Slip and Fall Attorneys, Find a Personal Injury Claim Lawyer

Is filing a car accident personal injury claim on your mind? We are going to chat about 3 things to avoid saying to the insurance company in this article.You might be feeling terrible about what happened when you go through a car accident.  Even if things are not your responsibility you might be wishing there was something that you could do to make things better. You will find there is nothing you can do sometimes. You may just be the one that deserves to file the car accident personal injury claim this time around. Let’s now go on to talk about 3 things to avoid saying to the insurance company. Number 1 – I Was At FaultEven if you were feeling awful about what occurred you should never say that you were at responsibility in the accident. The insurance companies and police as the ones that can really figure out who was at liability and who deserves to make the car accident personal injury claim. When you let the professionals do their job things will turn out a lot better.Number 2 – Family And Friend’s InformationFor some reason the insurance company may be asking you for contact info of your friends and family. Why are do they want this info? You are not obligated to give it to them. Just tell them no.Number 3 – I Do Not Have A LawyerThis is a big no no. Do not let the opposition know that you are coming in unprepared. I am hoping that you do have a lawyer but if you don’t you should never tell the insurance company. If they find out that you are on your own fight then they may not take you seriously. They are going to offer you the offer that they want you to take and no more.


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1. We’re going to have to take a recorded statement from you and ask you all sorts of personal questions, before we can accept coverage.

 

2. We don’t really think your doctor bills are reasonable. Couldn’t you have just taken some aspirin?

 

3. We don’t think your car rental bills are reasonable. Couldn’t you have rented a motor scooter?

 

4. I’m afraid we can’t accept the conclusion in the police report. Our insured says you were at fault.

 

5. This really isn’t going to look good on your driving record.

 

6. If you want to avoid the hassle of our investigation, we can pay you $500 and you can be done with it.

 

7. Your car was over a year old. We can’t replace the parts on your car with new parts.

 

8. Our computer analysis says you should be done with your treatment by now.

 

9. Our computer analysis says the reasonable value of your medical bills is about one third of the bills so that’s all we can pay.

 

10. Since the X-rays and MRIs didn’t show anything, we can’t include those charges, even if the doctor thought they were necessary.

 

Here are ten additional tips of advice from a personal injury lawyer to follow if you have been in an accident. You can also learn more about how to handle a personal injury in Costa Mesa, or any city, by calling the Law Offices of R. Sebastian Gibson at any of the numbers which can be found on our website at http://www.SebastianGibsonLaw.com  and learning how we can assist you.

 

Obviously, if you have had an accident, and you are reading all of this advice, it may have been a few hours since the accident. However, if you ever have another accident, or if it’s only been a few hours since you were hurt, here’s what you should do from the start.

 

First, take a look around and determine if you or anyone, are hurt. If so, taking steps like trying to prevent further injury or loss of blood are the most important thing you can do. Even if some other driver caused you to be injured, it’s just good manners to help the other driver if they are hurt. They may even be so thankful that they admit their fault to you. The worst thing you can do is get angry or start a fight.

 

Second, make sure everyone is safe from being injured further. If you are in the middle of traffic, and you are dizzy, sit down away from traffic. If your vehicle is a traffic hazard and you have accident warning devices like flares or triangles, put them out on the road to warn other drivers and get away from the car. Let the police an other emergency personnel investigate the scene with the vehicles in place and move them more safely at a later point.

 

Third, call the police. Accident reports are extremely helpful if the police will do such a report. Let the police know you are injured immediately. Answer the police questions honestly. But if you are dazed or confused, let them know you need medical treatment and answer only what you feel sure about. Remember, your statements can and will be used against you if you admit fault, and it will be too late and too fishy to later say you didn’t know what you were saying at the scene. Police know that your best recollection is immediately after an accident.

 

Fourth, get the other driver’s information including their names, addresses, driver’s license numbers, make and model of their vehicles, license plate numbers, and their insurance company name and policy number. If there are witnesses, get their names, addresses and telephone numbers as well. If the other driver makes any admissions of fault, write those down as well.

 

Fifth, if you have a camera on your cell phone or in the car and you aren’t too injured, take some photos of the vehicles and the scene. If you can’t do it right away, do it after you are released from the hospital.

Sixth, if you are hurt, obtain medical treatment. Don’t decline the ambulance or hospital examination to save your insurance company money or to be stoic. Take your valuables out of your car if you can and get checked out at the hospital. If you are not hurt, don’t get treatment you don’t need. However, remember, after an accident, you may feel a rush of adrenaline that causes you to only start feeling symptoms of pain a few hours later. If you have a health plan that requires you to obtain permission first, call them and find out where you are allowed to seek treatment.

 

Seventh, call a good personal injury attorney as soon as you have had your initial treatment, so the attorney can gather other important evidence and prevent the insurance company from taking advantage of you and obtaining such things as recorded statements that you feel fine, when many of your symptoms have yet to manifest themselves. A good personal injury lawyer can save you from making a great deal of mistakes and can shoulder much of the hassle of knowing what to do about car repairs, car rentals, medical treatment, witness statements and the like. If you think you will save money by not having an attorney, think again. A good personal injury lawyer can almost always obtain much higher settlements, obtain reductions of medical bills and insurance liens and prevent you from making costly mistakes. Also, most personal injury lawyers advance costs of obtaining police reports, medical records and the like and are paid and reimbursed for these costs only out of any settlement.

 

Eight, you will need to report the accident to your insurance company, but since they will want to take a recorded statement from you, just like any other driver’s insurance company, it’s good advice to retain an attorney first. And if the other driver did not have insurance, remember that it is your own insurance company that will be your adversary. You will also need to report the accident to the Department of Motor Vehicles and your lawyer can give you the form for this.

 

Ninth, do not agree to settle your claim privately with the person at fault for the accident. This almost never works out to your advantage. Don’t agree not to call the police. Police reports that determine the fault for an accident are golden. Your agreement to not involve the police only affords an opportunity for the other driver to change his story and blame you when the police will no longer investigate the accident.

 

Tenth, don’t pay a traffic ticket without a fight if you weren’t at fault or agree to accept a small payment for your vehicle repairs without knowing that the amount will in fact cover the cost of all the repairs.

 

If you’ve had a personal injury accident in Orange County, Newport Beach, Anaheim, Irvine, Huntington Beach, Corona del Mar, Laguna Beach, Santa Ana, Orange, Fullerton, costa Mesa, Westminster, Buena Park, Mission Viejo, Garden Grove, Laguna Niguel, San Clemente, Chino Hills, or anywhere in Southern California, we have the knowledge and resources to be your Costa Mesa Personal Injury Lawyer and your Orange County Personal Injury Attorney. Be sure to hire a California law firm with auto, motorcycle, truck, bicycle, pedestrian, car, bus, train, boat and airplane accident experience, wrongful death experience and insurance law expertise who can ensure you are properly represented and get the compensation you deserve.

 

If you have a personal injury legal matter, a dog bite or if you’ve lost a loved one in a wrongful death accident, call the Law Offices of R. Sebastian Gibson, or visit our website at http://www.SebastianGibsonLaw.com  and learn how we can assist you.


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How is automobile insurance not extortion? If I got into a coup¨¦ accident and it was MY blemish….I would want the person I hit to be taken care of. It’s individual fair that they get their coup¨¦ fixed and their medical bills paid…they didn’t do anything wrong! If it was NOT my error, I would want the person…How long does it cart to collect insurance money after an automobile calamity?A woman was driving in front of m and established to make an illegal u-turn and merely slammed on her brakes, not knowing I was behind her. I hit her and my coup¨¦ is pretty much totaled. Does anyone know how long it would take to collect insurance…How long does it pocket an insurance company to issue an automobile insurance policy after unloading deposit?I’ve been with duplicate company almost five years. My car insurance is renewed every six months, after I make the required renewal deposit. Like clockwork, I receive the contemporary payment coupons, and temporary insurance card. 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I have full coverage. 2 speeding tickets in the second 3 yrs. Blah. $114.00 through Geico for a 07 Ford Taurus. 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If I be in an accident within that county, would my automobile insurance be valid even though I was violating the emergency command by driving? it should be valid, but that doesn’t aim…Is in that an insurance company surrounded by california where on earth I can bring GAP insurance for an automobile loan?A phone number or a website would be great. a true “gap” insurance should be obtained from the finance company for your vehicle, but some companies submission a similar coverage that may cover over a vehicle’s actual cash value contained…Is in that title insurance for automobile purchases?When you buy a house, it is a good idea to procure title insurance in case near are any undivulged debts or liens on the property. When these are discovered the insurance is used to pay off the liabilty. In skin an auto has some outstanding debts or liens, it would… More Automobile Insurance quesions please visit : InsuranceQuotesFAQ.com


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Remember now, back in March of this year, he invited the CEO’s of the major insurance companies to a White House summit.

Afterward, Obama praised them for their ideas and cooperation with his plan

(Flash forward 4 month, and his ratings tanking) Ins Companies are now the “villains”

Uh, I don’t think so Mr President:

Total Health Care spending in the US 2.2 Trillion
Ins company profits – .06% ( That is .60 cents per $100 dollars)
Ins co. CEO salaries – 0.005 % ( that is 1/2 cent per $ 100 dollars)

http://www.factcheck.org/2009/06/pushing-for-a-public-plan/

Why don’t you ask where the other $99.39 went???

(Hint: Drive around your local hospital and count how many “personal injury” law offices you can find within sight of it)

Think that 350+ lawyers in DC might have something to do with that?

FACT is.. the left can’t pass their agenda without making the weak minded “feel” upset in some way. But, they will NEVER sell out their brethren.. the trial lawyers.
typo – 0.6%.. still 60 cents
I’m referring to the “evil” profits that the left is now laying the blame on .
hey g.. if you’re too stupid to read.. i’ll read the article to you.

Calling me stupid.. prove it. Love to do an online, live video chat with you.. hell, we can advertise it here so all your friends can watch too.

You pick the topic.. c’mon.. why pass up a chance to prove it ? .. email is open

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You’ve been injured in a automobile accident. Your child in the backseat has also suffered an injury. Neither of these injuries would be considered life threatening or permanent. The other driver ran a red light and admitted it was his fault, he just wasn’t paying attention.Under Pa auto insurance laws, you could now be entitled to a settlement for your injuries. A settlement for your pain and suffering which is over and above your medical bills and other out of pocket expenses. Will you receive a payment? When you purchased your auto insurance you chose a tort option. Depending on the type of purchase and the agent, you may or may not remember having the option explained in detail. This option will be the deciding factor in whether or not you are offered a settlement or you have to pursue legal action and fight for a settlement. Understanding the tort choices may help you avoid the frustration of finding out you signed away your rights and the rights of your children after its too late.Full TortFull tort is the most expensive option. This is the option your counsel will be hoping you chose. Under this option, your pa auto insurance policy will provide you with the option to recover a settlement for any injury no matter how minor. Pa state law says that the insurer for the “at fault” party in the accident must offer you a settlement for your pain and suffering. No lawyers, no hassle, they are required to evaluate the medical costs and make an offer. Of course you are not obligated to accept their offer and may choose to fight for a higher settlement. This tort option applies to your entire family or what is referred to as the “first party” in your pa auto insurance policy.Limited Tort Limited tort is the alternative option. By far the most popular option in the state. This option is normally 10-15% cheaper than the full tort option. Whether its the cost savings or the personal choice of the client this option needs to be fully understood. Using the same accident scenario as above. If it is determined that your injuries are not “serious and permanent” you will not be offered any payment for “pain and suffering”.Under the Pa auto insurance law there are only two sets of circumstances that will allow you to collect payment. First would be if the other driver was from out of state. Since Pa insurance law gives visiting out of state drivers full tort, then you are granted the same priviledge. The other case would be if the other driver was determined to be operating his/her vehilce while under the influence of drugs or alcohol. These two exceptions are the only stipulations that will restore your right to recover. Of course you always have the option to hire a lawyer and try to prove your case in court at your expense.I’ve found as many clients who didn’t understand this option as I’ve found who didn’t realize they had the option. Be very careful when making this important decision on your pa auto insurance, it will travel with you wherever you go. Using a trusted agent who can explain your choices in language you understand.


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Can a lawyer put in an amount to an insurance adjustor to try and make a settlement for a personal injury case without first discussing it with the client?
He never even told us the amount, he just put in the offer. We were expecting it to be much higher but it is a very unique case hopefully he knows best. I thought before he put in the amount he should of at least contacted me and let me know what was going on which he never did.

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Those paying monthly insurance premiums should not be affected by an increase in claims revealed an industry expert.

Colin Ettinger, president of the Association of Personal Injury Lawyers, said: “Whenever there has been an investigation into whether or not increases in insurance premiums have been down to rises in the number of claims the answer has always been no.”

He added that an investigation by the Department for Work and Pensions and the Office of Fair Trading came to the conclusion that hardening of the stock market has forced insurance companies to increase their premiums.

The Association of British Insurers (ABI) claim that the rise in premiums does not necessarily equal a rise in profits.

Jane Milne, of the ABI, said: “Certainly premiums have risen over the last few years but even in 2003 insurers paid out £1.10 for every pound they collected and we are still seeing claims costs rise between 12% and 15% a year.

“Forty pence of every pound that insurers payout goes to either legal or medical advisers.”

Small business are thought to be one group to feel the squeeze from growing numbers of claims.

Stephen Alambritis, of the Federation of Small Businesses, said: “There are a lot of cases of small businesses who are not taking risks, in terms of acting entrepreneurially, and employing people that they would normally take because of this problem.

“They are worried about these personal injury lawyers who incite people to take companies to court as they are often seen as a soft target.”

The ex- Lord Chancellor, Lord Falconer, also asked claims firms to refrain from encouraging the population from taking legal action for “frivolous claims”.

Mr Ettinger said: “Government information has shown that the levels of claims that have been brought forward in the last 12 months have actually dropped. That includes public liability as well as accidents at work and road traffic cases.”

He added: “I would like to say why don’t these companies make their workplaces safer so a lot of these claims don’t happen?”

A personal injury claim can made for a variety of reasons. These can include tripping over, car accidents, whiplash and work-related stress. In order to pursue a claim it has to be shown that whoever is being sued has acted negligently and the an injury resulted because of this carelessness.

There are two types of damages that can be claimed for: Special Damages and General Damages. Physical and mental injury come under the general damages category and they have to be proved by a medical examination.

Financial costs are included in special damages and include loss of earnings and expenses.

Following a medical examination and input from experts the opponents solicitors are contacted to see if they accept liability for the injury. A settlement is reached if they do and damages are paid.

The help of a solicitor is normally needed to guide the claimant through this procedure. When taking action for personal injury legal aid is not normally an option although many firms offer a ‘no win no fee’ kind of contract.

Claims rarely reach court and have to be started within three years of the injury occurring.


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Automobile insurance laws in Florida require the owner of a vehicle to have a certain amount of personal injury protection. Fla. Stat. § 627.736. Personal injury protection provides compensation to you in the event you are in an accident. The minimum amount of personal injury coverage required by law is $10,000.00 Fla. Stat. § 627.736, but you can purchase higher amounts of insurance that covers medical, surgical, funeral, and disability benefits regardless of fault. This is known as no-fault insurance. Fla. Stat. § 627.731.

Throughout most of the United States, auto insurance functions under a traditional fault-based system. Insurance companies make payments based on each person’s degree of fault in a particular motor vehicle accident. However, long, drawn out court battles are often required to determine who is at fault in many cases. In an attempt to cut down on this problem, thirteen states (Florida, Hawaii, Kansas, Kentucky, Massachusetts, Michigan, Minnesota, New Jersey, New York, North Dakota, Pennsylvania, Utah, and Colorado) have adopted no-fault insurance laws- also called personal injury protection or PIP.

Under Florida’s no-fault insurance statute, if you are hurt in an accident, your insurance automatically will pay 80% of your reasonable medical expenses related to injuries sustained in the accident and 60% of your lost earnings subject to the limits of the no-fault coverage and any applicable deductible (or up to the specified policy limit) regardless of who caused the accident.

If you are a family member, no-fault insurance also covers relatives in your household who do not have their own no-fault policy. Personal Injury Protection benefits can be paid by your policy even if family members are passengers in another person’s car or pedestrians when they are hurt. In the event that you cause damage to someone else’s property, no-fault insurance will pay up to a predetermined limit for damages your vehicle does to other people’s tangible property such as buildings, trees, road signs, etc, and will pay to repair or replace other vehicles, but only if the vehicles were properly parked.

In the instance you are killed in a car accident, no-fault pays survivor’s benefits, which is income which you would have provided to your family. These benefits are usually limited to a maximum amount per month for a set amount of time. Your policy will not pay benefits if you are the owner or registrant of an uninsured motor vehicle that was involved in an accident. Therefore, it is important that you have insurance coverage on all vehicles that you own.

Many people commonly believe that if they meet the requirements under Florida law then they have full coverage. As the descriptions of the different categories of automobile insurance below indicate, the Florida requirements constitute a very bare minimum and rarely do they adequately protect persons involved in automobile accidents. The statutory minimum alone does not constitute full coverage. Uninsured motorist coverage, essential coverage, including bodily injury coverage, and collision are not required by Florida law.

Limits to No-Fault Insurance

Drivers should be aware that no-fault insurance has several limitations. These are a few things which no-fault insurance generally does not pay for: repairs to your vehicle after an accident no matter whose fault it was; repairs to another person’s vehicle after an accident, no matter whose fault it was, unless the vehicle was properly parked; and costs for replacement of your vehicle if it was stolen.

In order to receive a guaranteed payment, you must give up some of your rights to sue the other driver involved in the accident. You may be allowed to sue for non-economic damages if the amount of these damages exceeds a specified tort threshold. Florida, Michigan, New Jersey, New York and Pennsylvania have verbal thresholds. The other eight states use a monetary threshold: Colorado, Hawaii, Kansas, Kentucky, Massachusetts, Minnesota, North Dakota and Utah. New Jersey, Pennsylvania and Kentucky have a “choice” no-fault law. In these three states, motorists may reject the lawsuit threshold and retain the right to sue for any auto-related injury.

If you wish to file a lawsuit against the at fault driver, Florida’s no-fault insurance law requires that you must show that you sustained a “serious” injury. Fla. Stat. § 627.737. Pain and suffering damages are generally only recoverable for serious injuries that involve sustained permanent injury, significant scarring or disfigurement, or death.

There are two categories of auto insurance – first-party coverage and third-party coverage. First-party coverage covers you and your property (such as medical expenses, damage to your vehicle and the insurance company’s duty to defend you in the event that you are sued as the result of your operation of a vehicle, etc.). Third-party coverage is for your responsibility to pay for injury caused to other people (and vice versa), whether in your vehicle, or another vehicle involved in the accident.

The coverage (and its exclusions) is explained in your insurance policy. In exchange for the payment of a premium, the insurance company promises to provide compensation in the event of certain occurrences. While adequately explaining all aspects of insurance coverage and laws would be far too time consuming, the following is a brief synopsis of the most typical coverage and issues.

Personal Injury Protection

In addition to liability insurance, Florida requires all drivers to have Personal Injury Protection (PIP) coverage. Fla. Stat. § 627.736. Personal injury coverage is not health insurance, and it is not designed to pay for your medical bills. What it is designed to do is offer a onetime settlement or payment for all of your damages. In Florida, your policy must cover eighty percent of all reasonable expenses for medically necessary medical, surgical, X-ray, dental, and rehabilitative services, including prosthetic devices, and medically necessary ambulance, hospital, and nursing services. Fla. Stat. § 627.736. The personal injury insurance minimum required by law in Florida is ten thousand dollars for bodily injury or death of one person in any one accident. Fla. Stat. § 627.736. Lawsuits in Florida must be filed against the negligent driver and may not also name the insurance carrier as a defendant. In fact, the jury is not allowed to know that there is insurance coverage available on the defendant. If the jury renders a verdict in excess of the defendant’s liability policy limit, the defendant is then personally liable out of his or her own assets for the additional amount.

Bodily Injury Coverage

If your injury is caused by the negligence of a defendant, your attorney can file a claim under the bodily injury liability coverage of the negligent defendant’s insurance policy. Bodily injury liability coverage covers a driver’s legal liability for the injury or death that they, or any permitted user, may cause with their vehicle. When you are injured in a car accident and the person at fault is either the driver of the other vehicle or, if you are a passenger, the driver of the car in which you are riding, you may file a bodily injury claim with that driver’s insurance company. In most bodily injury liability policies, bodily injury includes sickness, disease, injury, or death arising from sickness, disease, or injury.

Medical Payments (Med-Pay) Coverage

When purchasing automobile insurance, you may elect to receive an optional type of coverage called medical payments (med-pay) coverage. Fla. Stat. § 627.736. Med-pay coverage pays accident-related medical expenses not covered by Personal Injury Protection. This coverage is available to the insured driver (the individual who holds the policy which includes med-pay coverage) and any passengers in the insured’s vehicle for injuries sustained, regardless of the fault of the driver. It is important to note that the insurance policy of the negligent party does not pay med-pay or PIP benefits to an injured plaintiff. These benefits are limited to the driver or passengers in the insured vehicle, regardless of fault. The plaintiff looks to his own insurance policy or the policy on the vehicle in which he was a passenger for med-pay or PIP benefits.

Collision Coverage

Collision coverage is a type of voluntary coverage you can purchase, which will cover the repair or replacement of your own vehicle after an accident, regardless of who is at fault. An innocent victim of an accident may present a claim for the property damage under his or her own collision coverage or under the negligent defendant’s property damage liability insurance coverage. Your own collision coverage normally includes a deductible, while property damage liability insurance coverage does not. In an automobile accident case, after a claim has been paid under collision coverage, the insurance carrier who paid the claim may proceed against the property damage liability insurance carrier for the negligent defendant to recover the amount paid out. This process is called subrogation, and does not affect your recovery.

Uninsured and Underinsured Motorist Benefits

Uninsured/underinsured motorist benefits are another type of voluntary coverage you can purchase, and it is recommended that you add this type of coverage to your policy. This coverage protects you against a negligent defendant who either does not have liability insurance coverage or only has minimum coverage that is inadequate to fully compensate you for your injuries. If you are involved in an accident with an uninsured but negligent individual, your attorney would make a claim for you under your own uninsured motorist coverage. Your own insurance carrier would then have to pay any judgment which may be rendered, up to the limits of the policy which you purchased.

If the person who caused the accident has liability insurance, but the policy limit of his or her liability insurance is less than the uninsured motorist coverage of your policy, your attorney can make an additional claim under your own policy for what is called underinsured motorist benefits, in the event that your damages exceed the limits of the other party’s liability coverage. Uninsured/underinsured motorist claims can be a problematic area of law to practice, and the experience of an attorney familiar with these issues is important in order to obtain the maximum amount of recovery for you.


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When we mention crime, even white-collar crime, insurance fraud is not what immediately comes to mind. Yet, insurance fraud has lately become one of the front-runners among the most often prosecuted white-collar crimes in New Jersey.

In fact, New Jersey has the toughest criminal insurance fraud statutes in the country. The Health Care Claims Fraud statute, N.J.S.A. 21-4.3 and the Insurance Fraud statute, N.J.S.A. 2C:21-4.6, make many acts of insurance fraud second-degree crimes. For starters, a second-degree crime in New Jersey carries with it a prison term of up to ten years and fines of up to $150,000.

The vast majority of insurance fraud cases in New Jersey are investigated and prosecuted by the Office of Insurance Fraud Prosecutor (OIFP) and these cases involve all thinkable areas of insurance fraud, including health, life, disability, auto, homeowners’ or commercial insurance coverages.

According the 2007 OIFP report, there was “a 10% increase in criminal sentences over last year’s figure and sent defendants to prison for a combined total of 147 years”. The report exemplifies the wide array of individuals who found themselves in trouble for insurance fraud: ” In 2007, OIFP recorded OIFP won convictions of four former police officers, two of whom will serve a total of 12 years in State prison. Four licensed health care providers received State prison sentences totaling 12 years. A licensed insurance agent was sentenced to a five-year State prison term. An auto body shop owner and his accomplice were sent to State prison for a total of nine years. The sentences imposed on several members of vehicle theft rings totaled 77 years in State prison, over $1.8 million in restitution, and $9,500 in civil insurance fraud fines”. The list goes on.

So, what is “insurance fraud” made of? One large area of Insurance fraud in New Jersey is Automobile Insurance Fraud. The most popular crime here is auto theft and “give up schemes”, where the owner or lessee of a car abandons the car or gives it up to a someone who agrees to dispose of the car. Next come staged accidents and fraudulent Personal Injury Protection Claims and criminal use of “runners”. These types of cases normally involve organized rings of “runners”, medical providers, and lawyers. Vehicle Insurance policies in New Jersey provide medical benefits for persons injured in car accidents as part of Personal Injury Protection (PIP) coverage. PIP insurance typically covers diagnostic testing and treatment for persons injured in automobile accidents. In many cases, uninjured passengers involved in accidents are contacted by “runners” who convince them to file claims for “soft tissue” injuries, such as “whiplash”. Such injuries are not easily verifiable by x-rays and MRI. In the end, “runners” receive their illegal commissions, medical and chiropractic mills provide unnecessary medical services, including fake diagnostic and treatment, for which they bill, and lawyers file unwarranted lawsuits.

Other case involving New Jersey Automobile Insurance Fraud are selling and buying fake insurance ID cards and insurance agent fraud where licensed agents steal insurance premiums or are engaged in fraudulent premium financing schemes.

Another large area that pays bills for New Jersey insurance fraud criminal defense attorneys is Health Care insurance fraud. Most such cases involve submitting fraudulent claims for payment for health care services that were never provided and received. The most often targeted individuals here are New Jersey doctors, dentists, chiropractors, nurses, physical therapists, pharmacists, and social workers.

The most widely used tool in New Jersey heal care insurance fraud prosecutions is the Health Care Claims Fraud status, N.J.S.A. 2C:21-4.3 that makes it a crime for any health care provider just to submit a false claim to insurance companies, no matter what the amount is. A non-provider only needs to submit a false claim for $1,000 to have committed a second-degree crime. Other criminal charges used in prosecutions of New Jersey health care insurance fraud cases are usually charges of theft, conspiracy, and falsifying records.

Another area of New Jersey insurance fraud is life and disability insurance fraud, both governed by the Insurance Fraud Statute, N.J.S.A. 2C:21-4.6. Life insurance fraud offense is submitting a claim that falsely represents death of a claimant or otherwise misrepresenting important facts concerning the claim. Disability fraud involves faking a non-existing condition in order to receive benefits or knowingly failing to disclose new income.

Probably the largest single area of New Jersey Insurance Fraud is Medicaid fraud, which is investigated and prosecuted by the OIFP’s Medicaid Fraud Section. New Jersey Medicaid Fraud can be committed by any health care provider that participates in the Medicaid program. New Jersey physicians, dentists, clinics, chiropractors, pharmacists, laboratories, nursing homes, etc. are routinely prosecuted for New Jersey Medicaid fraud.

The basic New Jersey Medicaid fraud crime involves billing the Medicaid program for services that were never provided or might not be provided by the billing provider, or when the amount billed exceeds the costs of services performed (over billing). Other Medicaid fraud charges in New Jersey may be associated with charges of patient abuse and criminal neglect.

Another related New Jersey Medicaid fraud area is Medicaid prescription and drug diversion fraud. This involves pharmacies billing Medicaid for drugs that were not actually dispensed. Doctors, who sometimes form “partnerships” with pharmacies to engage in this fraud, are understandably find themselves in deep trouble as well.

Home health care fraud is the last largely prosecuted New Jersey Medicaid fraud crime. Medicaid pays for personal care provided for eligible beneficiaries by certified home care assistants, aides, and nurses, all of whom must be certified and licensed by the State to participate in the program. Criminal activities in this are involve billing for services that were not provided, employing non-certified providers, and lying in the certification process.

New Jersey insurance fraud is a wide area and persons facing any of the insurance fraud charges should seek legal counsel as soon as they discover that they are under investigation. A consultation with a competent New Jersey fraud defense attorney is absolutely indispensable.


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