Insurance Fraud Lawyer Assistance Case | Client Charged With Insurance Fraud, Non-referral

This is the background of the case as understood by the insurance fraud attorney.

The client, who operated an orthopedic clinic, often performed surgery on or treated patients from traffic accidents.

Because insurance proceeds for automobile accidents are paid afterward, it sometimes happened that a receipt was issued first and the patient paid the treatment costs after receiving the insurance proceeds.

However, one day the insurance company reported the client to the police, claiming that the client's conduct violated the Special Act on Prevention of Insurance Fraud.

Feeling that this was unjust, the client sought out an insurance fraud attorney and requested help in order to defend against punishment with legal assistance.

In the client's case, the issuance of receipts before treatment or surgery was performed gave rise to a suspicion that an insurance accident had been disguised.

Beyond this, there are certain types of conduct classified as insurance fraud.

Representative Types of Insurance Fraud

To accurately determine whether such an insured event is established, it can be advisable to seek advice from an attorney with experience and expertise in the relevant field.

According to the Special Act on Prevention of Insurance Fraud, disguising or fabricating an insured event itself is regarded as insurance fraud.

However, the act of issuing the receipt first had no direct causal relationship with the insured event, that is, the injury caused by the car accident.

The attorney emphasized that it was difficult for the client's charge to be established, on the ground that there was no actual connection between the insured event and the act of issuing the receipt.

One of the important elements for establishing fraud, including insurance fraud, is that there must be an intentional act of deception and resulting financial loss.

Because the client had merely provided treatment in good faith, it was difficult to establish any act of deception at all.

The attorney, relying on the relevant statutes and other grounds, emphasized that merely issuing the receipt first could hardly be interpreted as deception.

The client had only issued a receipt in advance and had never provided false treatment or issued a false medical certificate.

This also did not in any way correspond to disguising or fabricating an insured event.

The attorney emphasized that, because the client did not engage in any false treatment, insurance fraud was not established at all.

This was a case in which a client who had been reported by an insurance company and become involved in a charge of the crime of fraud successfully defended against punishment by obtaining a non-referral decision through the help of an attorney.

As such, in insurance fraud cases, one must combine deep expertise in the relevant laws with knowledge of related fields such as medicine, so the help of a specialist attorney is important.

At Daeryun Law Firm, based on expertise in criminal law, we operate an all-around response system by forming task forces with experts in fields related to the case.

In particular, numerous insurance specialist attorneys are affiliated with the firm, and we also have attorneys who have handled numerous insurance fraud cases.

If you are experiencing a similar problem, we hope you will seek help at any time through a 🔗legal consultation reservation.