Miami Insurance Fraud Defense Lawyer

If an investigator calls about a car accident or a home insurance claim, ask which part of the claim is in dispute. Sometimes the issue is a single line on a repair estimate that someone else prepared. Miami criminal defense attorney David Edelstein represents people under investigation or charged with insurance fraud. He can review the claim with you and advise you before you give a recorded statement.

When an Investigator Asks for a Statement

Ask who the investigator works for and which claim or statement is in question. An insurance company’s special investigations unit may ask for a recorded interview or send a notice of an examination under oath. Check the letter for a date. Your policy may require you to answer questions or turn over records as part of the claim. A defense lawyer can review the request and the policy with you before you respond.

If a detective calls about a criminal investigation, you can speak with counsel before agreeing to a voluntary interview. If you have already given a statement, save any recording or transcript you received. If you received a subpoena, give counsel a copy promptly so there is time to address what it requires.

What Florida Must Prove in a False-Claim Case

Under section 817.234(1)(a), Florida Statutes, a false-claim charge can rest on something a person said or wrote. The state must prove beyond a reasonable doubt that the person knew the statement contained false, incomplete, or misleading information about a fact that mattered to the claim and acted with intent to injure, defraud, or deceive the insurer. The law reaches a person who submits the statement, causes someone else to submit it, or prepares it for submission. The insurer can deny the claim and a charge can still follow.

Suppose an adjuster values storm repairs at $12,000 and the contractor estimates $20,000. The gap may reflect a disagreement over whether the whole roof needs replacing. An invoice saying that work was already done raises a different question. Who supplied the invoice, what work had been done by that date, and what did the person who sent it know?

A false answer on an insurance application can also lead to a charge. If the allegation concerns where a car was kept, the exact question on the application matters. Ask for the signed application and any earlier version the agent filled out.

How the Claim File Can Help the Defense

Start with the copy the insurer actually received. A contractor may have revised an estimate after you approved it. The email that carried each version can show which one you saw and who sent the final copy. For a homeowners’ or business claim, photos taken before the loss and dated repair records can help distinguish old damage from new damage.

In a car insurance case, find out whether investigators dispute the crash itself or a bill for treatment afterward. A passenger may be able to describe the collision yet have no idea what a clinic later billed. The crash report, appointment records, and the bill answer different questions. If a provider is accused of billing a federal health program, the case may instead involve federal healthcare fraud.

Keep the originals, including messages and photos on your phone. If you later discover an error, record when you found it and tell your lawyer. Leave the original claim and its attachments as they were.

Florida Insurance Fraud Penalties

For offenses covered by section 817.234(11), the felony degree depends on the value of the property involved. The ordinary maximum prison terms for a single count are listed below.

• Under $20,000 — third-degree felony, up to 5 years.
• $20,000 to less than $100,000 — second-degree felony, up to 15 years.
• $100,000 or more — first-degree felony, up to 30 years.

The charge, your prior record, and your Florida sentencing scoresheet matter when assessing a possible sentence. A separate rule applies to a person who organizes, plans, or knowingly takes part in a staged crash or a scheme to document a crash that never happened to pursue a motor vehicle tort claim or personal injury protection (PIP) benefits. A conviction under section 817.234(9) is a second-degree felony and carries a two-year minimum prison term.

Other charges have their own rules. Florida’s workers’ compensation fraud law covers false statements made to obtain or deny benefits. Prosecutors may charge organized fraud when they allege someone obtained property through an ongoing scheme to defraud.

Speak With a Miami Insurance Fraud Defense Lawyer

David Edelstein began his career at the Miami-Dade County Public Defender’s Office. He was admitted to The Florida Bar in July 1995 and holds Martindale-Hubbell’s AV Preeminent® peer review rating.

For the consultation, have the investigator’s letter or charging papers handy. If you know which statement is in dispute, identify it and tell the firm when you are expected to respond.

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