Can a mistake on my claim lead to insurance fraud?

Written on behalf of Abramson Smith Waldsmith LLP

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Having a motor vehicle accident on California’s streets and highways is stressful enough – but the process of filing your insurance claims form just doubles that stress. If you realize after the fact that you have made a mistake in your claim, particularly one that may result in increased compensation in your benefit, will your insurance company prosecute you for insurance fraud?

Only if you realize the mistake and make no attempt to correct it. The California Department of Insurance defines insurance fraud as the intersection of intent and action, where you would have to have deliberately misrepresented the situation to your advantage and successfully gained a favorable action from it. You could actually deliberately present fraudulent information to a claims adjuster and still not be guilty of insurance fraud if the fraudulent information was identified and challenged before any claim was paid.

In the event of a mistake on your claims form, however, if you are unaware of the mistake or if you realize it in hindsight and contact your insurance company to make a correction, you are unlikely to face any punitive action. Your insurance provider would need to be able to definitively prove that you acted with intent to deceive for monetary gain, and in the instance of an accident or a mistake it is generally a simple matter to clear up the misunderstanding to prevent any investigations or difficulties processing your claim.

This has been an informational blog post that should not be used as a substitute for actionable legal advice.

Jeffrey R. Smith

Jeffrey R. Smith

Managing Partner

Robert B. Waldsmith

Robert J. Waldsmith

Partner, 1999

William B. Smith

William B. Smith

Partner, 1978

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