Most people accused of insurance fraud have never been in trouble with the law. They filed a claim, often after a stressful accident or loss, and months later a letter, a phone call or a visit turns their life upside down.
If that is where you are, you are not alone, and you are not out of options. This post explains how these investigations usually begin, what to do first, and why it can help to get advice before you say anything.
How these investigations usually begin
Insurance companies have special investigations units that review claims they consider unusual. California insurers are generally required to report suspected fraud to the California Department of Insurance, and investigators there may work with the district attorney's office. The San Diego County District Attorney's Office has prosecutors who handle insurance fraud cases.
The first sign is often one of these:
- The insurer asks for a recorded statement or more documents
- You are asked to sit for an examination under oath
- Your claim is denied with a note about misrepresentation
- An investigator or detective calls, emails or visits
- You receive a letter about a court date
What to do first
- Do not give a statement yet. Speak with a defense attorney before you talk to an investigator or a detective, even if you believe you can clear things up in five minutes.
- Do not try to fix the story. Contacting the repair shop, a doctor's office or a witness to "line things up" can look like something it is not.
- Keep every document. Save the policy, the claim, photos, receipts, emails and texts. Do not change or throw anything away.
- Stay off social media. Posts about the accident, the claim or the investigation can be found and used.
- Write your own timeline. While it is fresh, write down what happened and who you spoke to, and keep it private for your attorney.
- Do not repay or sign anything without advice. A payment or a written admission made in a hurry can be used later.
Statements travel. What you tell an insurance investigator can be shared with law enforcement and prosecutors. Getting advice first is not about hiding anything. It is about making sure your words are not misunderstood.
Recorded statements and examinations under oath
Many insurance policies require you to cooperate with the insurer's investigation, which can include a recorded statement or an examination under oath. Refusing can affect your claim. At the same time, what you say can become evidence in a criminal case. Weighing those two risks is exactly the kind of decision a defense attorney can help you make.
What prosecutors generally have to prove
A claim that turns out to be wrong is not automatically a crime. Under California's main insurance fraud law, Penal Code section 550, prosecutors generally must show that a false or misleading statement was made knowingly and with intent to defraud. Honest mistakes, confusing forms and miscommunication with an adjuster are common. The details of who said what, and when, often matter a great deal. Read more about insurance fraud defense.
Why early help can matter
Many fraud cases are investigated for months before anyone is charged. During that time, an attorney may be able to respond to investigators on your behalf, gather documents that explain what happened, and present the context of your life and your claim. Sometimes that early work can influence whether charges are filed, or which charges. No result can be promised, but waiting rarely helps.
Talk to Marcus
Marcus E. DeBose has defended San Diego clients since 2001, and people with no prior record who are facing a first accusation are at the heart of his practice. He takes the time to learn what happened and why, then tells your story to the prosecutor and the judge. Book a free consultation in person at the Mission Valley office, or by phone or Zoom. Hablamos español.
This post is general information about California law, not legal advice for your situation. Every case is different, and past results do not guarantee a similar outcome.