LOS ANGELES INSURANCE FRAUD ATTORNEY

Learn how to fight insurance fraud charges.  Spolin Law, and former insurance fraud prosecutor Aaron Spolin, can defend you and your reputation.

  1. How to Fight Insurance Fraud Charges
  2. Common Types of Insurance Fraud
  3. Defenses to Insurance Fraud Claims
  4. Legal Motions to Suppress Illegal Evidence
  5. Winning at Trial

HOW TO FIGHT INSURANCE FRAUD CHARGES

Being charged with insurance fraud means that the prosecutor is accusing you of making a fraudulent (false) act to get a certain outcome from an insurance company.  Most insurance fraud cases involve car insurance or health insurance, although other types of insurance can be involved.

Fighting an insurance fraud charge can be difficult.  However, if you hire an attorney with experience fighting insurance fraud cases, you can often achieve a better outcome for yourself.

To fight and win insurance fraud cases, Spolin Law takes the following steps:

  • Investigate the facts thoroughly for issues that may weaken the prosecution’s case. They may have an allegation of insurance fraud, but we have had success spotting holes in the insurance paperwork or other issues that prevent the prosecutor from proving their case.
  • File legal motions to dismiss the case or drop certain charges. Often the District Attorney or US Attorney will “overcharge” the case and add inappropriate charges. Motions to dismiss certain counts can be successful in limiting exposure or dismissing the entire case.
  • File legal motions to suppress illegal evidence. If law enforcement has broken the law, you may have a right to exclude or suppress illegal evidence.  These “suppression motions” can limit the prosecutor’s evidence, which may result in a favorable plea deal, a dismissal, or a stronger case to take to trial.
  • Present legal defenses to the “fraudulent” act. As discussed below, certain legal defenses will prevent a criminal conviction for insurance fraud.
  • Present a strong case at trial. Sometimes presenting a strong case a trial is the best defense.  This can often involve explaining to a jury how what you did was an accident and was not a deliberate attempt to defraud the insurance company. If the prosecutor cannot prove that you intended to
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    Spolin Law is led by a former insurance fraud prosecutor. The firm defends people accused of fraud.

    defraud, the result can be a not-guilty verdict.  Winning at trial is discussed in more depth below.

This approach, and an experienced fraud attorney, can be help you fight and win your insurance fraud case.  Spolin Law focuses its practice on insurance fraud defense and is headed by a former insurance fraud prosecutor.  Give us a call for a free consultation to discuss your case. We are at (310) 424-5816.

  1. How to Fight Insurance Fraud Charges
  2. Common Types of Insurance Fraud
  3. Defenses to Insurance Fraud Claims
  4. Legal Motions to Suppress Illegal Evidence
  5. Winning at Trial

COMMON TYPES OF INSURANCE FRAUD

Auto Insurance Fraud – Penal Code section 548 to 551

Automobile insurance fraud essentially involves a knowingly false statement related to a car that was made with the intent to receive insurance payment.

According to California law, a person commits automobile insurance fraud when he or she:

  • Makes a false claim to an insurance company regarding a car-related incident (e.g., damage or theft of an insured car).
  • Damages or abandons a vehicle with the intent to collect insurance money for the vehicle.
  • Makes two insurance claims for the same single incident.
  • Participates or creates an accident to obtain insurance money.
  • Knowingly presents a false statement to an insurance company.

The most common type of car insurance fraud involves the acts listed above, although there are other rarer forms of insurance fraud that can be charged as well.

The following examples demonstrate some of the ways a person can commit insurance fraud:

  • Abandoning your car and then telling the insurance company that the car was stolen.
  • Telling the insurance company you got into an accident when really you did not.
  • Getting in an accident with minor damage but claiming that you spent more money on repairs than you actually did.
  • Slamming on the breaks in the highway in front of an expensive car for the purpose of getting a pay-out from the other driver’s insurance.

Punishment for auto insurance fraud can involve state prison time, restitution of payment, probation, and fines.  Los Angeles prosecutors usually charge these car insurance cases as felonies.

Defending yourself from car insurance fraud charges frequently involves showing how the prosecutor cannot prove that you committed the crime.  As discussed in the other sections, this can involve legal motions to suppress evidence or dismiss charges, presentation of appropriate legal defenses, and advocacy before and during trial.

Health Care Insurance Fraud – Penal Code 550

Healthcare fraud involves a false statement or deceptive acts done with the intention of receiving payment from a healthcare company or government agency. Healthcare fraud frequently involves private insurance companies, but with the widespread use of Medicare and Medicaid, the government can be the one that is defrauded.

Common examples of healthcare fraud can involve:

  • billing for a service that was not performed
  • overcharging the insurance company or government for service
  • submitting multiple claims for a single incident

Healthcare providers are most frequently the target of healthcare fraud charges. However, Los Angeles prosecutors sometimes charge alleged patients of the healthcare provider if they believe the patients were involved in the fraudulent activity.  Since felony charges are usually filed, penalties can include state prison time as well as other serious sanctions.

Workers’ Compensation Insurance Fraud – Penal Code 549-550 & Insurance Code 1871.4

Workers’ Compensation fraud involves receiving payment or intending to receive payment related to a Workers’ Compensation claim.  “Workers’ Compensation” involves the system of insurance that pays for injuries or disabilities happening on the workplace.

Under California law, Workers’ Compensation fraud can be committed by:

  • Knowingly making a false statement in order for workers’ compensation benefits to be granted or denied.
  • Encouraging another person to make a false statement related to Workers’ Compensation.
  • Submitting a claim for healthcare treatment for an actual injury, when the injury was not actually treated by a healthcare professional.
  • Submitting multiple claims for the same treatment in the same injury

Some examples of Workers’ Compensation fraud can include

  • claiming that you were injured at work when really you were not injured.
  • claiming you were injured at work when really you received the injury in a non-work setting.
  • submitting a bill for healthcare treatment for an injury, when you did not actually receive that treatment, even if the injury is legitimate.

These types of claims frequently involve a large amount of money, which frequently results in the insurance fraud claims being charged as felonies.  While prosecutors sometimes offer non-jail or non-prison plea deals, conviction for workers’ compensation insurance fraud can result in significant prison time.

Defending against workers’ compensation insurance fraud charges can be difficult.  However, an attorney with insurance fraud experience can make a large difference.  Some of the tactics used to fight these charges can include legal motions to suppress evidence or dismiss charges, the presentation of valid legal defenses to the crime, and strong advocacy before and during a trial.

Other Insurance Fraud (including Property, Fire, and Life Insurance)

Other cases of insurance fraud follow a similar pattern. The element in common they all have is an intent to present false facts to an insurance company for monetary or other gain.

Examples of other general types of insurance fraud include filing a false claim about property that was supposedly damaged, a house they may have burned, a life insurance policy where the medical paperwork submitted was fake, or any other false statement made with the intention of getting a gain from an insurance company.

California Penal Code sections 448 to 451 cover most instances of insurance fraud. Insurance fraud cases are charge as felonies in most cases. Therefore, they carry with them the penalties traditionally associated with felonies, including prison time, possible probation, restitution, and fines.

Defending against these other types of insurance fraud include many of the same steps described below.

  1. How to Fight Insurance Fraud Charges
  2. Common Types of Insurance Fraud
  3. Defenses to Insurance Fraud Claims
  4. Legal Motions to Suppress Illegal Evidence
  5. Winning at Trial

DEFENSES TO INSURANCE FRAUD CHARGES

There are a number of valid legal defenses that will prevent a conviction for insurance fraud.

Spolin Law’s approach to defending insurance fraud cases includes arguing and proving all valid defenses.  If your attorney is successful presenting any of these defense to the judge or jury, you cannot legally be convicted of insurance fraud.

Legal Defenses to Insurance Fraud:

  • Lack of Knowledge of Falsity: To be guilty of insurance fraud, you must have known that what you were saying/writing was false. If you did not know it was false, we can present a strong “lack of knowledge” defense.  For example, if you wrote something false on the insurance paperwork because someone else told you it was true, and you did not know it was false, we will likely be able to present this defense.
  • Lack of Intention: To be guilty of insurance fraud, you must have intended to submit or communicate the false claim. If this was a complete accident (and you did not intend to transmit/communicate the false claim) we will be able to present this defense. For example, if we can prove you tried to “save” an electronic draft of your insurance paperwork, but you accidentally pressed “submit” instead, we may be able to argue that you never intended to transmit the false statement to the insurance company.
  • Duress: The duress defense is used if you were forced to do something against your will. If someone forced you to commit an act of insurance fraud by making serious threats against you, we could use the duress defense. For example, if a violent street gang told you to purposefully drive into a car so that they could claim the insurance money (i.e., a fraudulent “staged” accident), and then threatened to kill your wife if you failed to cooperate, you would have a strong duress defense.
  • Entrapment: The entrapment defense can be used when the criminal idea originated with law enforcement and you were not otherwise inclined to carry out the criminal act. If you were pressured or otherwise encouraged to file a fraudulent insurance claim by an agent of law enforcement, this defense could apply to your case.  For example, if a detective asks you to file a false insurance claim so that the detective can then investigate the insurance company, you will likely be able to present this defense to avoid criminal liability
  • Withdrawal from Conspiracy: If the prosecutor alleges that you conspired with others to commit insurance fraud, you can avoid conviction for the actual insurance fraud if you withdrew from the conspiracy at an early stage. You can avoid any conviction if you withdrew before any act occurred that “furthered” the conspiracy.  You can also avoid conviction on the insurance fraud charges if you withdrew from the conspiracy before the fraud was committed.
  • Mistaken Identity: A mistaken identity defense involves claiming that you did not fill out the fraudulent insurance paperwork or carry out any fraudulent act.  Insurance fraud is a paper-heavy crime.  There usually are no eyewitnesses.  Therefore, someone else could have committed the insurance fraud but then signed your name on the false document. Unless there is video surveillance, witnesses, or other direct evidence that you filled out the fraudulent insurance paperwork, you may have a strong case for mistaken identity.  If the prosecutor is unable to prove that you personally committed the insurance fraud, we will likely be able to prevent any criminal conviction.
  • Ambiguous Statement: Most types of insurance fraud involve a false statement of some sort. However, if what you wrote or said was truthful but the insurance company or prosecutor simply misinterpreted the statement, we may be able to present this defense regarding the ambiguity of the statement.

Will one of these defenses apply to your case? To find out and to learn how we can fight your case, call former insurance fraud prosecutor (and now insurance fraud defense attorney) Aaron Spolin, of Spolin Law, at (310) 424-5816.

  1. How to Fight Insurance Fraud Charges
  2. Common Types of Insurance Fraud
  3. Defenses to Insurance Fraud Claims
  4. Legal Motions to Suppress Illegal Evidence
  5. Winning at Trial

LEGAL MOTIONS TO SUPPRESS EVIDENCE OR DISMISS CHARGES

After someone has been charged with insurance fraud, his or her attorney will have a chance to file “legal motions.” Motions are requests for the judge to take an action that affects the case.  Effective motions explain why the law requires a certain action by the judge.

Spolin Law takes an aggressive approach to filing legal motions.  We file any and all motions that are warranted.  If a motion is successful, it can result in a significantly stronger defense case or the outright dismissal of the case.

Some of the most common legal motions include:

  • Motion to dismiss the case: A motion to dismiss asks the court to dismiss the case against the accused individual. Insurance fraud cases can involve many different methods for seeking case dismissal.  The basis for dismissal can include (1) a failure of the prosecution to show probable cause at the preliminary hearing, (2) the failure to present evidence on a necessary element of the crime, (3) the absence of “jurisdiction” (i.e., the court does not have a right to hear this case), (4) the failure of the prosecution to bring charges within the maximum number of years, (5) the failure of the court to bring the case to trial within the necessary time limit, or (6) any number of other legal bases for dismissal.  Contact Spolin Law to learn about whether any of these circumstances may apply to your case.
  • Motion to suppress illegal evidence: The Constitution gives you certain rights. When those rights are violated by the police agencies, you may be entitled to have that evidence suppressed.  “Suppressed” means that the prosecution cannot use the evidence at trial, so it weakens or ruins the prosecution case.  In the context of an insurance fraud case, this may include suppression of (1) documents that were found during an illegal search of your home or office, (2) a statement you made that the prosecution is trying to use against you, or (3) other evidence that was obtained illegally and in violation of your rights.
  • Motion to prevent certain prosecution testimony: Before trial begins, an effective insurance fraud defense attorney may file motions “in limine.” These types of motions ask the judge to prevent the prosecutor from using evidence that violates an existing law. Motions in limine are similar to the oral objections that you may hear at trial (for example: “Objection! Hearsay!”).  However, motions in limine explain why the evidence should never even be presented, and they usually involve a far greater level of depth and research that is presented to the judge.  An example of a successful motion in limine might be a motion asking the judge to prevent the prosecutor from letting the fraud investigator say that he thinks the defendant is lying.
  • Motion to dismiss an improper charge: Prosecutors frequently file inappropriate charges against people accused of insurance fraud.  The prosecutor usually thinks that he or she should simply accuse the defendant of all possible crimes that may have been committed (instead of simply charging the defendant with the crimes that the evidence supports).  Motions to dismiss improper or unsupported charges can came at nearly any stage of the criminal proceeding.  Successful dismissal of certain charges can drastically reduce the possible penalties that an accused person may face. They may also effectively force a prosecutor to offer a better plea deal.

Spolin Law has been successful filing these types of motions because our firm founder is a former insurance fraud prosecutor.  If you want to learn how we can fight your case with aggressive and effective legal motions, call us at (310) 424-5816.

  1. How to Fight Insurance Fraud Charges
  2. Common Types of Insurance Fraud
  3. Defenses to Insurance Fraud Claims
  4. Legal Motions to Suppress Illegal Evidence
  5. Winning at Trial

WINNING AT TRIAL

Strength at trial is often your best defense. This is as true in the insurance fraud context as it is anywhere.

There are a number of different tactics to win at trial when you’re charged with insurance fraud. The effectiveness of each tactic depends on the facts of the case and the abilities of the defense attorney.

Winning at trial requires a number of actions:

  1. Attack the prosecution case: One of the most effective methods to win at trial is to show how the prosecution has failed to prove its case beyond a reasonable doubt. “Beyond a reasonable doubt” is a high standard, and an effective defense attorney’s job is to demonstrate how the minimal evidence presented is not enough for a conviction. The prosecutor frequently has to prove that the defendant knew his statement was false. (For example, if you are charged with filing a false insurance report, the prosecution would have to prove not only that the report was false but that you knew it was not true). This is usually the weakest link in the prosecution case, and it is a ripe target for attack at trial.
  1. Get testimony from experts to support your case: Spolin Law’s success in insurance fraud cases has a lot to do with our approach to hiring outside experts. Bringing in a fraud investigator from the beginning of the case can help us understand what happened and where the prosecutors have made mistakes.  Additionally, presenting expert testimony at trial (from, for example, forensic accountants) can be a powerful method of showing the jury how our clients are not actually guilty of insurance fraud.
  1. Hire a great insurance fraud defense lawyer: If you want to win your trial, hiring a skilled and successful insurance fraud defense attorney should be your number one priority.  At the end of the day, your trial case is only as strong as the lawyer presenting it.  Spolin Law’s founding attorney is a former insurance fraud prosecutor. Mr. Spolin, a Princeton graduate, is also the winner of the American College of Trial Lawyer’s Medal for Excellence in Oral Advocacy.  He is a former member of California Law Review and is recognized as one of the leading insurance fraud defense attorneys in California.

 

HIRING THE BEST FOR YOUR DEFENSE

Hiring a skilled and experienced attorney is the single most important step you can take.

Los Angeles Criminal Defense Attorney Aaron Spolin

Former insurance fraud prosecutor Aaron Spolin, of Spolin Law

Spolin Law’s founder, Aaron Spolin, is a former insurance fraud prosecutor and has been on the winning side of hundreds of criminal cases.  A former Assistant District Attorney, he now represents people charged with insurance fraud and similar crimes.  Mr. Spolin is a former member of California Law Review and has a B.A. from Princeton and J.D. from U.C. Berkeley.  He is also the winner of the American College of Trial Lawyers’ Medal for Excellence in Oral Advocacy.

Spolin Law provides 100% free consultations.  Call our office for to learn more about how we can fight—and potentially win—your case.

Call (310) 424-5816 for a free consultation.

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