If you filed an insurance claim and received a notice of review after a simple mistake, like mixing up two numbers, you may be feeling scared. Statutes define fraud as knowingly making false statements to an insurer for financial gain.
In Texas, insurance fraud is a criminal offense with penalties that increase in severity based on the total claim value. However, the outcome of your situation will rely heavily on whether you can demonstrate the error was unintentional. Your intent is what separates a clerical slip from a criminal act.
Intent’s role in how state law defines fraud
Prosecutors must prove that you knew the facts you submitted were false, and intended to submit a false claim.
Simple errors about policy language do not usually meet this high legal bar. Courts look for patterns that suggest intent to defraud. Without proof of intent, a mistake typically falls outside the scope of criminal prosecution. It may instead result in a claim denial or civil coverage dispute.
Common mistakes that trigger investigations
Common mistakes often cause insurers to flag claims:
- Wrong dates of service from memory lapses
- Overestimating repair costs without professional quotes
- Misinterpreting complex medical billing codes
- Forgetting to mention prior property damage
These errors occur because insurance forms are complex. Early talks with agency personnel may resolve errors before they grow into formal criminal charges.
How to confront an insurance fraud investigation in Houston
Insurance fraud investigators in Harris County use a variety of methods to determine intent. They may interview people who may know about the claim’s facts, or review bank records. How you communicate with fraud investigators is significant. Individuals often find it helpful to discuss strategies with their lawyer:
- Clarifying the nature of the error
- Organizing supporting documentation
- Addressing complexities in policy language
Certain statements may suggest criminal intent even when a person acted in good faith. Avoid doing any of the following:
- Do not admit to intentional deception for accidental errors
- Avoid guessing about specific facts when you cannot recall details
- Do not sign written statements without checking them for accuracy
Speaking with a lawyer may help clarify your options.
Protecting your future
Preventing a simple mistake made on an insurance claim form from becoming a life-changing legal issue is possible. A qualified criminal defense attorney can help you approach the insurance company to admit the error without creating additional problems that may prompt an investigation, or move the investigation into a criminal charge.
