Insurance Fraud

Practice Areas

State and federal law enforcement are actively investigating and prosecuting insurance fraud. In Massachusetts, the Insurance Fraud Bureau conducts many investigations and refers them to local District Attorneys, the Massachusetts Attorney General and to the United States Attorney’s Office. We have experience representing clients in connections with such investigations. We defend against both the case itself, as well as to protect the collateral license and employment consequences of these investigations.

Frequently Asked Questions

What is insurance fraud under Massachusetts law?

Insurance fraud occurs when someone intentionally deceives an insurer for financial gain.
That can mean submitting false claims, exaggerating losses, concealing facts material to the claim, or providing false information in an application.
The key element is intent — that the person acted knowing the information was false or misleading.

What statutes apply and what types of acts are covered?

Massachusetts General Laws Chapter 266, Section 111A covers false or fraudulent claims, false statements, or misrepresentations in insurance matters.
There are also provisions for motor vehicle insurance fraud specifically, and laws governing fraudulent insurance applications.
The Fraudulent Claims Board (Division of Insurance) investigates motor-vehicle and other insurance claims for misrepresentation or exaggeration under Section 8B.

What penalties might someone face if convicted of insurance fraud?

Penalties can include prison time (depending on severity), substantial fines, restitution to the insurer, and possibly loss of driving privileges in some motor-vehicle fraud cases. Mass.gov+2Altman & Altman+2
In auto-claim related fraud (under Chapter 266) fines can be up to $10,000 and up to five years in state prison.

What defenses are available in insurance fraud cases?

Arguing lack of intent or knowledge is common — that false information was a mistake rather than deliberate.
Challenging whether the misrepresentation was material (whether it actually influenced the insurer’s decision) can work as a defense.
Procedural defenses may include contesting whether evidence was properly obtained or whether the person had notice.

What should someone do if under investigation or charged with insurance fraud?

Retain specialized defense counsel experienced in insurance fraud.
Preserve all documents, claims, communication, records relevant to the claim or application.
Avoid speaking without counsel.
Review your insurance policy and claim forms carefully.