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Personal Injury Fraud: When The Victim Becomes The Defendant

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Exaggerating the extent of your personal injuries after an accident can lead to a variety of problems if you're caught, not the least of which is criminal charges. Learn more about how allegations of fraud can turn a personal injury plaintiff into a criminal defendant really fast.

What is personal injury fraud?

Insurers estimate that somewhere between 5%-10% of claims in the U.S. and Canada are fraudulent—and some claim the percentage is even higher, closer to 20%. Insurers generally break down personal injury fraud into two basic categories

  • Hard fraud is where actions are taken for the sole purpose of inventing a claim that would be paid for by insurance, including staged accidents.
  • Soft fraud involves crimes of opportunity, where the plaintiff in a personal injury case was actually injured, but pads the claim with exaggerated injuries in hopes of a higher settlement

How do people get caught?

Because there's a growing trend to try to eliminate insurance fraud, insurers are putting more effort into looking for proof that fraud is happening and the internet is becoming a more useful tool than ever:

  • Online court databases can be searched—the presence of traffic tickets after the date of injury can be used to show that a plaintiff is lying about being unable to drive.
  • Insurance industry databases carry records of previous insurance claims and injuries—which can be used to show that a plaintiff is trying to blame an old injury on a new accident.
  • Employment records can reveal that a claimant had physical limitations long before the recent accident. The might also show that someone who is claiming to be impaired has no history of special considerations at work related to the supposed injury.
  • Online profiles on Facebook, Youtube, and LinkedIn can be mined, looking for pictures of a claimant doing something that he or she claims to be unable to do or advertising for work services despite an alleged disability. Some people are caught essentially bragging about their purposeful accidents.
  • Video surveillance can be used to try to capture the claimant in the act of doing something that he or she claims to be unable to do, like shoveling the sidewalk despite a back injury or going fishing despite a shoulder injury.

What types of charges could someone face?

Insurance fraud is a specific crime in 48 states plus Washington D.C., and the majority of those states are required to report any suspicion or evidence of fraud to the police. If that happens, the personal injury plaintiff could be charged with insurance fraud, but that's only the start. If the plaintiff testified to his or her injuries under oath during a deposition or in court, he or she can also be charged with perjury. If the plaintiff sought out medical care for fake injuries, he or she could also be in violation of federal laws. Medicare or Medicaid fraud charges are possible, as well as charges for illegally obtaining narcotic prescriptions if the plaintiff managed to fool a doctor with his or her pretend pain. In addition, any personal injury suit would likely be lost. If money was already received, it would have to be returned.

The problem with the increasing attention on issues of fraud in the industry creates a problem, however, for innocent claimants as well. Insurance agents may suspect someone with a perfectly legitimate claim of "padding" just because they saw a chiropractor instead of their regular doctor for post-accident treatment. Someone else might get accused of staging an accident simply because he or she had been unlucky enough to be in one a decade before that resulted in a personal injury lawsuit.

When that happens, it's time to get an attorney who specializes in criminal defense, not personal injury. Consider talking to a defense attorney like Law Offices Of Jerald Silvia at the first hint that you're being investigated for fraud, so that you and your attorney can discuss all the possibilities in advance.