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Attorneys for Insurance Fraud in Cincinnati, OH

Many insurance fraud cases in Cincinnati and Hamilton County are investigated by the Ohio Department of Insurance and the National Insurance Crime Bureau. In many of these cases, insurance fraud investigators employed by the insurance company will initiate the investigation. A significant portion of all claims received by insurance companies are fraudulently submitted or the losses are exaggerated.

Because insurance fraud increases the cost of insurance for all of us, the Department of Insurance aggressively pursues these allegations. In many of these cases, the defendant will be accused of engaging in a scheme to defraud insurance companies by filing reports about losses or damages that never actually happened.

Various types of insurance companies can be involved in fraud cases including health insurance companies. auto insurance companies, property owners insurance companies and home owners insurance companies. Related charges often include identity theft, forgery and tampering with records.

The attorneys at Joslyn Law Firm represent clients charged with a variety of serious white collar crimes and fraud charges under Chapter 2913. The crime of insurance fraud in Ohio is set out in Ohio's R.C. Section 2913.47.

If you were charged with insurance fraud in Cincinnati or the surrounding areas of Hamilton County, Ohio, then contact the attorneys at Joslyn Law Firm. Our criminal defense attorneys are ready to help you fight your charges. Let us put our experience in fighting financial crimes to work for you. Call (513) 399-6289 today for a free consultation.


Elements of Identity Fraud in Ohio

The elements of identity fraud in Ohio are set out in Ohio's R.C. Section 2913.49. The prosecutor in an insurance fraud case must prove that the defendant acted with the purpose to defraud or knowing that he or she was facilitating a fraud.

The elements of the first alternative way of proving identity fraud are as followings:

  • The defendant presented to or caused to be presented to an insurer any written or oral statement that is:
    • part of or in support of an application for insurance;
    • a claim for payment on a policy;
    • claim for any benefit on a policy;
  • The defendant knew that the statement or any part of the statement was false or deceptive.

The elements of the second alternative way of proving identity fraud are as followings:

  • With another person the defendant:
    • assisted;
    • aided;
    • abetted;
    • solicited;
    • procured; or
    • conspired;
  • To prepare or make any written or oral oral statement; 
  • The statement was intended to be presented to an insurer;
  • The presented state was made as part of or in of an application for insurance, claim for payment, a claim for other benefit of a policy;
  • The Defendant knew that the statement or any part of the statement was false or deceptive.

The standard jury instructions for Insurance fraud under Ohio's R.C. 2913.47 is found in CR 513.47 for offenses committed on and after July 1, 1996.


What is Insurance Fraud?

Insurance fraud has exists since the time issuing insurance policies begin. Insurance fraud occurs when a person commits any act with the intent to fraudulently obtain some benefit or advantage to which they are not otherwise entitled. Insurance fraud can also occur when someone knowingly denies some benefit that is due and to which someone is entitled.

The most common example of insurance fraud is filing a false insurance claim with the intent to defraud an insurance provider when the loss was planned, staged or never occurred at all. Even if the loss is legitimate, fraud can occur if the amount of the loss is exaggerated.


Definitions under Ohio's Insurance Fraud Statute

Under Ohio's insurance fraud statute, the term “defraud” means to knowingly obtain, by deception, some benefit for oneself or another or to knowingly cause, by deception, some detriment to another.

Under R.C. 2913.01(B), the definition of the noun “fraud” is identical to that of the verb “defraud.” The term “insurance policy” is defined to include a policy, certificate, contract, or plan that is issued by an insurer.

"Insurer" means any person that is authorized to engage in the business of insurance in this state under Title XXXIX [39] of the Revised Code, any health insuring corporation, or any other person engaging either directly or indirectly in this state in the business of insurance or entering into contracts substantially amounting to insurance under section 3905.42 of the Revised Code.


Fraud Unit of Ohio's Department of Insurance (ODI)

The mission of the ODI’s fraud unit is to investigate suspected insurance fraud and crimes involving insurance in Cincinnati, Hamilton County and throughout the entire State of Ohio. This criminal justice agency investigates complaints of persons suspected of fraudulently attempting to receive a benefit from an insurance company. 

Should an investigation find evidence of a crime, the Fraud Unit refers the matter to the appropriate local, state, or federal prosecutor for consideration of criminal charges. The Department of Insurance provides information on indicators of insurance fraud and instructions on how to file a complaint online.

Under Ohio law, each insurer must adopt an anti-fraud program in a written plan to deal with instances of insurance fraud or suspected insurance fraud. If an insurer, as defined in section 3999.42 of the Ohio Revised Code, has a reasonable belief that a person is perpetrating or facilitating an insurance fraud, as established by section 2913.47 of the Ohio Revised Code, or has done so, the insurer must notify the department of insurance.

The Fraud Unit only investigates complaints regarding a consumer or a provider, but not an insurance companies or agents. A complaint against an insurance company goes to the Consumer Service Division and a complaint against an agent goes to the Enforcement Unit. The department encourages people with information about someone committing insurance fraud to call the state's fraud hotline at 1-800-686-1527.


Finding an Insurance Fraud Defense Attorney in Cincinnati, Ohio

The Ohio Revised Code requires every insurer to adopt an anti-fraud program. The insurer must specify in a written plan the procedures it will follow when instances of insurance fraud or suspected insurance fraud are brought to its attention. The insurer is not required to file the plan with the department of insurance.

If you were charged with insurance fraud under Ohio's R.C. Section 2913.47, then contact an experienced criminal defense attorney at Joslyn Law Firm to discuss your case. We represent clients on a wide variety of fraud charges throughout the greater Cincinnati area and all of Hamilton County, Ohio.

Call (513) 399-6289 today for a free consultation. Let us put our experience to work for you.

This article was last updated on Friday, November 11, 2015.