Insurance Fraud

J.P. Gonzalez-Sirgo
Founder of J.P. Gonzalez-Sirgo, P.A.

If your insurance company accuses you of fraud, attorney J.P. Gonzalez-Sirgo says there are 3 things you need to know:

First - what is and is not insurance fraud?

At its heart, insurance fraud boils down to good faith or bad faith on the part of the insured.

A typical definition of insurance fraud is a “false and materially relevant” statement made to the insurer, which the insured knows to be false, and which is intended to deceive the insurer.

Remember inconsistencies or over-valuing something in the claims process should not necessarily equal a claim denial. Intent is the key.

Second - what effect will fraud or misrepresentation have on your claim?

Almost every insurance policy comes with a broad anti-fraud provision.

Basically, if you commit fraud, misrepresentation, or concealment in connection with a  claim, you're done. The insurance company can, and will, deny benefits.

One important factor here: the fraud must be materially relevant.

A false statement that is immaterial to the claim, even if made knowingly and willfully, is generally not a deal breaker.

Finally what rules does your insurance company need to follow to deny your claim based on fraud?

Obviously most insurance companies look to avoid paying on a claim and a bogus allegation of fraud is a common tactic.

Florida law offers some consumer protection - and the burden of proof is on the insurer.

So insist that your insurance company send you a detailed denial letter explaining the facts that support their fraud accusation.

If you're accused of fraud you don't need to panic but you do need to contact an experienced insurance claims attorney.

 You can reach Miami Insurance Claims Lawyer J.P. Gonzalez-Sirgo by dialing his direct number at (786) 272-5841, calling the main office at (305) 461-1095, or Toll Free at 1 (866) 71-CLAIM or email Attorney Gonzalez-Sirgo directly at [email protected].