NY Penal Law § 176.15: Insurance fraud in the fourth degree

Insurance fraud is a white collar crime that occurs when someone provides false information to an insurance company in order to receive a payment from the insurance company that they would otherwise not have received. While it is often associated with medical insurance, it can involve any type of insurance arrangement such as life insurance, automobile insurance, property insurance, workers' compensation, commercial insurance, and publicly funded insurance arrangements such as Medicare or Medicaid. Under the New York criminal code you would have committed a fraudulent insurance act if with intent to defraud you provide an insurance company with false information or you hide information from the insurance company. Examples of insurance fraud include burning property to collect insurance money, falsely claiming that a car was stolen in order to collect the insurance money, claiming that property was damaged in an accident or stolen during a robbery when it was not, or overstating the value of stolen or damaged property.

There are several different insurance fraud offenses in the New York criminal code. If you commit a fraudulent insurance act the specific insurance fraud crime you will face will depend on several different factors, such as the type of insurance plan involved and the amount of money involved. Under New York Penal Code § 176.15 you will be charged with insurance fraud in the fourth degree if you commit an insurance fraud act and thereby obtain or attempt to obtain property with a value of over $1000 but not over $3000.

Gladys injured her back while working in a warehouse. She filed a workers' compensation claim. Her claim included a statement that she was not working anywhere. However, Gladys was working part time at a friend's restaurant. Gladys could be charged with insurance fraud since she lied about a material fact on her application for workers' compensation benefits.

Terry Grant, a licensed dentist, was charged with insurance fraud in the fourth degree based on submitting falsified claims forms to various insurance companies over a span of 6 years. People v. Grant, 61 AD3d 177 (N.Y. App. Div., 2009)

1. Life settlement fraud in the fourth degree: New York Penal Code § 176.50
2. Health care fraud in the fourth degree: New York Penal Code § 177.10

In order to commit insurance fraud you would have had to have made a false statement about a material fact. If you lied about a minor issue that would not affect whether or not the insurance payout would have been authorized under the plan, or the amount of the payout, you would not face insurance fraud charges.

In addition, you would not be guilty of insurance fraud if you did not have the intent to defraud the insurer. For example, if you submit a claim for property loss in a burglary, you mentioned a laptop that was actually removed by a family member prior to the burglary, then you would not have committed insurance fraud. Similarly, if the claim relates to vehicle damage in an accident and you mistakenly include damage that actually occurred in a previous incident, you would not have committed insurance fraud.

Insurance fraud in the fourth degree is a class E felony if you are convicted you could be sent to prison for up to 4 years and you could be ordered to pay a fine. In addition, the judge could sentence you to serve a probation term of 5 years. Furthermore, the judge may order you to pay restitution.

A person is guilty of insurance fraud in the fourth degree when he commits a fraudulent insurance act and thereby wrongfully takes, obtains or withholds, or attempts to wrongfully take, obtain or withhold property with a value in excess of one thousand dollars.

If you are under investigation for insurance fraud in the fourth degree, it is critical that you immediately contact an experienced attorney. The consequences of a conviction are serious and may include significant time in prison. The best way to avoid these consequences is to be represented by someone with experience. The staff at the Law Offices of Stephen Bilkis & Associates has years of experience successfully defending clients in New York criminal courts who have been charged with felonies and misdemeanors in violation of New York state law and federal law. Contact us at 800.696.9529 to schedule a free, no obligation consultation regarding your case. We represent clients in the following locations: the Bronx, Brooklyn, Long Island, Manhattan, Nassau County, Queens, Staten Island, Suffolk County and Westchester County.