Houston Insurance Fraud Lawyer

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Houston Insurance Fraud Attorney

Facing insurance fraud allegations can be overwhelming, intimidating, and extremely difficult. The potential consequences that could come from a conviction can impact all areas of your life in significant ways. However, it is important to keep in mind that accusations do not mean you are guilty. You have the right to defend your innocence and can do so with the assistance of a Houston insurance fraud lawyer.

Having over 45 years of legal experience, along with extensive knowledge of state and federal statutes, gives me the resources and skills needed to be an excellent defense attorney. At The Law Offices of Richard Kuniansky, all cases are handled with the utmost care and respect.

I know how stressful it can be to deal with criminal charges, and I can provide you with the support you need while working diligently on an aggressive defense plan. Whether you’ve been charged with Medicare fraud, life insurance fraud, or property insurance fraud, I’m prepared to tirelessly defend you.

Houston Insurance Fraud Lawyer

Understanding Texas Insurance Fraud

Insurance fraud in Texas is defined as knowingly and intentionally defrauding or deceiving an insurance company by providing them with false or misleading information. A person can commit insurance fraud when they are completing an insurance application or filing an insurance claim to receive benefits. Types of insurance fraud include:

There are multiple ways one can engage in insurance fraud, and they are as follows:

  • Knowingly including false or misleading information when filing an insurance claim or filling out an application.
  • Purposely failing to divulge important information that could potentially affect the terms or acceptance of an insurance policy.
  • Falsely stating or representing some kind of damage or loss in order to receive insurance benefits.
  • Taking part in a scheme with the intent to defraud an insurance company.

The state of Texas takes insurance fraud seriously. Depending on how severe the charges are, those accused of insurance fraud can face high penalties and possible prison time. The Texas Department of Insurance Fraud Unit investigates all reports of fraud in the state, working with attorneys, prosecutors, and fraud examiners.

The unit’s investigation process consists of interviewing witnesses, sending out subpoenas for relevant documents, analyzing all documents and evidence collected, conducting necessary surveillance, executing search warrants as needed, and filing a case report. If their findings are sufficient, the accused party may be arrested and could possibly be put on trial.

Common Types of Insurance Fraud

According to the Texas Department of Insurance, the following are common types of insurance fraud:

  • Unlicensed Insurance – The illegal selling of insurance without a license. Companies that don’t meet state financial requirements are usually unlicensed because they may not be able to afford to pay claims.
  • Healthcare Provider Fraud – Some healthcare professionals or hospitals may sometimes over-bill an insurance company for services they provided, do unnecessary procedures and tests to bill insurance companies more, or bill companies for services that were not provided.
  • Agent Fraud – Insurance agents can also commit fraud. They do this by selling policies that aren’t real, putting false information on an insurance application, or holding on to customers’ premiums for personal use.
  • Homeowner Fraud – It is not uncommon for homeowners to commit fraud by filing fake claims for crimes such as arson or burglary or exaggerating the amount of a real claim.
  • Auto Accident Fraud – There are multiple ways a person may commit auto accident fraud, including causing a car accident and giving the impression that they are the victim, filing a claim for a car accident or auto theft that never actually happened, and padding their claim.
  • Mortgage Fraud – Mortgage fraud happens when mortgage borrowers make misleading or false statements in order to get a loan. It is also considered fraud to misuse escrow funds that are being held in an escrow account at settlement.

Insurance Fraud Penalties in Texas

An individual can be charged with anything from a Class C misdemeanor to a first-degree felony if they commit insurance fraud. It all depends on the specifics of the act committed.

Intentionally deceiving an insurance company by paying, offering, asking for, or receiving benefits related to goods or services covered under an insurance policy is a method of fraud that can range in the severity of the charge. It is usually dependent on the amount of money involved and whether the act placed someone at risk of death or serious physical harm.

If an individual knowingly creates or presents a statement to their insurer that contains misleading or false information in order to receive payment from an insurance claim, the charges depend on the same factors. When a person knowingly creates or presents a statement to an insurer that contains misleading or false information while applying for an insurance policy, they may be charged with a state jail felony.

If you are convicted of insurance fraud, you can not only be subject to fines and possible prison time, but you can also be ordered to pay restitution, including court fees and lawyer fees, to the insurer that was affected.

As your defense attorney, I can investigate your case and come up with a defense strategy that works for your circumstances. Your chances of seeing a favorable outcome increase significantly with an experienced attorney on your side.

Strategies for Insurance Fraud Defense

When a criminal insurance fraud case goes to trial, the burden of proof is on the prosecution. They have to provide evidence that shows, beyond a reasonable doubt, that the accused committed fraud. They must demonstrate that you knowingly and intentionally deceived the plaintiff and that you intended to defraud them.

There are a few possible defenses that can be used in a fraud case, depending on the circumstances of the case:

  • Lack of intent to deceive. This defense argues that you did not intentionally mislead or give the plaintiff false information. This defense could mitigate liability.
  • The information is not false. This argues that although the plaintiff believes the information you gave is false, it is, in fact, accurate. If this can be proven successfully, the entire claim of fraud could be undermined.
  • Mistake of fact. This defense argues that you were honestly and reasonably mistaken about the facts of the matter. This can invalidate intent and, again, mitigate liability.
  • A portion of the claim resulted from a valid injury, loss, expense, or service covered by the policy. This argument, when proven, can lessen the amount of restitution that may need to be paid.

It is important to note that with each of these defenses, the burden of proof is on the defense. You must provide evidence that supports your defense and place doubt in the jurors’ minds regarding the prosecution’s claims. If there is a reasonable doubt, you could potentially avoid conviction, or you could receive less severe penalties.


Q. Is There a Statute of Limitations for Insurance Fraud in Texas?

A. There is a statute of limitations for felony insurance fraud in Texas. This countdown does not begin when the fraud is committed, as one might believe. It begins when the insurance fraud is discovered or when it reasonably should have been discovered. After discovering the fraud, the prosecution has to file charges within a certain time frame.

Q. What Happens if You Give False Information to an Insurance Company?

A. If you knowingly give false information to an insurance company in Houston, TX, a number of things can happen. The insurance company can deny your claim or reduce the payout amount. They could cancel your policy altogether, leaving you without insurance and potentially making it harder to get insurance in the future. You could face criminal charges, depending on how severe the false information is. The insurance company could also file a claim against you.

Q. Can You Be Sued for Insurance Fraud?

A. Yes, you can be sued for insurance fraud. If you submit false information in an insurance claim and receive a payout because of it, the insurance company can file a civil suit against you to get the money back. There is also the potential to face criminal charges for this act and be ordered to pay more money in fines.

Q. How Long Does an Insurance Company Have to Investigate a Claim in Texas?

A. After you file your claim, your insurance company has a certain number of days to acknowledge that they received the claim and begin their investigation. After getting the necessary documentation and information from you, they have another time frame in which to let you know if they will accept or reject your claim. If the claim is rejected, the insurance company must inform you of the reasoning in writing. There may be some exceptions to these timeframes under specific circumstances.

Your Trusted Houston Insurance Fraud Lawyer

You don’t have to face fraud charges alone. Contact The Law Offices of Richard Kuniansky. I can address your concerns, answer your questions, and inform you of what comes next in this process. I am your trusted advocate, here to guide and support you every step of the way.



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