The business of insurance involves many transactions, which have potential for abuse and fraud. There are a number of law enforcement agencies charged with the responsibility for investigating and prosecuting fraudulent activity. The Santa Clara County Office of the District Attorney has several attorneys, investigators, and a paralegal whose sole responsibility is to prosecute and investigate insurance fraud cases.
Automobile Insurance Fraud Unit
The Automobile Insurance Fraud Unit investigates and prosecutes insurance fraud cases which arise from automobile insurance policies. From 10% to 20% of all auto claims are estimated by the industry and prosecutors to arise from fraud. Typically this involves a person who lies to an automobile insurance company in order to collect money. Some examples of fraud include persons who are in an accident and attempts to "pad" their claim with expenses not incurred. More serious cases involve people who commit insurance fraud as part of their regular business, such as auto body shops, which take insurance payments but do not do all the work, or chiropractors who bill for services they did not perform. The most serious cases involve insurance fraud rings where lawyers, chiropractors, doctors, body shops, and others get together to either create totally false claims or inflate real claims.
Typically automobile insurance fraud carries up to five years in prison, and by a fine not exceeding $50,000 or double the fraud, whichever is greater.
Automobile insurance fraud is a very serious problem. It results in billions of dollars being lost every year. Everyone's insurance rates are increased to cover those losses. The Santa Clara County District Attorney's Office has assigned both investigators and attorneys to help attack the problem.
Workers Compensation Fraud Unit
Workers' compensation fraud harms employers by contributing to the high cost of workers' compensation insurance premiums. It harms employees by undermining the legitimacy of workers' claims and diverts monies that could otherwise be used for benefits.
The Santa Clara County Office of the District Attorney believes that the prevention of workers compensation insurance fraud will reduce the payment of false claims and will produce a proportional reduction in costs to employers. The prevention of this fraud will assist in restoring public confidence in this system and will facilitate workers in obtaining full compensation for workplace injuries. It is also unlawful for employers to make fraudulent representations to discourage an injured worker from obtaining benefits or pursuing a claim.
Another type of insurance fraud occurs when employers fraudulently underreport their payroll or fail to report their payroll to their insurance company in order to pay lower workers' compensation premiums. This type of fraud results in increased premium costs to honest employers and gives an unfair competitive advantage to the offending businesses.
Typically workers' compensation fraud carries up to five years in prison, and by a fine not exceeding $50,000 or double the fraud, whichever is greater.
If you are aware of a business or individual committing insurance fraud, please file a report by calling (800) 927-4357 or (408) 299-7400.
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