Where accusations come from
Insurance fraud reaches claimants, policyholders, and the businesses around them. Some cases involve a claim said to be inflated or invented after a fire, theft, or accident. Others involve applications, such as listing a car at an address other than where it is kept, or leaving out drivers or prior losses to lower a premium. In New York, no-fault auto claims have been a recurring focus, and investigations there often look at medical providers, clinic owners, recruiters, and patients together. Insurers report suspected fraud to the state's Department of Financial Services, which can pass matters to prosecutors, and federal charges are possible when the mail or wires were used. Being part of an investigation does not mean you are its target.
Statements under oath and recorded interviews
Before any criminal case, an insurer may ask for a recorded statement or an examination under oath, a formal questioning session with a court reporter that many policies require as a condition of coverage. Refusing can jeopardize the claim, yet what you say will be used both in the claim and in any later investigation. Prepare for it with counsel, bring the documents the insurer requested, and say so when you do not know something rather than guessing. Keep receipts, photographs, repair estimates, medical records, and every letter from the insurer. If you realize something in the claim or application was wrong, raise it with your lawyer before correcting it with the insurer.
Separating the claim from the case
Insurance fraud matters often have several moving parts: a denied claim, a rescinded policy, a civil suit by the insurer, and a possible criminal referral. In a first meeting we sort out which of these exist and which are only threatened, because a strategy for getting a claim paid can look very different from one aimed at avoiding a charge. We look at whether the insurer's theory rests on documents, on a retained technical witness, or on assumptions about how a loss happened. If you are a provider or other licensed professional, a licensing board may also be involved. That tells us how to communicate with the insurer and whether to reach out to investigators.
