From claim file to criminal referral
Insurance fraud defense often starts with the insurer's own file. Special investigations units collect claim forms, recorded statements, transcripts of examinations under oath, photographs, repair estimates, and sometimes surveillance, and that material can be forwarded when a case is referred. In New York, insurers report suspected fraud to the Department of Financial Services, whose investigators can refer cases to a district attorney, and some matters go to federal prosecutors. Insurance fraud is charged in degrees, often with related counts such as falsifying business records or attempted larceny. Withdrawing a claim does not necessarily end the exposure, although the timing and circumstances can matter to how prosecutors view it.
Testing what the prosecution says you intended
Most of these cases turn on intent. A claim can be wrong without being fraudulent: an inventory list prepared from memory after a fire, a contractor's inflated estimate submitted in good faith, or a medical history question misunderstood on an application. Who actually prepared each document matters, particularly when public adjusters, contractors, clinics, or relatives were involved. Inconsistencies between a first recorded statement and later testimony are often presented as lies, but they may reflect stress, translation problems, or simple confusion. We look closely at how statements were taken, whether an interpreter was used, and what you were actually asked.
Early choices in the defense
Avoid giving further statements to the insurer or investigators about the claim until you have spoken with a lawyer, and do not contact witnesses, repair shops, or others involved to line up accounts. Keep the documents you have, including your copy of the policy, the claim submission, and correspondence. If a civil lawsuit by the insurer or a policy rescission is also in play, the criminal and civil matters need to be coordinated so that steps in one do not hurt you in the other. Licensed professionals and non-citizens face additional consequences that should be evaluated before any plea. When we begin, we go over the claim file you have, the charges or allegations, and the steps the prosecution is likely to take next.
