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When Your Personal Injury Claim Becomes Fraud

If you’ve been injured, your instinct may be to file a claim to offset the cost of medical care and recovery. Loss of earning potential and lost wages can be a heavy burden on anyone dealing with a personal injury, but it is important to be careful when filing a claim. A fraudulent claim will likely have serious consequences. Not only can your insurance company deny your claim and drop your coverage, but you may also be liable for any money you’ve received from the company. In some instances, you might even be charged with punitive or criminal damages.


What is a Fraudulent Claim?

A fraudulent claim is defined as any claim intended to get compensation for an injury that is nonexistent, exaggerated or unrelated to an accident covered by your policy. A fraudulent claim is a serious matter, and some examples may involve:

  • Exaggerating injuries from a car accident
  • Staging an accident or incident to make a preexisting injury seem new
  • Staging an incident to get coverage for a nonexistent injury

You may be held accountable for fraudulently filing a personal injury claim even if you haven’t falsified any information on the claim. Withholding information that you’re legally required to disclose or that would be relevant to the claim is just as fraudulent from a legal perspective.


Have I Filed a Fraudulent Claim?

The most common type of fraudulent claims involve “soft” insurance fraud. This occurs when an individual exaggerates their injury — for example, claiming a case of whiplash involved cracked vertebrae — in an attempt to maximize the amount of money received in compensation.

“Hard” insurance fraud occurs when an accident is staged in order to recover compensation for injuries. This may also involve property issues if an individual’s car is damaged and they are seeking compensation for this property from the insurance company.

To help determine whether your claim is fraudulent, ask yourself the following questions:

  • Was I injured before the accident happened?
  • Have I reported my injury honestly, including my medical reports?
  • Have I filed for compensation for anything not directly related to the claim?

What Should I Do if My Claim is Considered Fraudulent?

Insurance companies are always cautious while reviewing claims, and they may use your claim history against you. If you’ve had a spell of bad luck and have been in several accidents, an insurance company may mark your latest claim as fraudulent. They may also examine your credit history or your social media accounts to determine if your claim is fraudulent or not.

If your claim is labeled as fraudulent, but you feel your claim is legitimate, it may be helpful to seek legal representation. In particular, you might want to seek out an experienced DC personal injury attorney who can help ensure you receive the compensation you deserve. There’s no reason to pay for someone else’s mistake if you’ve been honest in your insurance claim, and a qualified personal injury attorney can help you navigate any legal issues at hand.


Thanks to our friends and co-contributors at Cohen & Cohen, P.C. for their added insight into this subject.

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