Insurance Fraud Lawyer in St. Louis

Insurance Fraud Lawyer in St. Louis, MO

Facing insurance fraud allegations can be daunting. The insurance industry is one of the most heavily regulated industries, both locally and nationally. Whether you're accused of staging an accident, falsifying claims, or exaggerating losses, a conviction could mean prison time, steep fines, and lasting damage to your reputation.

At Combs Waterkotte, our criminal defense lawyers in St. Louis have successfully handled numerous white-collar cases, including high-stakes insurance fraud at both the state and federal level. We don’t just defend—we fight back hard to protect your freedom and your future.

Types of Insurance Fraud Charges We Handle in St. Louis, MO

Missouri law covers a wide range of activities that can be prosecuted as insurance fraud. These include:

• Auto insurance fraud: Staging or exaggerating accidents, falsifying injury claims, or providing false repair estimates.
• Health insurance fraud: Submitting false medical bills, billing for services not rendered, or using another person’s insurance information.
• Life insurance fraud: Faking a death, forging documentation, or misrepresenting health history on a policy application.
• Property insurance fraud: Arson for profit, inflated loss claims, or misreporting valuables in homeowners' policies.
• Workers' compensation fraud: Faking or exaggerating work-related injuries or continuing to work while receiving benefits.
• Insurance agent fraud: Misappropriation of client funds, ghost policies, or unauthorized policy modifications.

What Happens When You’re Accused of Insurance Fraud in St. Louis, MO?

When you're accused of insurance fraud in St. Louis, the consequences can be swift, serious, and long-lasting. Here’s what typically happens, and why immediate action is crucial:

You May Be Investigated Before You’re Charged

Insurance companies often initiate internal investigations if they suspect fraud. They may then pass information to the Missouri Department of Insurance, the Missouri Attorney General’s Office, or federal agencies such as the FBI, HHS-OIG, or DOJ, depending on the nature of the claim (e.g., health, life, property). You might not even know you're being investigated until agents contact you or you receive a subpoena.

Formal Charges Could Be Filed

If prosecutors believe they have enough evidence, you could be formally charged with insurance fraud, typically under:

• Missouri Revised Statutes § 375.991 for state-level insurance fraud
• Federal statutes such as 18 U.S.C. § 1347 (healthcare fraud) or 18 U.S.C. § 1033/1035 (fraud by insurance providers).

The charges could be misdemeanors or felonies depending on the value of the alleged fraud, the type of insurance involved, and whether the claim was paid.

You Could Be Arrested or Receive a Court Summons

Depending on the severity of the alleged fraud, you may be arrested or ordered to appear in St. Louis City or County Circuit Court or the U.S. District Court in the Eastern District of Missouri. You may be fingerprinted, photographed, and formally arraigned.

Your Finances and Any Professional Licenses May Be Frozen or Suspended

In some cases, a court may issue a restraining order on assets, freeze bank accounts, or suspend any relevant insurance, medical, or business licenses pending the outcome of the case.

A Strong Insurance Fraud Defense in St. Louis, MO Can Make a Huge Difference

Because many fraud cases hinge on intent, an experienced Combs Waterkotte insurance fraud defense attorney, depending on the specifics of your case, may be able to:

• Argue lack of intent or honest mistake
• Challenge weak, unlawfully obtained, or circumstantial evidence
• Investigate overzealous agents or officers
• Show your actions were authorized
• Negotiate for reduced charges, diversion, or dismissal

Possible Penalties for Insurance Fraud in Missouri

Under RSMo § 375.991, insurance fraud can be charged as a felony or misdemeanor depending on the value of the fraud and whether you have prior offenses. Penalties can include:

• Class D Felony: Up to 7 years in prison and fines up to $10,000 for fraudulent claims exceeding $750.
• Class E Felony: Up to 4 years in prison and fines for lesser fraud amounts.
• Restitution: Courts may order full repayment of fraudulent gains to victims or insurers.
• Loss of Professional License: Especially for insurance professionals or healthcare providers involved in fraud.

What Evidence is Needed to Prove Insurance Fraud in St. Louis, MO?

To prove insurance fraud in St. Louis, prosecutors must present clear, admissible evidence that shows not just that a false claim was made, but that it was done knowingly and with intent to deceive. Whether you’re charged at the state or federal level, the government bears the burden of proving each element beyond a reasonable doubt.

Here’s a breakdown of the types of evidence commonly used to prove insurance fraud in St. Louis:

1. False or Misleading Documentation

This is often the core evidence in insurance fraud cases in St. Louis. Examples include:

• Inflated or fabricated invoices or repair estimates
• Falsified medical records or prescriptions
• Staged accident reports
• Forged receipts or documentation for stolen property
• Fake employment or wage loss statements

2. Statements & Interviews

Prosecutors may rely on:

• Recorded statements made to insurers or investigators
• Inconsistencies in written or verbal claims
• Statements made during interviews or depositions
• Testimony from claims adjusters, doctors, or police officers involved

Note: Anything you say, even casually, can and will be used as evidence. That’s why it’s critical to speak with a lawyer before answering any questions from insurers or investigators.

3. Surveillance Footage or Photographs

Insurance companies often use private investigators to capture:

• Video of an individual performing activities inconsistent with their injury claim
• Photos of vehicles, homes, or properties alleged to be damaged
• Evidence that property claimed as stolen is still in your possession

4. Digital & Electronic Records

Increasingly, investigators rely on electronic records to show intent or misrepresentation:

• Cellphone data showing your location
• Text or email messages related to the claim
• Social media posts contradicting the alleged injury or loss
• Access logs, digital signatures, or app usage

5. Expert Witness Testimony

Specialists may testify about:

• The improbability of the damage or injury as described
• Medical inconsistencies or billing anomalies
• Technical proof of claim fabrication (e.g., staged auto collisions)
• Standard industry procedures that were ignored or violated

6. Witness Statements

Witnesses, such as neighbors, coworkers, or family members, may be called to contradict:

• Your version of events
• Your reported injuries or losses
• Whether the alleged property damage, theft, or injuries actually occurred

7. Insurance Policy Language

The insurer may also present policy documents to show:

• What was actually covered or excluded
• How the claim violated policy terms
• Whether the claim was submitted in bad faith

8. Evidence of Prior Fraudulent Activity

Though not always admissible, prosecutors may try to introduce:

• Evidence of prior fraudulent claims
• Suspicious past payouts
• A pattern of similar behavior, especially in federal cases

Our Client-Centered Approach to Insurance Fraud Defense in St. Louis, MO

At Combs Waterkotte, we don’t treat our clients like case numbers—we treat them like people. We understand that being accused of insurance fraud in St. Louis is more than just a legal crisis—it’s a threat to your freedom, finances, career, and reputation. That’s why we prioritize open, honest, and ongoing communication every step of the way.

From your very first consultation, we take the time to listen. We want to understand your goals, your side of the story, and what’s at stake for you and your family. Then we tailor our defense strategy accordingly, because no two clients, and no two cases, are exactly alike.

• Direct access to your attorney: You won’t get passed off to a case manager or left wondering about your case status. We’re here when you need us.
• Regular updates: We keep you informed at every phase of your defense, with clear explanations and proactive case planning.
• Respect and dignity: We know this is a difficult time. Our job is to guide you through it with professionalism, empathy, and fierce advocacy.

When you hire Combs Waterkotte, you don’t just get legal defense—you get a legal partner who’s fully invested in protecting your future.