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New York Fraudulent Insurance Claim Offense
Insurance fraud involving deceitful insurance claims is a criminal offense under New York law. This article outlines the legal criteria that define the offense, types of fraudulent actions, applicable penalties, and strategies for mitigating potential sentences.
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1. New York Fraudulent Insurance Claim Offense
In New York, fraudulent insurance claims are prosecuted under Article 176 of the Penal Law. The offense occurs when an individual knowingly submits false information or fabricates evidence with the intent to defraud an insurance company.
New York Fraudulent Insurance Claim Offense | Constituent Elements
To constitute an offense, the following elements must generally be present:
- The person acts with intent to defraud.
- A false or misleading written statement is made to an insurance provider.
- The statement pertains to a material fact connected to a claim or application.
- The insurer either suffers loss or is exposed to risk of payment based on the fraudulent claim.
The act does not have to result in actual payment for it to qualify as an offense.
2. New York Fraudulent Insurance Claim Offense | Key Offense Types
Various types of actions can fall under this offense, depending on how the fraud was committed and the context of the insurance relationship.
New York Fraudulent Insurance Claim Offense | False Policy Applications
This includes providing false information during the insurance application process—such as faking medical history, altering age or employment status, or hiding pre-existing conditions—to obtain favorable policy terms.
New York Fraudulent Insurance Claim Offense | Intentional Accident Staging
Deliberately causing a car accident, arson, or other staged event to claim insurance benefits is among the most serious forms. New York courts often treat such acts as felonies when physical harm is involved.
New York Fraudulent Insurance Claim Offense | Falsifying Evidence or Documentation
Submitting fake repair bills, falsified medical records, or non-existent treatment documents qualifies as a criminal act. Even digital alterations can lead to criminal liability under New York Penal Law §175.30 (offering a false instrument for filing).
New York Fraudulent Insurance Claim Offense | Overstating Damages
This involves exaggerating the extent of injury or property damage to obtain a larger settlement than legally warranted. Even partial truth paired with inflated claims constitutes fraud.
3. New York Fraudulent Insurance Claim Offense | Penalties and Enhanced Sentencing
Conviction for this offense can lead to substantial criminal penalties depending on the value of the false claim and the defendant’s criminal history.
New York Fraudulent Insurance Claim Offense | Sentencing Guidelines
Under N.Y. Penal Law §176.10 to §176.35:
| Offense Level | Fraudulent Value | Potential Penalty |
|---|---|---|
| Fifth Degree | Any amount | Class A Misdemeanor (Up to 1 year imprisonment) |
| Fourth Degree | Over $1,000 | Class E Felony (1.5–4 years) |
| Third Degree | Over $3,000 | Class D Felony (Up to 7 years) |
| Second Degree | Over $50,000 | Class C Felony (Up to 15 years) |
| First Degree | Over $1 million | Class B Felony (Up to 25 years) |
Additionally, offenses involving schemes to defraud multiple entities or repeated offenses may be charged under N.Y. Penal Law §190.65.
New York Fraudulent Insurance Claim Offense | Restrictions on Employment
Convicted individuals may face employment restrictions, especially in the insurance, finance, or public service sectors. Under New York Executive Law §845-b, any conviction related to financial misconduct can trigger limitations on obtaining certain licenses or public appointments.
4. New York Fraudulent Insurance Claim Offense | Mitigating Factors and Early Action
While the legal system imposes strict penalties, there are valid paths to reduce sentencing or avoid incarceration entirely.
New York Fraudulent Insurance Claim Offense | Strategies for Sentence Reduction
Mitigation depends on several factors:
- Early confession and restitution of fraudulent gains.
- Lack of prior criminal record.
- Demonstrating lack of intent or reliance on misleading guidance.
- Full cooperation with law enforcement investigations.
Engaging a legal defense early in the investigation—particularly during pre-indictment—can also significantly reduce exposure.
New York Fraudulent Insurance Claim Offense | Practical Tips for Defense
- Do not communicate with insurance investigators without legal counsel.
- Preserve all relevant communication records, such as emails and billing statements.
- Avoid disposing of physical or digital evidence.
- Consider financial restitution and apology statements when appropriate.
If the claim was partially truthful or derived from an honest misunderstanding, your legal team may argue lack of fraudulent intent.
The information provided in this article is for general informational purposes only and does not constitute legal advice. Reading or relying on the contents of this article does not create an attorney-client relationship with our firm. For advice regarding your specific situation, please consult a qualified attorney licensed in your jurisdiction.
