What is Insurance Fraud?
Insurance fraud occurs when someone knowingly lies to obtain some benefit or advantage that they are not entitled to. The insurance company itself might commit insurance fraud by selling bad insurance policies or failing to pay valid claims.
Depending on the specific issues involved, the Georgia Insurance and Safety Fire Commissioner's Fraud Unit will handle the alleged wrongful act as either an administrative action against agents, adjusters, unlicensed companies and insurance carriers or as criminal matter against any of the parties involved.
Common types of insurance fraud in Georgia include auto glass fraud, inflated tow/storage charges, hail damage, farm losses, auto repair/body shop, staged/caused accidents, arson for profit, phony auto theft for profit, organized group/ring activity, and workers compensation fraud.
State and local prosecutors handle insurance fraud cases under the state's penal laws. Georgia and federal laws also permit law enforcement to pursue cases federally. In those instances, the crime of "insurance fraud" is usually pursued as "mail fraud," "criminal racketeering," or other federal offenses.
The following table highlights the main provisions of Georgia's insurance fraud laws.
Georgia Insurance Code Title 33, Section 33-1-9
|What is Prohibited||Knowingly lying about, or concealing an important fact in connection with a insurance claim or payment made under an insurance policy. Also applies to issuing fake insurance policies and rate-fixing.|
|Penalties||Felony, 2-10 yrs. in prison and a fine of not more than $10,000. Possible restitution to the victim(s). Also possible civil penalties.
|Who Can Be Prosecuted||Consumers, providers (such a doctor and auto repair shop), and insurance companies, adjusters, and others|
|Types of Insurance Fraud||Automobile, medical/healthcare, life, worker's compensation, fire, property|
The Georgia State False Claims Act allows whistleblowers to bring a lawsuit in the name of the State of Georgia where a wrongdoer engages in conduct that defrauds the state or local government of its healthcare dollars. This statute is designed to address Medicaid fraud.
A person or company found liable under the act must generally pay damages, civil penalties, plus costs and attorneys fees.
Consumers wishing to report suspected insurance fraud may do so by calling the Consumer Services Division of the Office of Commissioner of Insurance, at (404) 656-2070 or toll free at (800) 656-2298 or on the website .
|Insurance Industry Reporting||Mandatory reporting per Georgia law. Insurance providers must report suspected fraud through an online fraud reporting system .|
If you feel you have been victimized by insurance fraud, here is some contact information that can help you:
Get Legal Help with Your Insurance Fraud Case in Georgia
Insurance policies are great to have when you need them. While there are those who seek to take advantage of these policies, even legitimate insurance claims can look suspicious to outside eyes. If you've been charged with insurance fraud in Georgia, it's a good idea to contact a local criminal defense attorney to discuss the facts of your case and learn about your legal options moving forward.
Contact a qualified attorney.