Texas Penal Code 35.02 – Insurance Fraud
Current as of: 2024 | Check for updates
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(a) A person commits an offense if, with intent to defraud or deceive an insurer, the person, in support of a claim for payment under an insurance policy:
(1) prepares or causes to be prepared a statement that:
(A) the person knows contains false or misleading material information; and
(B) is presented to an insurer; or
(2) presents or causes to be presented to an insurer a statement that the person knows contains false or misleading material information.
(a-1) A person commits an offense if the person, with intent to defraud or deceive an insurer and in support of an application for an insurance policy:
(1) prepares or causes to be prepared a statement that:
(A) the person knows contains false or misleading material information; and
(B) is presented to an insurer; or
(2) presents or causes to be presented to an insurer a statement that the person knows contains false or misleading material information.
Attorney's Note
Under the Texas Codes, punishments for crimes depend on the classification. In the case of this section:| Class | Prison | Fine |
|---|---|---|
| State jail felony | between 180 days and 2 years | up to $10,000 |
| Class A misdemeanor | up to 1 year | up to $4,000 |
| Class B misdemeanor | up to 180 days | up to $2,000 |
Terms Used In Texas Penal Code 35.02
- Act: means a bodily movement, whether voluntary or involuntary, and includes speech. See Texas Penal Code 1.07
- Actor: means a person whose criminal responsibility is in issue in a criminal action. See Texas Penal Code 1.07
- Benefit: means anything reasonably regarded as economic gain or advantage, including benefit to any other person in whose welfare the beneficiary is interested. See Texas Penal Code 1.07
- Bodily injury: means physical pain, illness, or any impairment of physical condition. See Texas Penal Code 1.07
- Conduct: means an act or omission and its accompanying mental state. See Texas Penal Code 1.07
- Death: includes , for an individual who is an unborn child, the failure to be born alive. See Texas Penal Code 1.07
- Defendant: In a civil suit, the person complained against; in a criminal case, the person accused of the crime.
- Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
- Felony: means an offense so designated by law or punishable by death or confinement in a penitentiary. See Texas Penal Code 1.07
- Law: means the constitution or a statute of this state or of the United States, a written opinion of a court of record, a municipal ordinance, an order of a county commissioners court, or a rule authorized by and lawfully adopted under a statute. See Texas Penal Code 1.07
- Misdemeanor: means an offense so designated by law or punishable by fine, by confinement in jail, or by both fine and confinement in jail. See Texas Penal Code 1.07
- Person: means an individual or a corporation, association, limited liability company, or other entity or organization governed by the Business Organizations Code. See Texas Penal Code 1.07
- Restitution: The court-ordered payment of money by the defendant to the victim for damages caused by the criminal action.
- Trial: A hearing that takes place when the defendant pleads "not guilty" and witnesses are required to come to court to give evidence.
(b) A person commits an offense if, with intent to defraud or deceive an insurer, the person solicits, offers, pays, or receives a benefit in connection with the furnishing of goods or services for which a claim for payment is submitted under an insurance policy.
(c) An offense under Subsection (a) or (b) is:
(1) a Class C misdemeanor if the value of the claim is less than $100;
(2) a Class B misdemeanor if the value of the claim is $100 or more but less than $750;
(3) a Class A misdemeanor if the value of the claim is $750 or more but less than $2,500;
(4) a state jail felony if the value of the claim is $2,500 or more but less than $30,000;
(5) a felony of the third degree if the value of the claim is $30,000 or more but less than $150,000;
(6) a felony of the second degree if the value of the claim is $150,000 or more but less than $300,000; or
(7) a felony of the first degree if:
(A) the value of the claim is $300,000 or more; or
(B) an act committed in connection with the commission of the offense places a person at risk of death or serious bodily injury.
(d) An offense under Subsection (a-1) is a state jail felony.
(e) The court shall order a defendant convicted of an offense under this section to pay restitution, including court costs and attorney’s fees, to an affected insurer.
(f) If conduct that constitutes an offense under this section also constitutes an offense under any other law, the actor may be prosecuted under this section, the other law, or both.
(g) For purposes of this section, if the actor proves by a preponderance of the evidence that a portion of the claim for payment under an insurance policy resulted from a valid loss, injury, expense, or service covered by the policy, the value of the claim is equal to the difference between the total claim amount and the amount of the valid portion of the claim.
(h) If it is shown on the trial of an offense under this section that the actor submitted a bill for goods or services in support of a claim for payment under an insurance policy to the insurer issuing the policy, a rebuttable presumption exists that the actor caused the claim for payment to be prepared or presented.