying on an insurance claim?
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What to Do If Accused of Lying on an Insurance Claim
Being accused of lying on an insurance claim can be scary. But try to stay calm. Getting defensive won’t help. Instead, be cooperative and get legal advice.
Why Insurers Investigate Claims
Insurance companies investigate claims to prevent fraud. But honest mistakes can look suspicious too. Like if you forget some medical history or get a date wrong.
If the insurer thinks you lied, they might deny the claim and cancel the policy. You could even face criminal charges for insurance fraud.
Don’t Panic – Get Legal Help
Being accused feels scary and unfair. But getting angry won’t convince the insurer you’re honest. Stay calm, be polite, and get a lawyer experienced with insurance disputes.
A good lawyer can review the case and help protect your rights. Having an advocate on your side makes the process less intimidating.
How a Lawyer Can Help
- Review the claim details and help build your defense
- Communicate with the insurer to clarify confusion
- Negotiate a settlement to avoid court
- Represent you if the case goes before a judge
Be Honest
Lying again or hiding information will make you look very guilty, even if the original “lie” was an honest mistake.
Tell the full truth to your lawyer so they can give good advice. Being open now can help avoid bigger troubles down the road.
Examples of What to Tell Your Lawyer
- Any facts you omitted or stated incorrectly on the claim
- Reasons why omissions/errors happened
- All medical history related to the claim
- Any past insurance claims you’ve filed
Try Settling Out of Court
Fighting an insurance fraud case in court can be lengthy and expensive. Many cases settle through negotiation between lawyers before going to trial.
Settlements often have better outcomes too. Instead of harsh all-or-nothing verdicts, settlements can lead to:
- Lesser penalties
- Avoiding policy cancellation
- Partial reimbursement of claim
With an experienced lawyer negotiating for you, settling often makes the most sense.
When Settlement May Not Be Possible
If the insurer believes you intentionally tried to mislead them, they may refuse to settle. Then your lawyer can help build legal defenses and represent you in court if needed.
Build Your Defenses
There are defenses that could help you fight or reduce the charges, such as:
Lack of Intent
If errors resulted from an honest misunderstanding rather than deliberately misleading the insurer, you may be able to reduce or avoid penalties. Your lawyer can argue you never meant to misrepresent facts.
Unclear Policy Terms
If the insurer’s application materials or questions were unclear, it weakens their argument you intentionally lied. Your lawyer may claim the insurer shares some blame.
No Harm Done
If your mistakes on the form didn’t affect the claim outcome or amount paid, it helps show there was no real harm or fraud. This can also lead to reduced consequences.
Be Prepared for Trial
If settling out of court isn’t possible, your lawyer will defend you at trial. This means:
- Gathering evidence and documents to support your case
- Interviewing any witnesses from your side
- Preparing testimony to tell your version of events
Having an experienced trial lawyer gives you the best chance at success. Many cases also settle shortly before trial, so be ready for that possibility too.
Consequences If Found Guilty
If found guilty of insurance fraud, either through trial or settlement, you may face:
- Fines up to $10,000 or more
- Jail time in serious cases
- Restitution payments to the insurer
- Future difficulty getting any insurance
- Permanent criminal record
These high stakes make having a strong legal defense extremely important.
Avoid Future Problems
Once your current case closes, be very careful on future insurance applications. Always answer questions fully and accurately.
Disclosing information upfront prevents issues later on. If you’re unsure about any question when applying, discuss it with the agent to avoid misunderstandings.
Having been accused of fraud also means insurers will look at your applications more closely for some period of time. Reduce risk by being extra transparent about your history.
Ask Your Agent or Lawyer If Unsure
If any part of an application is unclear when reapplying for insurance, ask your agent or lawyer to help fill it in accurately. That keeps you safe in case questions ever come up again about a claim.