Overview of Florida Insurance Fraud Laws
Florida has seen more than its share of insurance schemes and frauds over the years. With hurricanes and real estate hucksters aplenty, the Sunshine State makes it an insurance fraud crime to defraud, deceive or mislead an insurer.
If you receive any kind of benefit from a false insurance claim, you can be prosecuted under Florida's insurance fraud laws. Indeed, any deceptive or intentionally misleading action or statement made to an insurance company in hopes of gaining an insurance benefit is a criminal act.
Real-Life Example of Florida Insurance Fraud:
To better illustrate how insurance fraud happens, let's look at a recent home insurance fraud ring in South Florida. In Feb. 2014, 22 people in the Miami area were charged in a fraud scheme that bilked insurance companies out of $7.6 million by intentionally setting fires or causing floods in homes.
A public adjuster worked with recruiters and “finders” to locate homeowners willing to allow him to set fires or burn their homes and then file a homeowner’s claim with insurance companies. The adjuster staged 17 fires and floods in homes between 2006 and 2014, authorities said.
The adjuster would meet with a homeowner, decided whether a fire or flood would work best and then agree on a date. As a public adjuster, he would then file a claim with the insurance company and get a cut of 20-30 percent, once the insurance company paid.
In one case, the adjuster concocted a plan to set fire to a BMW in a garage, so that the house would burn. He then put a claim for more than $600,000. In another case, he and another man loosened the master pipe for the sink in the master bedroom of a home and let the water run freely. He then filed a claim for more than $100,000.
The adjuster was charged with racketeering, grand theft, arson and forgery and could face more than 30 years in federal prison.
The text box below provides you with important information about Florida insurance fraud laws and how to find an attorney if you’ve been accused of this crime.
Florida Statutes Section 817.234
Elements of Insurance Fraud
A person commits insurance fraud by submitting a claim based on a false, exaggerated, or deliberate injury or loss. It is against Florida law to submit false or misleading information to an insurer on a claim or an application for an insurance policy.
Penalties and Sentencing
- The penalties for a conviction on charges of insurance fraud vary depending on the amount or value of the claim. Lawyers, doctors and other professionals face losing their licenses; criminal liability is on the table as are civil fines and penalties. The severity of the penalty imposed increases with the increased value of the fraudulent claim, either a first, second, or third degree felony charge.
- Note that both a defendant could face federal and state charges as well.
Special Penalties for Health Care Practitioners
A licensed health care practitioner who is found guilty of insurance fraud for an act relating to a personal injury protection insurance policy loses his or her license to practice for 5 years and may not receive reimbursement for personal injury protection benefits for 10 years.
- Lack of intent to deceive or defraud
- The claim or information is not fraudulent or false
- Mistake of fact (i.e. the defendant truly thought the fire that destroyed his house was an accident and it later comes to light that someone purposely set the fire without the defendant's knowledge.)
Note: State laws are always subject to change through the passage of new legislation, rulings in the higher courts (including federal decisions), ballot initiatives, and other means. While we strive to provide the most current information available, please consult an attorney or conduct your own legal research to verify the state law(s) you are researching.
Florida Insurance Fraud Laws: Related Resources
Get Legal Help with Your Insurance Fraud Case in Florida
Fraud cases can be hard to prove, but if the prosecutor is able to prove your guilt beyond a reasonable doubt to the jury, you could face severe criminal penalties. Also, depending on your situation, you may lose your professional license. For these reasons, it's a good idea to speak with a criminal defense attorney in Florida if you've been charged under Florida insurance fraud laws.