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Effectively dealing with allegations of insurance fraud: work with experienced attorney

Insurance companies are keen, in every circumstance, to minimize their losses. This is why insurance companies have very specific underwriting standards, which they are careful to follow. It is also why insurance companies are careful to monitor for potential claimant fraud. Insurance fraud can take a variety of forms, depending on the type of insurance claim.

When an insurance claimant is accused of engaging in fraud, it is a serious allegation. Not only is there the possibility of civil liability, but also criminal prosecution. Fraud occurs when a claimant knowingly lies in order to obtain benefits to which they are not entitled. 

According to the California Department of Insurance, insurance fraud can be prosecuted when certain circumstances are present. First of all, the claimant must have had the intent to defraud the company. This intent would not be present when the claimant simply made a mistake or acted carelessly in filing a claim, as sometimes happen.

Second, fraudulent intent must accompany the act of filing the false claim. In other words, the intent to defraud must have been there at the time of filing the claim. Third, the act of fraud must have been completed, which is the case as soon as a claimant makes a fraudulent misrepresentation. It doesn’t require that the insurance company have paid out the false claim. No actual loss is necessary.

Claimants who have been accused of filing a fraudulent insurance claim need to get in contact with an experienced attorney as soon as possible to receive guidance in the insurance company’s investigation of the claim and in any subsequent investigations, legal claims or criminal charges that might result. An experienced advocate can help sort through the evidence to determine whether there is a basis for allegations of fraud, and whether there are any available defenses or mitigating circumstances in the case.  

It should also be mentioned that insurance companies themselves can also be charged with fraud when they knowingly deny benefits to which a claimant is entitled. An experienced advocate can also in these cases to ensure the insurer is held accountable. 

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