Insurance Fraud in New Jersey

N.J.S.A. 2C:21-4.6 · Fraud & White Collar Offenses

What the law says

A person commits insurance fraud by knowingly making or causing a false, fictitious, fraudulent, or misleading statement of material fact, or omitting or causing the omission of a material fact, in a document connected with specified insurance or premium finance matters. A person may also commit insurance fraud by knowingly making a specified false statement about the person’s residence or where a vehicle is principally garaged to obtain motor vehicle insurance in another state.

This is an indictable crime. It's prosecuted in the Superior Court, Criminal Part, in the county where it allegedly happened, usually after grand jury review. First-time defendants may be eligible for Pretrial Intervention (PTI).

What the State must prove

To convict, the prosecutor must prove each element beyond a reasonable doubt. Under N.J.S.A. 2C:21-4.6, that means:

• The person knowingly makes or causes to be made a false, fictitious, fraudulent, or misleading statement of material fact, or omits or causes a material fact to be omitted.
• The statement or omission is in a record, bill, claim, or other document, in writing, electronically, orally, or in any other form.
• The person attempts to submit, submits, causes to be submitted, or attempts to cause the document to be submitted in connection with a claim for payment, reimbursement, or other benefit under an insurance policy or from an insurance company or the Unsatisfied Claim and Judgment Fund Law; an application to obtain or renew an insurance policy; a payment made or to be made under an insurance policy or premium finance transaction; or a document used in an insurance or premium finance transaction.
• For subsection b., the person operates on this State’s public highways a motor vehicle insured under a policy issued under another state’s laws, maintains a principal residence in this State or has the vehicle principally garaged in this State, and knowingly makes a written, electronic, or oral statement to an insurance company or producer licensed in the other state that results in obtaining a motor vehicle insurance policy there.
• For subsection b., the statement represents that the person to be insured maintains a principal residence in the other state or has the vehicle principally garaged in the other state, when the person’s principal residence or the vehicle’s principal garaging is actually in this State.

How the charge is graded

• Insurance fraud constitutes a crime of the second degree if the person knowingly commits five or more acts of insurance fraud, including acts of health care claims fraud pursuant to section 2 of P.L.1997, c.353 (C.2C:21-4.2) and if the aggregate value of property, services or other benefit wrongfully obtained or sought to be obtained is at least $1,000.
• Otherwise, insurance fraud in violation of subsection a. of this section is a crime of the third degree and insurance fraud in violation of subsection b. of this section is a crime of the fourth degree.

General sentencing ranges

Unless a statute sets a different penalty, New Jersey's general sentencing laws (N.J.S.A. 2C:43-6, 2C:43-8, and 2C:43-3) set these maximums:

Other rules that can matter

• Subsection b. does not apply to a person who insures a vehicle in another state, as permitted by and in accordance with that state’s laws, based on a second residence or attendance at an educational institution in that state, if the person truthfully discloses to the insurance company or producer the state of the person’s principal residence and the state where the vehicle is principally garaged.
• Each act of insurance fraud constitutes an additional, separate and distinct offense, except that five or more separate acts may be aggregated for the purpose of establishing liability under subsection c. Multiple acts contained in a single record, bill, claim, application, payment, affidavit, certification, or other document each constitute an additional, separate and distinct offense.
• Proof that a person signed or initialed an application, bill, claim, affidavit, certification, record, or other document may give rise to an inference that the person read and reviewed it.
• The Attorney General shall develop insurance fraud prosecution guidelines and disseminate them to county prosecutors within 180 days of the effective date of the act.
• Nothing in the act precludes an indictment and conviction for any other offense defined by New Jersey law.
• An assignment judge may dismiss an insurance fraud prosecution if the judge determines, pursuant to N.J.S.2C:2-11, that the charged conduct is a de minimis infraction.

Common defense strategies

Every case turns on its facts, but defenses we often explore include:

• Lack of intent to defraud, as opposed to a business dispute or honest mistake
• Challenging loss calculations that drive the degree of the charge
• Document, bank-record, and electronic-evidence review with forensic accountants
• Early negotiation and restitution that can keep a case out of state prison

What to do right now

1. Don't discuss the facts with police, the alleged victim, or anyone on a jail phone or social media.
2. Write down everything you remember, including names, times, and locations.
3. Keep every document you received, such as the complaint, summons, and release conditions.
4. Follow all release and no-contact conditions exactly.
5. Call a New Jersey criminal defense lawyer before your first court date.

How we help

Edward G. Appel has defended New Jersey clients since 1988 in municipal and Superior Courts in all 21 counties. We review the discovery, look for weaknesses in the State's case, file motions where they're warranted, and push for dismissals, downgrades, or diversion before you face a trial. Call 856-856-2373 for a free, confidential consultation about your Insurance Fraud charge.

Related charges

• Theft by Deception →
• Theft by Extortion →
• Computer Criminal Activity →
• Forgery →
• Bad Checks →
• Credit Card Fraud →
• Identity Theft →
• Money Laundering →

Disclaimer: This page is general information about New Jersey law, not legal advice, and doesn't create an attorney-client relationship. Prior results don't guarantee a similar outcome.