Defending Against Insurance Fraud Accusations In Texas

Overview of Insurance Fraud in Texas

Insurance fraud is a white-collar crime when an individual or entity intentionally provides false or misleading information to an insurance company for financial gain. In Texas, insurance fraud can be charged under the Texas Penal Code Section 35.02, which makes it illegal to knowingly or intentionally engage in fraudulent activities related to insurance claims or policies.

If you have been accused of insurance fraud in Texas, contact Varghese Summersett immediately. Our team of criminal defense attorneys includes Board Certified specialists and former prosecutors with more than four decades of combined experience fighting insurance fraud claims.

Types of Insurance Fraud

There are various forms of insurance fraud that can be committed in Texas. Some common examples include:

False Claims

Submitting false or exaggerated claims to an insurance company to receive undeserved benefits. This can occur in various types of insurance, such as auto, health, life, or property insurance.

Application Fraud

Providing false information on an insurance application to obtain coverage or lower premiums. This can involve misrepresenting facts about one’s personal history, health conditions, or property conditions.

Fraudulent Policies

Selling or issuing counterfeit or unauthorized insurance policies or knowingly assisting others in obtaining such policies.

Agent And Broker Fraud

Insurance agents or brokers engaging in deceptive practices, such as embezzling premiums, forging signatures, or steering clients towards unnecessary or overpriced coverage.

Elements of Insurance Fraud

To be charged with insurance fraud under Section 35.02, an individual must knowingly or intentionally:

Prepare, present, or cause to be presented a statement in support of a claim for payment or other benefits under an insurance policy that the individual knows contains false or misleading material information.
Solicit, offer, pay, or accept any benefit in connection with a claim for payment or other benefits under an insurance policy, knowing the claim contains false or misleading material information.
Conceal, remove, or dispose of property with the intent to defraud or deceive an insurer.
Prepare or cause to be prepared a statement for use in an application for an insurance policy that the individual knows contains false or misleading material information.

Penalties for Insurance Fraud in Texas

The penalties for insurance fraud in Texas are determined based on the value of the claim or benefits obtained or sought through the fraudulent act:

Less than $2,500: Class A misdemeanor, punishable by up to 1 year in jail and a fine of up to $4,000.
$2,500 to $30,000: Third-degree felony, punishable by 2 to 10 years in prison and a fine of up to $10,000.
$30,000 to $150,000: Second-degree felony, punishable by 2 to 20 years in prison and a fine of up to $10,000.
$150,000 or more: First-degree felony, punishable by 5 to 99 years in prison and a fine of up to $10,000.

What is the Statute of Limitations for Insurance Fraud?

A misdemeanor allegation of insurance fraud is barred after two years. A felony accusation is barred after three years.

Defending Against Insurance Fraud Allegations

A skilled defense attorney can evaluate your case and develop a tailored strategy to contest insurance fraud charges. Some potential defenses include:

Lack Of Intent

Demonstrating that you did not knowingly or intentionally provide false or misleading information to the insurance company. This may involve proving that any inaccuracies were the result of a mistake or misunderstanding.

Insufficient Evidence

Challenging the evidence presented by the prosecution, such as by questioning the validity of documents or the credibility of witnesses, to establish that there is not enough evidence to prove guilt beyond a reasonable doubt.

Entrapment

Arguing that law enforcement induced you to commit insurance fraud when you would not have otherwise done so through coercion, persuasion, or other means.

Good Faith

Asserting that you had a reasonable, good-faith belief that the information you provided was accurate, even if it later turned out to be incorrect.

Recent Texas insurance fraud cases in the news

In February 2023, former NFL receiver Corey Bradford pleaded guilty to submitting fraudulent health reimbursement claims after an investigation by the Texas Department of Insurance Fraud Unit. Bradford submitted claims for more than $224,000 to the NFL Player Health Reimbursement Plan for medical treatments he never received. He received 10 years deferred adjudication, 60 hours of community service, and was ordered to pay restitution.
In February 2023, the Louisiana Department of Insurance ordered a Houston-based law firm to cease and desist after finding it engaged in insurance fraud and unfair trade practices through an illegal scheme involving Alabama-based Apex Roofing and Restoration.
In January 2023, San Elizario mayor Isela Reyes was arrested for insurance fraud. She is accused of filing a fraudulent insurance claim with a value between $2,500 and $30,000 in March 2022.