Types of fraud cases

Insurance fraud can range from a single false claim to large, organized schemes. Under California law, fraud occurs when someone knowingly does any of the following with the intent to unlawfully obtain insurance benefits or reduce premium costs:

• Makes a false or misleading statement
• Conceals material information (information that would matter to the insurer)
• Engages in a deceptive act

Most common types of fraud cases include:

Falsifying claims

• Submitting a claim for damage or loss that never occurred, or exaggerating the extent of an actual loss.
• Example: Claiming that stolen items included jewelry or electronics that never existed.

Staged accidents

• Intentionally causing or fabricating an accident to collect insurance benefits.
• Example: “Swoop and squat” auto fraud schemes where fraudsters deliberately cause a rear-end collision to file injury claims.

Inflated repair bills

• Service providers (such as auto body shops or contractors) inflating the cost of repairs, charging for unnecessary work, or billing for work never performed.

Faked injuries or illnesses

• Claimants fabricating medical conditions, exaggerating injuries, or extending disability claims longer than necessary.
• Example: A person claiming permanent disability while secretly working another job.

Misrepresenting facts on applications

• Providing false information when applying for coverage, such as concealing medical history, misrepresenting vehicle usage, or underreporting payroll for workers’ compensation.
• Example: An applicant for life insurance failing to disclose a chronic illness.