Insurance Fraud

Pittsburgh Insurance Fraud Defense Attorney

Insurance fraud is a serious criminal offense in Pennsylvania.  Knowingly and intentionally committing fraud (in an insurance-related action) could expose you to penalties that not only include imprisonment, fines and restitution damages, but could significantly impact your ability to secure gainful employment in the future.

Prosecutors are often overly-aggressive in pursuing “justice.”  Oftentimes, they go after defendants without properly considering the circumstances of the case.  If you’ve been charged with insurance fraud, it’s important to understand that the prosecution does not necessarily have a guaranteed advantage.  Simply put: the case is by no means “open and shut.”

A Pittsburgh insurance fraud defense attorney at McKinney Law has extensive experience assisting those who have been accused of, arrested for, and charged with a range of Pennsylvania criminal offenses, including insurance fraud.  If you’d like to learn more about how we can help, contact us today to setup a free consultation.

Defining Pennsylvania Insurance Fraud

Section 4117 of the Pennsylvania Consolidated Statutes defines the insurance fraud offense and the actions constituting such fraud.  All actions require knowledge and intentional conduct (for the purpose of defrauding the victim).  Pursuant to the statute, a person will be deemed to have committed insurance fraud if they:

  1. File, present, or cause to be presented a document (to a state or local government agency) that contains incomplete, false, or misleading information concerning anything material to the agency’s determination in approving or disapproving a motor vehicle insurance action;
  2. Present or cause to be presented to any insurer or self-insured any statement in support of a claim that contains false, incomplete, or misleading information concerning anything material to the claim;
  3. Assist, abet, solicit, or conspire with another to prepare or make any statement intended to be presented to any insurer or self-insured in connection with a claim that contains false, incomplete, or misleading information concerning anything material to the claim;
  4. Engage in unlicensed agent, broker, or unauthorized insurer activity;
  5. Benefit from the proceeds derived from a violation of this section due to the assistance, conspiracy, or urging of any person;
  6. Are the owner, administrator, or employee of a healthcare facility and knowingly allow the use of such facility by any person in furtherance of a scheme or conspiracy to violate any of the provisions of this section;
  7. Borrow or use another person’s financial responsibility or other insurance identification card or permit his financial responsibility or other insurance identification card to be used by another;
  8. For the purpose of pecuniary gain, solicits a person to engage, employ, or retain either himself or any other person to manage, adjust, or prosecute any claim or cause of action for damages for negligence, or for personal injuries or death.

The above offenses are prosecuted as a third-degree felony, punishable by up to 7 years of imprisonment, $15,000 in fines, and potential restitution damages for the losses suffered by the victimized individual/entity.

Additional offenses are outlined by Section 4117.  Perhaps most relevant is that a person may not file an application for insurance containing any false information or conceal for the purpose of misleading information concerning anything material to the application.  This is prosecuted as a first-degree misdemeanor, punishable by up to 5 years of imprisonment, $10,000 in fines, and potential restitution damages.

Intent is Necessary for Criminal Liability

In Pennsylvania, criminal liability for insurance fraud requires knowing and/or intentional behavior. The court cannot convict a defendant who mistakenly defrauded an insurer, for example.  This requirement gives defendants a powerful weapon in their litigation arsenal to defend against prosecutors, as intent can be a tricky thing to establish. The evidence may not be sufficient to show “beyond a reasonable doubt” that the insurance fraud defendant committed such acts intentionally and/or knowingly.

Whenever there are weaknesses in the prosecution’s case, defendants are further empowered to negotiate a pre-litigation solution that could work as an effective compromise (without the hassle and anxiety of criminal litigation).  Prosecutors might agree to downgrade the offense or even drop the case altogether.

Schedule a Free Consultation with an Experienced Pittsburgh Insurance Fraud Defense Attorney at McKinney Law

If you’ve been accused of, arrested for, or charged with insurance fraud in Pennsylvania, you could be exposed to significant criminal (and civil) penalties that could have life-altering consequences.  It’s important that you contact a qualified criminal defense attorney as early as possible so that your case can be evaluated -- and an effective strategy developed -- before litigation proceeds.

Contact an experienced Pittsburgh insurance fraud defense attorney at McKinney Law to learn more.  Call (412) 520-3301 or submit an online case evaluation form to schedule a free, confidential and no-obligation consultation.