{"id":372758,"date":"2016-03-31T21:35:03","date_gmt":"2016-04-01T02:35:03","guid":{"rendered":"https:\/\/content.findlaw-admin.com\/ability-law\/state\/georgia-law\/georgia-insurance-fraud-laws.html"},"modified":"2018-03-21T00:00:00","modified_gmt":"2018-03-21T05:00:00","slug":"georgia-insurance-fraud-laws","status":"publish","type":"page","link":"https:\/\/www.findlaw.com\/state\/georgia-law\/georgia-insurance-fraud-laws.html","title":{"rendered":"Georgia Insurance Fraud Laws"},"content":{"rendered":"\n
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Georgia Insurance Fraud Laws<\/h1>\n
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Created by FindLaw’s team<\/a> of legal writers and editors<\/i><\/p>\n\n | Last updated\n

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This article has been written and reviewed for legal accuracy, clarity, and style by FindLaw\u2019s team of legal writers and attorneys<\/a> and in accordance with our editorial standards<\/a>.<\/em><\/p>\n\n <\/div>\n <\/details>\n\n

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The last updated date refers to the last time this article was reviewed by FindLaw or one of our contributing authors<\/a>. We make every effort to keep our articles updated. For information regarding a specific legal issue affecting you, please contact an attorney in your area<\/a>.<\/em><\/p>\n\n <\/div>\n <\/details>\n<\/section>\n

What is Insurance Fraud?<\/h2>\r\n

Insurance fraud<\/a> 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<\/a> by selling bad insurance policies or failing to pay valid claims.<\/p>\r\n

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.<\/p>\r\n

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.<\/p>\r\n

The Law<\/h2>\r\n

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<\/a>," or other federal offenses.<\/p>\r\n

The following table highlights the main provisions of Georgia’s insurance fraud laws.<\/p>\r\n

See also Association of Certified Fraud Examiners<\/a>, and Fraud<\/a>.<\/p>\r\n\r\n
Code Section<\/b><\/td>\r\n

Georgia Insurance Code Title 33, Section 33-1-9<\/a><\/p>\r\n<\/td>\r\n<\/tr>

What is Prohibited<\/b><\/td>\r\nKnowingly 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.<\/td>\r\n<\/tr>
Penalties<\/b><\/td>\r\nFelony<\/a>, 2-10 yrs. in prison and a fine of not more than $10,000. Possible restitution to the victim(s). Also possible civil penalties.
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Who Can Be Prosecuted<\/b><\/td>\r\nConsumers, providers (such a doctor and auto repair shop), and insurance companies, adjusters, and others<\/td>\r\n<\/tr>
Types of Insurance Fraud<\/b><\/td>\r\nAutomobile, medical\/healthcare, life, worker’s compensation, fire, property<\/td>\r\n<\/tr>

Whistleblower Laws<\/b><\/p>\r\n<\/td>\r\n

The Georgia State False Claims Act<\/a> allows whistleblowers<\/a> 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.<\/p>\r\n

A person or company found liable under the act must generally pay damages, civil penalties, plus costs and attorneys fees.<\/p>\r\n<\/td>\r\n<\/tr>

Consumer Reporting<\/b><\/td>\r\n

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<\/a>.<\/p>\r\n<\/td>\r\n<\/tr>

Insurance Industry Reporting<\/b><\/td>\r\nMandatory reporting per Georgia law. Insurance providers must report suspected fraud through an online fraud reporting system<\/a>.<\/td>\r\n<\/tr><\/tbody><\/table>\r\n

Enforcement Agencies<\/h2>\r\n

If you feel you have been victimized by insurance fraud, here is some contact information that can help you:<\/p>\r\n