What is involved in insurance fraud?

Insurance fraud involves the act of deliberately deceiving an insurance company to gain something of value that one is not entitled to, such as an unfair or unlawful payment of benefits. This can take many forms, including submitting false claims or inflating the amount of a legitimate claim, with the intention of misleading the insurer for personal gain.

In this context, the essence of insurance fraud lies in the intentional nature of the deception. It’s not simply about making a mistake or failing to disclose certain information. For example, accidental misrepresentation of information does not involve fraud as it lacks the element of intent. Providing accurate claims information, on the other hand, is the opposite of fraud since it reflects honesty and transparency in dealings with an insurance provider. Failing to disclose pre-existing conditions might reflect an omission but does not necessarily indicate a deliberate attempt to deceive unless it is done willfully with the intent to manipulate the outcome of a claim.

Thus, the focus on deliberate deception in order to secure an advantage in insurance settlements embodies the definition and context of insurance fraud most accurately.