Insurance-fraud cases often begin with a claim that looked suspicious to an adjuster before law enforcement ever became involved. Photographs, repair estimates, proof-of-loss forms, medical bills, recorded statements, policy documents, claim histories, and communications with an insurer may all become evidence. The criminal case can then turn on whether a statement was actually false, whether it was material to the claim, and whether the person acted intentionally.
Kevin Kennedy defends people accused of presenting false or fraudulent insurance claims in Nashville and throughout Middle Tennessee. These cases require a close reading of the claim itself. A disputed estimate, inaccurate recollection, incomplete form, or coverage disagreement is not automatically criminal insurance fraud.
Tennessee’s False or Fraudulent Insurance Claim Statute
Tenn. Code Ann. § 39-14-133 makes it an offense to intentionally present or cause to be presented a false or fraudulent insurance claim, or proof in support of such a claim, for payment of a loss or other insurance benefits.
The statute also covers preparing, making, or subscribing to a false or fraudulent account, certificate, affidavit, proof of loss, or other document with intent that it be used to support a claim. The offense is punished as theft, which means the grading of the charge depends on the amount associated with the fraudulent claim under Tennessee’s theft-value statute.
A Mistake on a Claim Is Not the Same as Intentional Fraud
The statute requires intentional conduct. Insurance paperwork can be complicated, and claimants may rely on contractors, medical providers, body shops, family members, or agents when providing information. An incorrect statement does not automatically prove a plan to defraud the carrier.
The defense should identify exactly which representation the State claims was false, who supplied it, when it was made, and what the accused actually knew at the time. The difference between a deliberate fabrication and an inaccurate estimate can be the difference between a criminal offense and an ordinary claim dispute.
The Claim Does Not Have to Be Paid
Tennessee’s statute is broad enough to reach intentionally false claims and documents presented in support of a claim. A prosecution does not necessarily depend on the insurance company actually paying the requested amount.
That makes the paperwork itself important. Draft documents, submitted forms, recorded statements, emails to an adjuster, estimates, photographs, and proof-of-loss materials may be used to show what was represented and when.
Property, Auto, Medical, and Other Insurance Claims
Insurance-fraud allegations can arise from many types of coverage. Property cases may involve fire, theft, storm, or vandalism claims. Automobile cases may involve collision damage, staged accidents, ownership, prior damage, or repair costs. Medical-related claims may involve treatment, billing, disability, or alleged injuries.
Each type of claim produces a different evidentiary record. A defense that makes sense in an auto-damage case may have little relevance to a fire-loss or medical-benefits case.
How the Amount Affects the Charge
Because § 39-14-133 is punished as theft, Tennessee’s value thresholds determine the offense grade. A claim valued at $1,000 or less generally falls within Class A misdemeanor treatment. More than $1,000 but less than $2,500 is generally a Class E felony; $2,500 to less than $10,000 is a Class D felony; $10,000 to less than $60,000 is a Class C felony; $60,000 to less than $250,000 is a Class B felony; and $250,000 or more is a Class A felony.
The defense should examine what amount the State is using. A demand in a claim form, an insurer’s reserve, the amount actually paid, and the amount allegedly attributable to a false representation may not always be the same.
Arson and Insurance Fraud Can Be Charged Together
Some of the most serious insurance-fraud prosecutions arise after a fire. Investigators may allege that a person intentionally caused a loss and then sought insurance benefits. Tennessee appellate courts have addressed prosecutions in which arson and false insurance claims were charged together.
Those cases involve two separate questions: what caused the fire, and whether the insurance claim or supporting proof was intentionally false. The State should be required to prove each offense rather than allowing suspicion about one to substitute for evidence of the other.
Recorded Statements and Examinations Under Oath
Insurance carriers often obtain recorded statements, sworn proof-of-loss forms, or examinations under oath before a criminal investigation becomes obvious. Those statements may later be compared line by line with police interviews, documents, surveillance, or witness accounts.
Inconsistency is not always fraud. Memory can change, estimates can be revised, and people may misunderstand technical questions about ownership, value, or prior damage. The defense should place statements in context and determine whether any difference was actually intentional and significant.
Experts and Valuation Evidence
Claims often depend on experts or specialists. Fire investigators, engineers, appraisers, adjusters, mechanics, medical providers, and accountants may all offer opinions that affect whether a claim appears legitimate.
Those opinions should be tested for methodology, assumptions, and incomplete information. A disagreement over value or cause can exist without criminal fraud.
How an Insurance Fraud Case Can Be Defended
Possible defenses include lack of intentional falsity, reasonable reliance on another professional, mistake, immaterial discrepancies, inaccurate valuation, lack of authorship or responsibility for a document, weak proof connecting the accused to the claim, unlawful searches, and unreliable expert conclusions.
Kevin focuses on reconstructing the claim from its first report through the criminal investigation. By comparing policy language, claim forms, adjuster communications, photographs, invoices, estimates, and recorded statements, the defense can identify whether the State is proving intentional fraud or merely pointing to inconsistencies. If you are accused of insurance fraud in Nashville or Middle Tennessee, contact Kevin Kennedy Law Firm for a free, confidential consultation.
Legal references: Tenn. Code Ann. §§ 39-14-105, 39-14-133, and 40-35-111. This page is general information, not legal advice.