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  • Writer's pictureRobert Schuerger

What Is Personal Injury Fraud?

Oftentimes, many people try to seize an opportunity by filing fraudulent personal injury claims. However, this could result in severe consequences, such as financial impacts as well as jail time.

These claims involve receiving money from insurance companies, which is why people often think they're harmless and victimless. Nevertheless, this isn't the case, as the claimant's intention is to deceive the insurance company and receive money for a nonexistent or exaggerated injury. Simply put, this is fraud, and it's vital to get the assistance of a knowledgeable personal injury attorney. They can help with questions like what is duty of care in personal injury law?

What Is Personal Injury Fraud?

What Is Personal Injury Fraud?

Any conduct intended to persuade an insurance company to pay for injuries that are exaggerated, nonexistent, or not connected to an incident covered by an insurance policy is commonly referred to as personal injury-related insurance fraud. Typical instances include fabricating or inflating the type and severity of injuries sustained in an accident, as well as organizing or arranging a robbery, fire, or vehicle collision.

What Are the Different Types of Fraudulent Personal Injury Claims?

Two types of fraudulent claims exist: "soft insurance fraud" as well as "hard insurance fraud."

Soft insurance fraud is the most prevalent fraudulent personal injury claim and takes place when a person exaggerates the seriousness of their injury, resulting in a higher claim amount. This is also known as opportunistic insurance fraud and is an offense. It's important to note that this type of fraud occurs when a person files a legitimate claim; however, they file a claim for losses not incurred or previous losses.

Hard insurance fraud, on the other hand, occurs when no insurance claim exists, but the person finds a way to file one. Also known as premeditated insurance fraud, this is a planned and deliberate action taken to deceive an insurance company. An example of hard insurance fraud would be staging a car theft or arson.

When it comes to investigating and prosecuting incidents of hard personal injury fraud, law enforcement and insurance companies are on the lookout. Furthermore, premeditated insurance fraud is often subject to harsh criminal and civil sanctions.

How Do People Commit Personal Injury Fraud?

There are many situations and contexts in which people can file a fraudulent claim. However, some of the most common ways include:

  • Committing fraud when applying for healthcare.

  • Providing or filing false information in a personal injury insurance claim.

  • Hiring or bribing a medical practitioner to give a false statement regarding an injury.

  • Submitting frivolous lawsuits.

  • Exaggerating the injury suffered.

  • Using false information to get workers' compensation.

  • Trying to get excess compensation for the losses suffered.

  • Filing for compensation for an injury that was previously sustained and not related to the current accident at hand.

What Are the Penalties for Personal Injury Fraud in Texas?

In Texas, insurance fraud has civil and criminal penalties that are determined based on the benefits obtained or sought after and the value of the claim.

Let's look at these penalties:

  • Less than $2,500: This is a Class A misdemeanor and is punishable by a fine of up to $4,000 and a maximum of one year jail time.

  • Between $2,500 and $30,000: This is considered a third-degree felony, which is subject to a maximum fine of $10,000 and between two and 10 years in prison.

  • $30,000 - $150,000: Considered a second-degree felony, this is punishable by a fine of up to $10,000 and two to 20 years jail time.

  • $150,000 or more: Lastly, this is a first-degree felony, which is punishable by a maximum fine of $10,000 and between five and 99 years in prison.

Furthermore, one should note that anyone found guilty of insurance fraud will probably be unlikely to obtain insurance coverage in the future.

How to Protect Against Yourself Against Fake Injury Claims

Drivers, employers, property managers, etc., are all at risk of having people make fraudulent personal injury claims against them. Some of the ways they can ensure they're not held liable for a false claim include:

  • Gathering sufficient evidence regarding the accident.

  • Informing law enforcement about the accident as soon as possible.

  • Obtaining witness statements and testimonies.

  • Hiring a reputable personal injury attorney.

  • Giving the correct facts to an insurance company.

Building a Defense Against a Fraudulent Claim Allegation

An experienced defense lawyer can assess the case and create a customized plan to contest accusations of insurance fraud. Some of the most common defenses are:

Insufficient Evidence

This involves contesting the prosecution's case, for example, by casting doubt on the authenticity of documents or the reliability of witnesses, in order to demonstrate that there is insufficient evidence to prove guilt beyond a reasonable doubt.

Lack of Intent

This involves proving that the defendant did not know or intentionally offer misleading or false information to the insurance provider. A Houston personal injury attorney can prove this by demonstrating that the relevant inaccuracies were a result of a misunderstanding or a mistake.


An attorney can try to prove that the defendant was coerced, persuaded, or forced into committing personal injury fraud by a law enforcement official, which they otherwise would not have done.

Good Faith

Lastly, the defense can prove that the accused had a reasonable and good-faith belief that they provided the correct information, even if it was found to be incorrect at a later stage.

Signs of a Fraudulent Personal Injury Claim

Signs of a Fraudulent Personal Injury Claim

Signs that a personal injury claim may be fraudulent include:

  • The person experienced financial distress before filing the insurance claim.

  • Has filed many personal injury claims previously.

  • Willingness to accept an early settlement.

  • Handling the case with extreme aggression or being overly nice.

  • Reluctance to provide evidence and cooperate.

  • Vague or changing evidence.

  • Discrepancies in details of the accident.

  • A lack of medical records.

Contact a Reputable Insurance Fraud Lawyer Today!

An experienced and professional personal injury law firm can assist anyone with fraudulent insurance claims placed against them by finding appropriate evidence that there was no dishonest act intended behind the claim. They can also help answer questions like what is a personal injury demand letter? There are many times when law enforcement and insurance companies try to accuse innocent people of committing personal injury fraud. Therefore, we're here to fight for their rights!

The experienced lawyers at Schuerger Shunnarah Trial Attorneys in Houston, Texas, are dedicated, professional, discreet, and thorough and will fight tooth and nail to disprove any false injury claims. Contact us today for a free consultation.


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