What shapes the exposure
New York grades insurance fraud by degree, largely according to the amount of the false claim, and the higher degrees are felonies. The charge brought, any prior record, and the way the case is resolved affect whether a custodial sentence is possible and how serious it could be. Whether a first insurance fraud charge leads to custody depends heavily on the facts, and it should not be assumed in either direction. When a case involves organized rings, such as staged accidents or no-fault clinic schemes, exposure tends to be much greater. Federal charges can be brought where mail or interstate wires are involved, and they carry their own sentencing framework.
How investigations usually start
Insurers run special investigations units that review suspicious claims, and in New York insurers are required to report suspected fraud to the state's financial regulator. You may be asked to sit for an examination under oath or give a recorded statement, which many policies treat as a duty of the insured but which can also produce evidence for a criminal case. Before giving any statement, talk with counsel about what is being sought and whether to proceed. Preserve your claim file, receipts, photos, repair estimates, and communications with adjusters. Do not supplement or revise the claim on your own once you know it is under review.
Reducing the risk you face
Our first question is whether a criminal case exists yet or whether this is still an insurer's investigation. We review the claim, the amounts involved, and what statements have already been given. If the claim was inflated by mistake or on someone else's advice, we discuss how that can be explained and whether withdrawing or correcting it is appropriate. We also consider how restitution might affect the outcome, and what a plea or conviction would mean for your immigration status, license, or job. That gives you a realistic picture of what you are facing instead of guesses.
