Frequently Asked Questions
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General Insurance Fraud
What are the most common criminal charges for insurance fraud?
Most prosecutions of insurance fraud allege one or both of the following:
· Penal Code section 550
· Insurance Code section 1871.4
How does Insurance Fraud effect the community?
Insurance Fraud totals over $15 billion each year, which is an average of $500 a year per resident of California. This results in higher premiums, higher taxes, and higher prices. Insurance fraud is the second most costly crime in the country. The impact of insurance fraud has a direct effect on a communities’ residents.
Click here for more information on the effect of insurance fraud.
Workers' Compensation Insurance Fraud
Are there any other agencies or departments where I can find more information?
Yes, see below for a short list of agencies that can provide more information.
California Department of Insurance (CDI)
http://www.insurance.ca.gov/
800-927-HELP (4357)
California Department of Industrial Relations (DIR)
http://www.dir.ca.gov/
I only have part time employees. Do I need to buy WC insurance?
Yes. If you are a business owner who employs workers who are part-time, whether your staff is mostly full-time, part-time or a combination of both, you must carry workers’ compensation insurance. Even if you have only one part-time worker, most employers are required to carry workers’ compensation insurance.
I don’t believe the details of my employee’s on-the-job injury. Can I deny their WC claim?
No. Only your WC insurance co can accept or deny a worker’s claim. Your responsibility is to cooperate with your insurance company.
I was hurt on the job. Can my employer refuse my request for medical care?
No. Most employers are required to carry workers’ compensation insurance (with few exceptions), and if you are injured on the job you have the right to make a claim. Start by contacting your employer and asking to begin the process. If your employer refuses to allow you to make a claim you may contact the California Department of Insurance at (916) 854-5760 or The Sonoma County District Attorney’s Office Hotline at (707) 565-2558.
Automobile Insurance Fraud
Are there any other agencies or department where I can find more information?
Yes, see below for a short list of agencies that can provide more information.
California Department of Insurance (CDI)
http://www.insurance.ca.gov/
800-927-HELP (4357)
National Insurance Crime Bureau (NICB)
https://www.nicb.org/
847-544-7002
Who commits automobile insurance fraud?
Perpetrators range from first time opportunists to organized criminal rings and can be auto repair professionals who charge for services/parts not rendered, or ordinary people who want to cover their deductible, pay less in premiums, or view filing a claim as an opportunity to make a little money.
What are staged crashes and what can they look like?
Staged crashes are also sometimes known as set-ups because the crash is set up by one or more perpetrators to collect on a claim against your insurance policy. Some common stages crashes are:
Swoop & squat. A vehicle swoops in front and jams on its brakes. You hit the rear. Passengers claim painful injuries. Your auto policy is falsely billed thousands.
Drive-down. You’re merging or turning. A dishonest driver waves you forward, then deliberately crashes into your vehicle blaming you. Drivers also wave you out of a parking space, then dart into your path.
Shady helpers. A stranger approaches the crash scene, or phones you right after. They try to steer you to a medical clinic, body shop or lawyer. You may be being set up for bogus insurance claims.
Who are likely victims of staged crashes?
Automobile Insurance fraud has a direct effect on innocent, law-abiding citizens. Fraud perpetrators have staged automobile collisions resulting in serious injuries and even loss of life. Perpetrators looking to stage collisions will often pick members of the community who may not be aware of their rights or local laws and less likely to report the fraud.
I was involved in a car accident. What can I do to prevent insurance fraud?
If safe to do so, after a crash take photos of damage to vehicles, the driver and any passengers. In some jurisdictions, law enforcement may not report to the scene of minor accidents if there are no injuries, so it’s important to document the scene.
Be accurate and honest when speaking to any member of law enforcement or an insurance company representative about the details of the accident. If the other driver asks you to lie about when the accident occurred or any other aspect of the incident, DON’T DO IT. The other driver might be attempting to commit insurance fraud, and if you go along with it, you could also be vulnerable to arrest and prosecution.