Insurance Fraud

Insurance Fraud accusations are very serious. Contact an experienced New York City Insurance Fraud Defense lawyer immediately if you find yourself the target of an insurance fraud investigation. Insurance Fraud occurs when a person commits what is defined as a "fraudulent insurance act." New York Penal Code 176.05 basically defines a fraudulent insurance act as an act committed by a person who, knowingly and with intent to defraud, presents, causes to be presented, or prepares with knowledge or belief that it will be presented to or by an insurer, self-insurer, or purported insurer, or purported self-insurer, or any agent thereof:
  1. any written statement as part of, or in support of, an application for the issuance of, or the rating of a commercial insurance policy, or certificate or evidence of self-insurance for commercial insurance or commercial self-insurance, or a claim for payment or other benefit pursuant to an insurance policy or self-insurance program for commercial or personal insurance that he or she knows to: (a) contain materially false information concerning any fact material thereto; or (b) conceal, for the purpose of misleading, information concerning any fact material thereto; or
  2. any written statement or other physical evidence as part of, or in support of, an application for the issuance of a health insurance policy, or a policy or contract or other authorization that provides or allows coverage for, membership or enrollment in, or other services of a public or private health plan, or a claim for payment, services or other benefit pursuant to such policy, contract or plan that he or she knows to: (a) contain materially false information concerning any material fact thereto; or (b) conceal, for the purpose of misleading, information concerning any fact material thereto.

There are many forms of insurance fraud that can occur. Examples run the gamut from situations that include people who inflate the damages to their property after an accident to gain more money from the insurance company than they are actually entitled to, to situations in which a doctor bills an insurance company for procedures that he never actually conducted.

Insurance fraud in its most basic form is Insurance Fraud in the Fifth degree. It is a class A misdemeanor. However, the amount of money profited from the fraudulent insurance act can aggravate the degree. For example, if a person commits a fraudulent insurance act and obtains over $1,000 as a result, he is now guilty of a Insurance Fraud in the Fourth Degree, which is a class E felony.

Below is an explanation of the various degrees of Insurance Fraud in New York, what the government needs to prove to sustain a conviction, and the applicable sanctions. If you or a loved one, is accused of any degree of Insurance Fraud, contact John Buza for a free consultation.

  • Insurance Fraud in the First Degree
Insurance Fraud in the First Degree is codified in New York Penal Code Section 176.30. It is a class B felony. If a person with no prior felony convictions is convicted of a class B felony, the minimum period of incarceration is an indeterminate sentence of 1-3 years in prison and the maximum is 8 1/3 - 25 years. An indeterminate sentence is one in which the person is sentenced to a range and the department of corrections determines how much of that range the person must serve before he is eligible for release. If the person has been previously convicted of a prior felony within 10 years of the new conviction, excluding time spent in prison, the minimum period of incarceration is 4 1/2 - 9 years and the maximum is 12 1/2 - 25 years. In all circumstances, the person is forced to be on parole between 1 to 3 years after his release.

For the government to sustain a conviction for Insurance Fraud in the First Degree, the government must prove the following three elements beyond a reasonable doubt. It must prove:
  1. the person committed a fraudulent insurance act;
  2. the person did so knowingly and with the intent to defraud; and
  3. the person thereby wrongfully took, obtained or withheld, attempted to wrongfully take, obtain or withhold property with a value in excess of $1,000,000.
  • Insurance Fraud in the Second Degree

Insurance Fraud in the Second Degree is codified in New York Penal Code Section 176.25. It is a class C felony. There is no minimum period of mandatory incarceration if a person with no prior felony convictions is convicted of a class C (non-violent and non-drug) felony, however, the maximum period of incarceration is an indeterminate sentence of 5 - 15 years. An indeterminate sentence is one in which the person is sentenced to a range and the department of corrections determines how much of that range the person must serve before he is eligible for release. If the person has been previously convicted of a prior felony within 10 years of the new conviction, excluding time spent in prison, the minimum period of incarceration is 3 - 6 years and the maximum is 7 1/2 - 15 years. There is no period of mandatory parole after the person is released from custody.


For the government to sustain a conviction for Insurance Fraud in the Second Degree, the government must prove the following three elements beyond a reasonable doubt. It must prove:
  1. the person committed a fraudulent insurance act;
  2. the person did so knowingly and with the intent to defraud; and
  3. the person thereby wrongfully took, obtained or withheld, attempted to wrongfully take, obtain or withhold property with a value in excess of $50,000.
  • Insurance Fraud in the Third Degree
Insurance Fraud in the Third Degree is codified in New York Penal Code Section 176.20. It is a class D felony. There is no minimum period of mandatory incarceration if a person with no prior felony convictions is convicted of a class D (non-violent and non-drug) felony, however, the maximum period of incarceration is an indeterminate sentence of 2 1/3 - 7 years. An indeterminate sentence is one in which the person is sentenced to a range and the department of corrections determines how much of that range the person must serve before he is eligible for release. If the person has been previously convicted of a prior felony within 10 years of the new conviction, excluding time spent in prison, the minimum period of incarceration is 2 - 4 years and the maximum is 3 1/2 - 7 years. There is no period of mandatory parole after the person is released from custody.

For the government to sustain a conviction for Insurance Fraud in the Third Degree, the government must prove the following three elements beyond a reasonable doubt. It must prove:
  1. the person committed a fraudulent insurance act;
  2. the person did so knowingly and with the intent to defraud; and
  3. the person thereby wrongfully took, obtained or withheld, attempted to wrongfully take, obtain or withhold property with a value in excess of $3,000.
  • Insurance Fraud in the Fourth Degree
Insurance Fraud in the Fourth Degree is codified in New York Penal Code Section 176.15. It is a class E felony. There is no minimum period of mandatory incarceration if a person with no prior felony convictions is convicted of a class E (non-violent and non-drug) felony, however, the maximum period of incarceration is an indeterminate sentence of 1 1/3 - 4 years. An indeterminate sentence is one in which the person is sentenced to a range and the department of corrections determines how much of that range the person must serve before he is eligible for release. If the person has been previously convicted of a prior felony within 10 years of the new conviction, excluding time spent in prison, the minimum period of incarceration is 1 1/2 - 3 years and the maximum is 2 - 4 years. There is no period of mandatory parole after the person is released from custody.

For the government to sustain a conviction for Insurance Fraud in the Fourth Degree, the government must prove the following three elements beyond a reasonable doubt. It must prove:
  1. the person committed a fraudulent insurance act;
  2. the person did so knowingly and with the intent to defraud; and
  3. the person thereby wrongfully took, obtained or withheld, attempted to wrongfully take, obtain or withhold property with a value in excess of $1,000.
  • Insurance Fraud in the Fifth Degree
Insurance Fraud in the Fifth Degree is codified in New York Penal Code Section 176.10. It is a class A misdemeanor. A person convicted of a class A misdemeanor may be sentenced up to 1 year in jail. 

For the government to sustain a conviction for Insurance Fraud in the Fifth Degree, the government must prove the following three elements beyond a reasonable doubt. It must prove:
  1. the person committed a fraudulent insurance act; and
  2. the person did so knowingly and with the intent to defraud.
  • Aggravated Insurance Fraud
Aggravated Insurance Fraud is codified in New York Penal Code Section 176.35. It is a class D felony. There is no minimum period of mandatory incarceration if a person with no prior felony convictions is convicted of a class D (non-violent and non-drug) felony, however, the maximum period of incarceration is an indeterminate sentence of 2 1/3 - 7 years. An indeterminate sentence is one in which the person is sentenced to a range and the department of corrections determines how much of that range the person must serve before he is eligible for release. If the person has been previously convicted of a prior felony within 10 years of the new conviction, excluding time spent in prison, the minimum period of incarceration is 2 - 4 years and the maximum is 3 1/2 - 7 years. There is no period of mandatory parole after the person is released from custody.

For the government to sustain a conviction for Aggravated Insurance Fraud in the Fourth Degree, the government must prove the following three elements beyond a reasonable doubt. It must prove:
  1. the person committed a fraudulent insurance act;
  2. the person did so knowingly and with the intent to defraud; and
  3. the person has previously been convicted of any offense that included the element of committing a fraudulent insurance act within the past five years.

Accusations of any kind of Fraud are serious. Feel free to contact John Buza, an experienced lawyer, for a free consultation if you, or a loved one, is accused of this crime.