Skip to Content

What to Do if You are Accused of Conspiring in an Insurance Fraud Scheme

Whether you suffered an injury in an accident or lost a home or business in a fire, you may be entitled to financial compensation when you file an insurance claim afterwards. The insurance payout is meant to cover medical expenses, lost wages, property damage, and even pain and suffering, depending on the type of claim you filed and why.

Both Texas and Federal law enforcement agencies work for insurance companies on allegations of insurance fraud schemes. Insurance company investigators frequently contact federal special agents and local police and refer them allegations of fraudulent activity, especially in large insurance claim areas, such as after weather events or in the case of massive highway accidents. You should be aware that completely honest and lawful conduct can be scrutinized as criminal activity if the insurance companies, in effort to curtail costs, make allegations that claimants are part of an insurance fraud scheme.

What is Insurance Fraud?

You can be accused of insurance fraud if your insurer believes you have provided them with any deceiving or misleading information regarding your insurance claim. For example, claims of overvaluing your finances to secure another mortgage on your home, or fabricating valuables you claim to have lost in a house fire can give rise to charges of insurance fraud. An insurance company is more likely to accuse you of insurance fraud if you have a string of insurance payouts for similar situations. Or you make a claim for loss after a weather event or a massive road accident in a manner that a claims adjuster or an insurance company representative believes is inconsistent with their actuarial data.

Texas has established the Texas Department of Insurance (TDI) to investigate and report suspected insurance fraud in all its forms. As a result, prosecutors in Texas often pursue charges of this white-collar crime tenaciously, knowing they can rely on information and evidence collected by the TDI. However, to secure an insurance fraud conviction, it must be proven beyond a reasonable doubt in court that you have intentionally committed insurance fraud by deceiving your insurance provider or collecting a payout under fraudulent circumstances.

Reduce Your Chances of Being Accused of Insurance Fraud

To ensure you are not accused of insurance fraud after accepting an insurance payout, all paperwork must be reviewed for accuracy before submission. Misinformation provided on insurance paperwork is one of the most common origins of insurance fraud accusations, as well as insurance claim complications. You should seek the advice of legal counsel in any large insurance claim. Lastly, read your policy to understand what is and what is not covered before you file a claim.

If you have already been accused of insurance fraud after receiving payment, the following are several steps you can take to protect your payment, rights, and freedom:

  • Hire an attorney – While many people believe hiring a criminal defense lawyer is the first sign of guilt, it is actually a sign of being proactive and careful. An attorney can review your case, identify issues with the insurance paperwork, and defend you against false charges. The goal is to prevent the prosecution from obtaining a conviction, and perhaps avoid a charge altogether.
  • File a motion to dismiss the entire case or certain charges – Prosecutors commonly “overcharge” a case and/or add improper charges to try to improve their odds of bringing at least one charge to conviction. Your lawyer can gather supporting evidence that shows the charges against you are unfounded and file a motion to dismiss.
  • File a motion to suppress evidence – If law enforcement agencies unlawfully gathered evidence by violating your constitutional rights, a motion to suppress could render the evidence inadmissible in trial. Without key evidence against you to obtain a conviction, your case could be dismissed.
  • Present an effective case at trial – Your attorney can show that your actions were not a deliberate attempt to defraud an insurance company by presenting legal defenses, such as your lack of knowledge of falsity, your lack of fraudulent intent, or the simple lack of any fraudulent behavior at all.

At the Law Office of Patrick J. McLain, PLLC, we provide our clients with strong and personalized legal solutions to protect their rights and future after being accused of insurance fraud. Our legal team understands insurance companies will do their best to make a profit and protect their bottom line by denying claims or accusing their policyholders of fraudulent behavior. Collecting a payout should be a relief, not a legal burden, which is why we are here to help.

If you have been accused of insurance fraud after accepting a payout in Dallas, contact us today at (214) 238-9392 to discuss your case.