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Insurance Fraud

The offense of insurance fraud applies to just about any fraudulent activities to obtain benefits. The State of New Jersey is extremely aggressive in policing insurance fraud for a whole host of reasons, including the high cost to consumers in NJ. The state is so concerned with this issue that it has created a special agency, the Office of the Insurance Fraud Prosecutor, whose sole mission is to serve as the focal point for criminal prosecution and other action for those who engage in fraud in conjunction with automobile accidents, automobile insurance, health care claims, insurance applications, Medicaid, disability benefits, unemployment insurance, and workers’ compensation. The laws in NJ, as well as the efforts of agencies like the Insurance Fraud Prosecutor, have resulted in many more arrests for submission of fraudulent or inflated claims, submission of bogus coverage applications, and other conduct. At the Law Offices of Jonathan F. Marshall, our team of criminal lawyers has experience defending against and even previously prosecuting all varieties of insurance fraud. To reach us anytime 24/7 and speak with an attorney, call 973-710-1520.

New Jersey Insurance Fraud Under N.J.S.A. 2C:21-4.6

The offense known as insurance fraud under N.J.S.A. 2C:21-4.6 involves a claim for payment, reimbursement or other benefit pursuant to an insurance policy or from an insurance company or the Unsatisfied Claim and Judgment Fund of New Jersey. A violation can also arise out of an application to obtain or renew an insurance policy. Third, it includes any payment made or to be made in accordance with the terms of an insurance policy or premium finance transaction. The final scenario where an insurance fraud offense can occur is where an affidavit, certification, record, or other document used in any insurance or premium finance transaction.

Material Elements The Prosecutor Must Prove? In addition to establishing that one of the four (4) scenarios applies, the state must prove that: (1) the accused made, or caused to be made, a false, fictitious, fraudulent, or misleading statement of material fact in, or omitted a material fact from, or caused a material fact to be omitted from, any record, bill, claim or other document, in writing, electronically or in any other form; and (2) that his/her conduct was knowing. . Third the state must prove that the defendant acted knowingly.

For insurance fraud to be elevated to a second degree crime, the prosecutor must also establish that the defendant committed five (5) or more acts of insurance fraud and that the aggregate value of the property of the fraud was $1,000 or more.

Degree of Crime

Insurance Fraud will either be a crime of the third or second degree. Typically, committing an act that constitutes Insurance Fraud will be a crime of the third degree. However, if the defendant commits five (5) or more act of Insurance Fraud and if the aggregate value of property, services, or other benefit wrongly obtained or sought to be obtained is at least $1,000, then it will be a crime of the second degree. It should be noted that multiple lies within a single claim are not separate individual acts when determining whether an offense should be charged as a second degree crime.

Penalties For Insurance Fraud

If convicted of Insurance Fraud in the second degree, then you will face up to ten (10) years in prison and a fine up to $150,000. There is a presumption of imprisonment for anyone convicted of second degree insurance fraud, meaning that it is a virtual certainty you will have to serve a jail/prison term.  If convicted of insurance fraud in the third degree, then you will face up to five (5) years in prison and a fine up to $15,000.

Newark Criminal Defense Lawyers Experienced In Defending Insurance Fraud

Our firm possesses over 100 years of experience in the criminal arena. Many years of this experience was working in the trenches as prosecutors responsible for enforcing the laws. Now our practice is dedicated exclusively to representing those accused of violating the laws, including New Jersey’s insurance fraud statute, N.J.S.A. 2C:21-4.6. The lawyers on our staff are equipped with the knowledge and skill you need. Call us for a free consultation so that we can address your questions, analyze the facts of your case, and plot a course that will lead to the best success of your case.