Insurance Fraud Lawyer in Woodbridge, Middlesex County

Reviewed by William A. Proetta, Esq. · Updated October 2026

Knowingly making a false or misleading statement of material fact, or leaving out a material fact, in connection with an insurance claim, application or payment is a 3rd-degree crime under N.J.S.A. 2C:21-4.6, with exposure of 3 to 5 years and a $15,000 maximum fine. It becomes a 2nd-degree crime, 5 to 10 years, when a person knowingly commits five or more acts of insurance fraud and the total value obtained or sought is at least $1,000; misstating your residence to get an out-of-state auto policy is a 4th-degree crime, up to 18 months.

Every grade is indictable, so the complaint is reviewed by the Middlesex County Prosecutor’s Office and heard in Superior Court at 56 Paterson Street, New Brunswick, not in the municipal court in Woodbridge or Edison. We defend people accused of claim and application fraud from our Edison office. I have spent more than 15 years in criminal trial work.

What Counts as Insurance Fraud

The State must prove three things.

• A false statement or a material omission. The statement can be written, electronic or oral: a claim form, a recorded call with an adjuster, a repair estimate, a medical bill, an application, or a sworn certification. Leaving out a material fact counts the same as saying something false.
• Materiality. The fact must matter to the insurance transaction. The insurer does not have to have paid or even been fooled; State v. Goodwin, 224 N.J. 102 (2016), holds that an insured can be convicted where the carrier was not induced to pay, so long as the misstatement was material.
• Knowledge. The person must know the statement is false or misleading. An honest mistake about a date, a policy term or an estimate is not insurance fraud.

The statute covers four settings: a claim for payment or benefits (including from the Unsatisfied Claim and Judgment Fund); an application to obtain or renew a policy; any payment under a policy or premium finance transaction; and any affidavit, certification or record used in an insurance transaction. Common Middlesex examples include reporting a car stolen that was sold or left somewhere, adding pre-existing damage to a fender-bender claim after a crash on the Turnpike or Route 1, inflating a burglary loss on a homeowner’s claim, listing a parent’s address on an application to lower a premium, and certifying lost wages that were never lost.

Two provisions surprise people. Under 2C:21-4.6(d), a jury may infer that someone who signed or initialed a document read and reviewed it. And under 2C:21-4.6(f), the insurance fraud charge does not prevent the State from also charging theft by deception, forgery or other offenses from the same facts.

Grading of Insurance Fraud and Health Care Claims Fraud

How the “five acts” rule works

The 2nd-degree tier is the one to watch. The statute treats each act of insurance fraud as a separate offense, permits five or more separate acts to be aggregated, and counts multiple acts within a single document separately. A person who submits several false invoices on one claim, or several claims over time, can reach the 2nd-degree threshold quickly, and the $1,000 aggregate floor is low. How the State counts the acts is often the most important question in the case.

The garaging exception matters to students and families with two homes. Subsection (b) does not apply to a second residence or to school attendance when the facts were disclosed truthfully.

Penalties and Other Consequences

Prison and the first-offender presumption. A first offender convicted of the 3rd- or 4th-degree crime has a presumption of non-imprisonment under N.J.S.A. 2C:44-1(e). A 2nd-degree conviction carries a presumption of imprisonment under 2C:44-1(d)(1), though the judge may sentence one degree lower under 2C:44-1(d)(2) if clearly convinced the mitigating factors substantially outweigh the aggravating factors.

Restitution. The court must order restitution when the insurer suffered a loss and the defendant is able to pay. Our restitution guide explains how the amount is set.

Civil penalties. Separately from the criminal case, the Commissioner of Banking and Insurance can pursue penalties under the Insurance Fraud Prevention Act, N.J.S.A. 17:33A-5: up to $5,000 for a first violation, $10,000 for a second, and $15,000 for each one after that, plus restitution, costs and attorneys’ fees.

De minimis dismissal. Under 2C:21-4.6(g), the assignment judge may dismiss a charge under N.J.S.A. 2C:2-11 when the conduct was too trivial to warrant a conviction.

Not NERA. Insurance fraud is not a No Early Release Act offense.

Expungement. Insurance fraud is not on the bar list in N.J.S.A. 2C:52-2(b), so a conviction can be expunged after the waiting period. See our expungement eligibility guide.

Immigration. Fraud offenses raise serious immigration questions, and the federal definition of an aggravated felony includes fraud where the victim’s loss exceeds $10,000. A non-citizen should have an immigration lawyer review any plea and any loss figure.

How Insurance Fraud Cases Reach Court in Middlesex County

Most cases start inside an insurance company. A claims adjuster notices that a damage photo does not match the reported crash, that a “stolen” car was listed for sale online the week before, or that the garaging address on a policy is a relative’s apartment in New Brunswick while the car is registered and parked elsewhere. The file goes to the carrier’s investigators, who may request a recorded statement, pull repair-shop and phone records, and then refer the matter to law enforcement. Depending on the case, it may be handled by the MCPO or by the State’s Office of the Insurance Fraud Prosecutor.

Because the case is built on paper, people are rarely arrested on the spot. Most receive a summons by mail or learn of the case from a detective’s phone call asking them to “clear up” a claim. Before any statement is given, we review the policy, the claim file the insurer will produce, and what the client actually signed. Our guide to police questioning explains why that call should go to a lawyer first.

After the complaint is filed, the case is scheduled in Superior Court in New Brunswick. A single-act case with a modest loss often resolves before indictment, through PTI or a negotiated plea, with restitution to the insurer arranged early. A case alleging five or more acts is presented to a grand jury in New Brunswick, and the count of acts becomes the focus of negotiation. Body shops and medical offices named in the same investigation often have their own lawyers, and what they say can cut either way for the policyholder.

PTI for Insurance Fraud

A first offender charged with 3rd- or 4th-degree insurance fraud is a reasonable PTI candidate, and repayment to the insurer is usually a condition. The application goes through the Middlesex Criminal Division and is due before the first case disposition conference after arraignment. A 2nd-degree charge for five or more acts carries a presumption against admission, which can be overcome only with extraordinary and compelling circumstances and the prosecutor’s consent; the application then needs to explain the person’s background, the size of the loss and why diversion serves the public. Our Middlesex PTI page covers the process.

Defenses to Insurance Fraud Charges

• No knowledge. The client trusted a broker, a body shop or a relative to fill out the form. The State must prove the client knew the statement was false.
• Not material. A wrong detail that had nothing to do with coverage, price or payment does not meet the statute.
• The act count is wrong. Challenging how the State counts acts can move a case from 2nd to 3rd degree.
• Truthful disclosure on residence. For a garaging charge, a second residence or school address that was disclosed accurately is a complete answer.
• Value of the claim. For the 2nd-degree tier and for restitution, the amount actually obtained or sought must be proven.
• Statements and searches. Recorded statements, phone extractions and records obtained by investigators can be tested through a motion to suppress when police were involved.

Call About an Insurance Fraud Investigation

If an adjuster, investigator or detective has asked you about a claim, hold off on statements and document requests until you have advice. Our Edison office answers (732) 659-9600 around the clock, or you can write to us here. Related charges are covered on our theft by deception page.