Preserve the claim and identify who is asking questions.
An insurer's inquiry, a subpoena and a criminal charge present different immediate decisions. Keep the complete request, attachments and deadline. Preserve applications, claim submissions, correspondence, photographs and payment records in their original form. Discuss the request with counsel before sending an explanation or changing a document.
New York insurance fraud is addressed in Penal Law Article 176. The investigation should be evaluated against the actual statutory theory, not the general label “fraud.”
Knowledge, intent and the alleged false information
Penal Law § 176.05 defines a fraudulent insurance act. Its provisions address knowing, intentional fraud involving material false information or concealment in specified insurance submissions. They also address certain conduct involving staging a motor vehicle accident. The type of submission and the facts attributed to the person matter.
A dispute over coverage or a mistake does not by itself establish every criminal element. Counsel should examine what was submitted, who prepared or authorized it, what the person knew and why the disputed information was material. A financial benefit actually received is not a universal requirement: fifth-degree insurance fraud requires a fraudulent insurance act, and the higher-degree statutes also cover specified attempted takings.
Degrees and potential penalties
The property-value thresholds below are strictly “more than,” not “at least.” The government must establish the fraudulent insurance act and the additional elements of the charged degree.
- Fifth degree, § 176.10: a class A misdemeanor; no dollar threshold is stated in that section. The maximum definite jail sentence is 364 days.
- Fourth degree, § 176.15: property value over $1,000; a class E felony.
- Third degree, § 176.20: property value over $3,000; a class D felony.
- Second degree, § 176.25: property value over $50,000; a class C felony.
- First degree, § 176.30: property value over $1 million; a class B felony.
The ordinary felony maximum terms under Penal Law § 70.00 are four, seven, fifteen and twenty-five years for classes E, D, C and B respectively. These are statutory limits, not predictions of an individual's sentence. Prior-record rules, the conviction and available sentencing alternatives require separate review. Discuss restitution, employment, professional licensing and immigration concerns before evaluating a disposition.
Evidence and defense analysis
The defense may need the full claim file rather than selected excerpts. Original forms, drafts, audit trails and communications can help establish authorship, knowledge and context. Records of payments and requested amounts matter to the alleged value and degree.
- Identify everyone who prepared, reviewed or transmitted a submission.
- Preserve supporting invoices, medical or repair records and photographs.
- Keep insurer requests, recorded-statement notices and prior responses.
- Tell counsel about seized devices, interviews and related civil proceedings.
Process, deadlines and early representation
Counsel can assess whether the immediate issue is an interview, production demand, arrest or court appearance. Investigation and document review guide any motions, negotiations and trial preparation. Do not assume that an insurance deadline pauses because a criminal issue has arisen, or that an informal explanation will end the investigation.
Use the consultation form for a short initial summary. Ask the firm how to transfer sensitive records securely.