• FreeAdvice has a new Terms of Service and Privacy Policy, effective May 25, 2018.
    By continuing to use this site, you are consenting to our Terms of Service and use of cookies.

Is it fraud?

Accident - Bankruptcy - Criminal Law / DUI - Business - Consumer - Employment - Family - Immigration - Real Estate - Tax - Traffic - Wills   Please click a topic or scroll down for more.

unanswered

Junior Member
What is the name of your state? OHIO

If someone filled out an insurance application for a family member as an employee, knowing they are not. Would that person be held responsible? It was done over five years ago and the same person called the insurance company without giving a name and claimed the family member was never an employee. Now that family member owes five years of hospital and surgery bills, when he did not know he was signed up as an employee.

My question is if the insurance company finds out the person that filed the application did not tell the family member that they were set-up as an employee can something be done legaly?
 


Happy Trails

Senior Member
unanswered said:
What is the name of your state? OHIO

If someone filled out an insurance application for a family member as an employee, knowing they are not. Would that person be held responsible? It was done over five years ago and the same person called the insurance company without giving a name and claimed the family member was never an employee. Now that family member owes five years of hospital and surgery bills, when he did not know he was signed up as an employee.

My question is if the insurance company finds out the person that filed the application did not tell the family member that they were set-up as an employee can something be done legaly?

How did the person understand that they were eligble to receive the health insurance coverage?

The person that signed this person up committed fraud.
 

unanswered

Junior Member
This person is a father-in-law and he thought he was getting health insurance paid by his son. It was paid, but the person that signed him up knew he is disabled and still put him as an employee. His son also did not know he was signed up as an employee. I don't understand why wouldn't the insurance look into it? Wouldn't they question the person that filled the application out? Can the insurance still do something about it, it has been a little over two years?
 

Happy Trails

Senior Member
unanswered said:
This person is a father-in-law and he thought he was getting health insurance paid by his son. It was paid, but the person that signed him up knew he is disabled and still put him as an employee. His son also did not know he was signed up as an employee. I don't understand why wouldn't the insurance look into it? Wouldn't they question the person that filled the application out? Can the insurance still do something about it, it has been a little over two years?

Insurance company didn't look into it at the time because they thought he was an employee and the premiums were getting paid.

The insurance company may be doing an investigation. They all possibly could get into trouble depending on the outcome.

Insurance companies don't like to pay out claims and if they prove it was paid out fraudently; they will try to get it back.
 

unanswered

Junior Member
I would like to know who will get in trouble. The person that filled the form, the person that owns the company, or the person that was covered by the insurance? Or all of them? The only person that really knew about it is the person that filled out the application. The others just signed without reading.
 

Happy Trails

Senior Member
unanswered said:
I would like to know who will get in trouble. The person that filled the form, the person that owns the company, or the person that was covered by the insurance? Or all of them? The only person that really knew about it is the person that filled out the application. The others just signed without reading.

That would depend on what the investigation would uncover. Everybody should know what they are signing.

How did the son think the FIL was being covered through his employment. It's not like he was claiming him as a dependent.
 

unanswered

Junior Member
Son told his wife to get insurance for his parents. He did not mean as employee. Parents did not have insurance and the son wanted to help them out. He did not know his wife put them as employees. Now the FIL owes thousands of dollars because insurance received a call by someone telling them FIL was never an employee.
 

Happy Trails

Senior Member
unanswered said:
Son told his wife to get insurance for his parents. He did not mean as employee. Parents did not have insurance and the son wanted to help them out. He did not know his wife put them as employees. Now the FIL owes thousands of dollars because insurance received a call by someone telling them FIL was never an employee.

From Ohio Statutes:
§ 2913.47. Insurance fraud.
(A) As used in this section:
(1) "Data" has the same meaning as in section 2913.01 of the Revised Code and additionally includes any other representation of information, knowledge, facts, concepts, or instructions that are being or have been prepared in a formalized manner.

(2) "Deceptive" means that a statement, in whole or in part, would cause another to be deceived because it contains a misleading representation, withholds information, prevents the acquisition of information, or by any other conduct, act, or omission creates, confirms, or perpetuates a false impression, including, but not limited to, a false impression as to law, value, state of mind, or other objective or subjective fact.

(3) "Insurer" means any person that is authorized to engage in the business of insurance in this state under Title XXXIX [39] of the Revised Code, the Ohio fair plan underwriting association created under section 3929.43 of the Revised Code, any health insuring corporation, and any legal entity that is self-insured and provides benefits to its employees or members.

(4) "Policy" means a policy, certificate, contract, or plan that is issued by an insurer.

(5) "Statement" includes, but is not limited to, any notice, letter, or memorandum; proof of loss; bill of lading; receipt for payment; invoice, account, or other financial statement; estimate of property damage; bill for services; diagnosis or prognosis; prescription; hospital, medical, or dental chart or other record; x-ray, photograph, videotape, or movie film; test result; other evidence of loss, injury, or expense; computer-generated document; and data in any form.

(B) No person, with purpose to defraud or knowing that the person is facilitating a fraud, shall do either of the following:

(1) Present to, or cause to be presented to, an insurer any written or oral statement that is part of, or in support of, an application for insurance, a claim for payment pursuant to a policy, or a claim for any other benefit pursuant to a policy, knowing that the statement, or any part of the statement, is false or deceptive;

(2) Assist, aid, abet, solicit, procure, or conspire with another to prepare or make any written or oral statement that is intended to be presented to an insurer as part of, or in support of, an application for insurance, a claim for payment pursuant to a policy, or a claim for any other benefit pursuant to a policy, knowing that the statement, or any part of the statement, is false or deceptive.

(C) Whoever violates this section is guilty of insurance fraud. Except as otherwise provided in this division, insurance fraud is a misdemeanor of the first degree. If the amount of the claim that is false or deceptive is five hundred dollars or more and is less than five thousand dollars, insurance fraud is a felony of the fifth degree. If the amount of the claim that is false or deceptive is five thousand dollars or more and is less than one hundred thousand dollars, insurance fraud is a felony of the fourth degree. If the amount of the claim that is false or deceptive is one hundred thousand dollars or more, insurance fraud is a felony of the third degree.

(D) This section shall not be construed to abrogate, waive, or modify division (A) of section 2317.02 of the Revised Code.

HISTORY: 143 v H 347 (Eff 7-18-90); 146 v S 2 (Eff 7-1-96); 146 v S 269 (Eff 7-1-96); 147 v S 67. Eff 6-4-97.

Wife, son and FIL should consult with an attorney.
 

cbg

I'm a Northern Girl
The wife who fraudulently listed her parents on the policy should prepare to be fired. No, she will not be eligible for unemployment. She will be lucky if she stays out of jail.
 

ablessin

Member
The wife is in HOT water here, as is probably the parents, for accepting the insurance, - - ignorance is NOT bliss - they didn't read what they were signing and illegally used insurance benefits they had NO right to be getting.

They most likely will have to pay the insurance back ALL of the monies paid out, since the relationship to the employee was falsly represented.

I don't know why people even bother to do this crap - everyone thinks they'll never get caught....... insurance carriers are always doing audits, etc.

I am surprised the employer put the application through - they have also been paying medical benefits for employees that are not employees!! Geez - -
yeah, I agree - wife should be prepared to be fired - what a mess.

And people wonder why health care premiums are so freaking high!!!!!!!!!!! Hello - we need not wonder. It's crap like this (plus other things)
 

cbg

I'm a Northern Girl
I am surprised the employer put the application through -

Me too; UNLESS the wife works in Human Resources or Benefits. If that's the case, she could easily slide it through without anyone noticing. So much the better if she's the one who audits the plans to see that they're not carrying anyone they shouldn't be.

If she's not in HR or Benefits, then all I can say is that the company was really sloppy in not checking to see that this person was legitimately an employee. I can see it going through initially if it's a really big company, but at SOME point in five years they should have been checking to see that everyone on the plan was legit.
 

unanswered

Junior Member
This helps me a great deal. And you're right it is a big mess. It is a small company where the husband trusted the wife, and by the way the husband was giving the check to the wife to send to insurance.
 

Find the Right Lawyer for Your Legal Issue!

Fast, Free, and Confidential
Top