New Jersey Insurance Fraud Attorney

Insurance fraud is a general term that may refer to any of several crimes in which fraud is committed upon an insurance company. Insurance fraud cases in New Jersey are aggressively investigated and prosecuted by local prosecutors’ offices and the Office of the Attorney General.

The New Jersey insurance fraud attorneys of Joseph Potashnik and Associates, PLLC offer legal defense against a broad range of these charges at the administrative, state, and federal levels.

Insurance fraud may occur with respect to any type of insurance, such as auto, homeowner, health, life, workman’s compensation, and Medicare or Medicaid. Fraud can include illegal actions like billing for services not actually rendered, submission of a false claim, and submission of false information, such as a declaration of an inaccurate state of residence.

Prosecution of insurance fraud related to healthcare and medicine in particular is on the rise. We know that a mere accusation of fraud can ruin careers and we are proud to be one of the few criminal defense firms steadfastly committed to defending New Jersey’s medical professionals.

Under § 2C:21-4.6 of New Jersey Code of Criminal Justice, the crime of insurance fraud is committed when the defendant knowingly makes a false or misleading statement of material fact in or omits a material fact from any document that the defendant submits to an insurance company in connection with either a claim for payment or an application to obtain or renew an insurance policy.

It is also a crime to submit false statements (or omit material facts) to an insurance company in connection with any payment made in accordance with the terms of an insurance policy or submit any false affidavit, certification, record or other document used in any insurance or premium finance transaction.

In New Jersey, insurance fraud is a crime of the third degree. It become a crime of the second degree if the person knowingly commits five or more acts of insurance fraud, including acts of health care claims fraud and the aggregate value of property, services or other benefit wrongfully obtained is at least $ 1,000.

A mere misrepresentation on an insurance claim may lead to a criminal investigation but cannot by itself be grounds for a conviction of unlawful insurance fraud in New Jersey. To obtain a criminal conviction in a New Jersey insurance fraud case, the prosecution must prove all of the following:

  • Misrepresentation of a fact
  • Defendant’s awareness that it was misrepresentation (not an honest mistake)
  • Defendant’s intention that the other party (insurance company) rely on the misrepresentation
  • Reliance by the insurance company
  • Resulting harm

These five prongs amount to unlawful “legal fraud.” However, another form of fraud in New Jersey is equitable fraud, for which the victim only seeks a fair or “equitable” outcome. In insurance fraud cases, a finding of equitable fraud typically leads to the termination of the insurance contract and not to criminal prosecution.

One way that our skilled New Jersey insurance fraud attorneys can mount a powerful defense on your behalf is to call attention to prosecutors’ inability to demonstrate all five prongs of legal fraud. If successful, this defense significantly weakens the government’s case and minimizes criminal and civil consequences.

Because insurance fraud defendants do face heavy fines and serious prison terms, quality legal defense is crucial, especially at the early stages of the investigation. We do what it takes to achieve optimal results, including employing expert private investigators and forensic accountants to work on your side.

If you may be facing insurance fraud charges, call our professional New Jersey Fraud Defense Lawyers right away. Remember, to protect your own best interests, do not discuss your case with anyone but your attorney.