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What is Insurance Fraud?

Insurance fraud is an act committed with the intent to deliberately obtain a payment from the insurance company to which you are not legally entitled. It is often committed by applicants, policy holders and claimants. This crime can be tried in either state or federal court depending on the circumstances of the case. If you are convicted of insurance fraud in Texas, in addition to a large fine, you may face prison time, depending on the specific circumstances and the severity of the charges.

This crime is one of the most commonly charged white collar crimes in Texas. Insurance fraud can be linked to various things, such as:

  • Auto insurance
  • Worker’s compensation claims
  • Medical insurance
  • Homeowner insurance
  • Life insurance policies

Because there are many innocent parties that can be affected by insurance fraud, the state of Texas does not take these offenses lightly. Since investigating a fraud claim and taking it to court can be a costly process, insurance companies often end up passing the expenses to their customers.

Insurance Fraud Sentencing Guidelines in Texas

Depending on the significance of the crime, insurance fraud can result in a Class C misdemeanor to a first degree felony charge in Texas. Sentencing varies significantly depending on the type of insurance fraud, as well as the circumstances of the case. The following are the consequences for insurance fraud offenses in Texas as they are listed in Chapter 35 of the Texas Penal Code.

  • a Class C misdemeanor if the value of the claim is less than $100
  • a Class B misdemeanor if the value of the claim is $100 or more but less than $750
  • a Class A misdemeanor if the value of the claim is $750 or more but less than $2,500
  • a state jail felony if the value of the claim is $2,500 or more but less than $30,000
  • a felony of the third degree if the value of the claim is $30,000 or more but less than $150,000
  • a felony of the second degree if the value of the claim is $150,000 or more but less than $300,000
  • a felony of the first degree if:
  1. The value of the claim is $300,000 or more; or
  2. An act committed in connection with the commission of the offense places a person at risk of death or serious bodily injury.
  3. An offense under Subsection (a-1) is a state jail felony.
  4. The court shall order a defendant convicted of an offense under this section to pay restitution, including court costs and attorney’s fees, to an affected insurer.
  5. If conduct that constitutes an offense under this section also constitutes an offense under any other law, the actor may be prosecuted under this section, the other law, or both.
  6. For purposes of this section, if the actor proves by a preponderance of the evidence that a portion of the claim for payment under an insurance policy resulted from a valid loss, injury, expense, or service covered by the policy, the value of the claim is equal to the difference between the total claim amount and the amount of the valid portion of the claim.
  7. If it is shown on the trial of an offense under this section that the actor submitted a bill for goods or services in support of a claim for payment under an insurance policy to the insurer issuing the policy, a rebuttable presumption exists that the actor caused the claim for payment to be prepared or presented.

Finding an Attorney You Can Trust

In many cases, committing insurance fraud will hinder your eligibility to apply for certain jobs, ability to chase educational opportunities and can result in the revocation of a professional license. If you are facing insurance fraud charges, contact me immediately to start building your defense. I will aggressively fight for your case and work to get you the best possible outcome.

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