Intentionally Presenting a False Claim is a Crime

Insurance Fraud Exists at the Time the False Claim is Made Not Payment of the False Claim

Barry Zalma

Oct 03, 2024

Transcript

FACTUAL BACKGROUND

On November 11, 2018, the Defendant purchased a 2006 black Hummer. The Defendant owned several other vehicles and did not have room to park the vehicle at his house. As such, he arranged to park the Hummer at the home of his employee, Heath Metcalf.

Less than one month later, on the morning of December 7, 2018, the Defendant asked Mr. Metcalf to pick him up in the Hummer and take him to a lunch meeting in West Knoxville. After Mr. Metcalf drove him to the restaurant, the Defendant instructed Mr. Metcalf to park the Hummer at a nearby apartment complex where one of the Defendant’s friends lived. He informed Mr. Metcalf that his Lincoln Aviator was parked across the street from the apartments and instructed Mr. Metcalf to drive the Lincoln home after parking the Hummer.

Defendant later that day called the Knoxville Police Department (KPD) to report that his Hummer had been stolen.

The Defendant reported the theft to his insurer, GEICO. The insurance agent gave the Defendant a “vehicle theft questionnaire,” and the Defendant returned this form twelve days later on December 19. On the questionnaire, the Defendant represented that he purchased the Hummer for $8,500, though he later testified at trial that the actual purchase price was $4,500.

The Hummer was recovered on December 12 about three miles from the restaurant. During GEICO’s claim investigation it examined the vehicle and found no indication of forced entry or that the vehicle had been started in any manner other than by a key.

A Knox County grand jury charged the Defendant with presenting a false or fraudulent insurance claim and the charge was tried to a jury. At the conclusion of the trial, the jury convicted the Defendant of presenting a false or fraudulent insurance claim. The trial court sentenced the Defendant to serve sentence of four years for each of the convictions in the Tennessee Department of Correction.

FALSE OR FRAUDULENT INSURANCE CLAIM

The proof showed that the Defendant falsely reported to his insurance company that his car had been stolen and that he did so to obtain payment.

Presentation of a “Claim”

A defendant may present a “claim” even if he or she fails to comply with the terms of the insurance contract for presenting formal claims, such as by filing a proof of loss. In addition, while at GEICO on December 7, the Defendant showed the vehicle’s key to the agent in response to a request by the insurance company.

The Falsity of the Claim

The appellate court concluded that a rational juror could have found that the Defendant presented an insurance claim on December 7, 2018, related to the theft of his vehicle. In addition, the insurance company understood that the Defendant’s claim was related to the theft of his vehicle. Moreover, a rational juror could have concluded that this theft claim was false because the Defendant’s vehicle had not been stolen.

Value of the Claim

The insurance fraud statute does not criminalize one’s “obtaining” payment as a result of a false claim. Instead, the law punishes one’s intentional presenting of a claim for payment. The statute’s clear and unambiguous intent is to criminalize a person’s intentional efforts to obtain monies under an insurance contract through the presentation of false or fraudulent information to the insurer. The statute does not require a defendant to “obtain” money before criminal liability may attach.

This direct and circumstantial evidence fairly and legitimately tends to connect the Defendant with the commission of the crime.

In summary, the court of criminal appeals held that the evidence was legally sufficient to sustain the Defendant’s conviction for presenting a false or fraudulent insurance claim. Affirmed the judgment of the trial court in all other respects.

ZALMA OPINION

The facts presented at the trial established with the testimony of his employee, and his own testimony, a clear attempt to make a false and fraudulent claim to the insurer, GEICO, by signing a theft form which, in my experience, is usually a sworn document that is a proof of claim, that he knew was false and fraudulent since he admitted at trial the purchase price and value of the vehicle. Making the claim was sufficient to establish the crime even if the insurer failed to pay him.