{"id":9077,"date":"2025-11-10T11:30:00","date_gmt":"2025-11-10T19:30:00","guid":{"rendered":"https:\/\/www.businessinsuranceusa.com\/news\/?p=9077"},"modified":"2026-03-24T14:21:57","modified_gmt":"2026-03-24T21:21:57","slug":"what-counts-as-business-insurance-fraud","status":"publish","type":"post","link":"https:\/\/www.businessinsuranceusa.com\/blog\/insurance\/what-counts-as-business-insurance-fraud\/","title":{"rendered":"What Counts as Business Insurance Fraud"},"content":{"rendered":"\n<p class=\"yoast-reading-time__wrapper\"><span class=\"yoast-reading-time__icon\"><svg aria-hidden=\"true\" focusable=\"false\" data-icon=\"clock\" width=\"20\" height=\"20\" fill=\"none\" stroke=\"currentColor\" style=\"display:inline-block;vertical-align:-0.1em\" role=\"img\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 24 24\"><path stroke-linecap=\"round\" stroke-linejoin=\"round\" stroke-width=\"2\" d=\"M12 8v4l3 3m6-3a9 9 0 11-18 0 9 9 0 0118 0z\"><\/path><\/svg><\/span><span class=\"yoast-reading-time__spacer\" style=\"display:inline-block;width:1em\"><\/span><span class=\"yoast-reading-time__descriptive-text\">Estimated reading time: <\/span><span class=\"yoast-reading-time__reading-time\">8<\/span><span class=\"yoast-reading-time__time-unit\"> minutes<\/span><\/p>\n\n\n\n<div class=\"wp-block-yoast-seo-ai-summarize yoast-ai-summarize\"><h2>Key Takeaways<\/h2>\n<ul class=\"wp-block-list yoast-ai-summarize-list\">\n<li>Understanding insurance fraud is crucial for business owners to avoid unintentional claims issues.<\/li>\n\n\n\n<li>Insurance fraud includes providing false information to insurers before, during, or after policy issuance.<\/li>\n\n\n\n<li>Types of fraud include application fraud, claims fraud, and misrepresentation that can lead to severe penalties.<\/li>\n\n\n\n<li>Insurers detect fraud through patterns and discrepancies, impacting overall premium rates for all policyholders.<\/li>\n\n\n\n<li>To mitigate risks, communicate honestly with insurers and utilize legal ways to reduce premiums, such as discounts and bundling policies.<\/li>\n<\/ul>\n<\/div>\n\n\n\n<p>Understanding insurance fraud matters. If you have a business policy that you might one day need to make a claim against, you need to be sure that you never make a fraudulent claim. There are many people who own a business who are not aware of the things that qualify as fraud.<\/p>\n\n\n\n<p>Insurance fraud means providing false, misleading, or incomplete information to an <a href=\"https:\/\/www.businessinsuranceusa.com\" target=\"_blank\" rel=\"noreferrer noopener\">insurance company<\/a>. This information can be provided before, during, or after the policy is issued. Fraud, when it is intentional, is committed with the intention of securing a financial advantage through the use of a business insurance policy.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-what-does-insurance-fraud-look-like\"><strong>What Does Insurance Fraud Look Like?<\/strong><\/h2>\n\n\n\n<p>Insurance fraud can mean:<\/p>\n\n\n\n<p>\u00b7 &nbsp; &nbsp; &nbsp; Taking steps to pay less for coverage than you should<\/p>\n\n\n\n<p>\u00b7 &nbsp; &nbsp; &nbsp; Making sure a policy is approved that would otherwise be denied<\/p>\n\n\n\n<p>\u00b7 &nbsp; &nbsp; &nbsp; Accepting claims payouts that you are not entitled to<\/p>\n\n\n\n<p>Understanding what insurance fraud looks like is important. These are the types of insurance fraud that you need to understand if you own a business.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-1-nbsp-nbsp-application-fraud-before-the-policy-has-been-issued\">1. &nbsp; &nbsp; Application Fraud (Before the Policy Has Been Issued)<\/h3>\n\n\n\n<p>Application fraud is committed during the underwriting stage of the insurance process, which is undertaken when you first apply for or renew insurance coverage. This kind of fraud might be:<\/p>\n\n\n\n<p>\u00b7 &nbsp; &nbsp; &nbsp; Being dishonest about your business operations<\/p>\n\n\n\n<p>You might say that you are a consulting firm, but you actually run a small manufacturing business that does welding work and has on-site labor.<\/p>\n\n\n\n<p>\u00b7 &nbsp; &nbsp; &nbsp; Underreporting revenue and payroll data<\/p>\n\n\n\n<p>Workers\u2019 comp premiums are generally based on payroll and classification codes (and commonly get finalized through a premium audit). Revenue is more commonly used as an exposure base for some liability classes, not as the primary basis for workers\u2019 comp.<\/p>\n\n\n\n<p>\u00b7 &nbsp; &nbsp; &nbsp; Misclassifying employees on purpose<\/p>\n\n\n\n<p>When you list workers in the wrong classes, you can save on premiums due to reporting their jobs as low risk when that is not the case.<\/p>\n\n\n\n<p>\u00b7 &nbsp; &nbsp; &nbsp; Hiring subcontractors and stating that you do not<\/p>\n\n\n\n<p>If you use subs, you need to claim them as they are considered higher risk than standard employees.<\/p>\n\n\n\n<p>\u00b7 &nbsp; &nbsp; &nbsp; Using fake or outdated business addresses for your company<\/p>\n\n\n\n<p>Listing your address as operating from your home or from a property that is smaller and less complex can save money on premiums, but it is definitely fraud.<\/p>\n\n\n\n<p>All of the above examples are classified as material misrepresentation, which means that they impact how insurers will make decisions about the kind of risk that is present during business operations. This impacts the pricing of your policies and the scope of them as well.<\/p>\n\n\n\n<p>Depending on the state, the policy terms, and the facts, fraud may lead to:<\/p>\n\n\n\n<p>\u00b7 &nbsp; &nbsp; &nbsp; Cancellation, nonrenewal<\/p>\n\n\n\n<p>\u00b7 &nbsp; &nbsp; &nbsp; Claims denial <\/p>\n\n\n\n<p>\u00b7 &nbsp; &nbsp; &nbsp; Civil liability, and potentially criminal prosecution<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-2-nbsp-nbsp-claims-fraud-occurs-after-the-policy-is-issued\">2. &nbsp; &nbsp; Claims Fraud (Occurs After the Policy is Issued)<\/h3>\n\n\n\n<p>This kind of fraud happens when businesses make false or exaggerated claims to get more money than they deserve from a claim.<\/p>\n\n\n\n<p>Some examples would be:<\/p>\n\n\n\n<p>\u00b7 &nbsp; &nbsp; &nbsp; Faking losses or inflating damages<\/p>\n\n\n\n<p>Stating that more items were damaged in the incident than truly were.<\/p>\n\n\n\n<p>\u00b7 &nbsp; &nbsp; &nbsp; Backdating occurrences<\/p>\n\n\n\n<p>Saying that losses occurred within the policy period when they really happened earlier than when the policy was in effect.<\/p>\n\n\n\n<p>\u00b7 &nbsp; &nbsp; &nbsp; Altering invoices or repair bills<\/p>\n\n\n\n<p>Submitting inflated costs can boost reimbursement and is definitely fraud.<\/p>\n\n\n\n<p>When you claim that you lost revenue for days that you actually were open and operating. According to the Coalition Against Insurance Fraud, <a href=\"https:\/\/insurancefraud.org\/wp-content\/uploads\/The-Impact-of-Insurance-Fraud-on-the-U.S.-Economy-Report-2022-8.26.2022.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">the $308.6 billion figure<\/a> comes from a Coalition Against Insurance Fraud report estimating the total annual cost of insurance fraud across multiple lines of insurance (not just commercial). If you want to cite that figure, describe it as the overall insurance fraud cost and avoid labeling it \u201ccommercial.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-why-insurers-take-this-kind-of-fraud-so-seriously\"><strong>Why Insurers Take This Kind of Fraud so Seriously<\/strong><\/h2>\n\n\n\n<p>Insurance fraud doesn\u2019t just impact insurance companies alone; it also leads to increased premiums for everyone around the country. When insurers spot inconsistencies in reported claims data, such as payroll figures that don\u2019t match reported taxes from previous filings or job descriptions that don\u2019t make sense when compared to job codes, they have to report them to state fraud bureaus or insurance oversight departments.<\/p>\n\n\n\n<p>Many states have a dedicated insurance fraud division that is part of the Attorney General\u2019s Office. This office applies the penalties that match the fraud that was committed. While penalties vary from state to state, many insurance fraud penalties are categorized as felonies because the dollar amount of the claim typically exceeds a few thousand dollars.<\/p>\n\n\n\n<p>For example:<\/p>\n\n\n\n<p>\u00b7 &nbsp; &nbsp; &nbsp; California <a href=\"https:\/\/leginfo.legislature.ca.gov\/faces\/codes_displaySection.xhtml?lawCode=INS&amp;sectionNum=1871.4\" target=\"_blank\" rel=\"noreferrer noopener\">Insurance Code \u00a71871.4(b) provides<\/a> for up to 1 year in county jail or 2\/3\/5 years (per Penal Code \u00a71170(h)), and a fine up to $150,000 or double the value of the fraud (whichever is greater), plus restitution.<\/p>\n\n\n\n<p>\u00b7 &nbsp; &nbsp; &nbsp; Florida Statute \u00a7817.234 grades the offense by value:<\/p>\n\n\n\n<p><strong> <\/strong>$20,000 \u2192 third-degree felony<\/p>\n\n\n\n<p>$20,000 to &lt; $100,000 \u2192 second-degree felony<\/p>\n\n\n\n<p>$100,000 \u2192 first-degree felony<\/p>\n\n\n\n<p>General felony sentencing caps <a href=\"https:\/\/www.flsenate.gov\/laws\/statutes\/2021\/775.082\" target=\"_blank\" rel=\"noreferrer noopener\">are in \u00a7775.082<\/a> (up to 5 \/ 15 \/ 30 years for third\/second\/first degree). General maximum fines <a href=\"https:\/\/www.flsenate.gov\/laws\/statutes\/2021\/775.083\" target=\"_blank\" rel=\"noreferrer noopener\">are in \u00a7775.083<\/a> (up to $5,000 for third degree; up to $10,000 for first\/second degree, unless enhanced).<\/p>\n\n\n\n<p>\u00b7 &nbsp; &nbsp; &nbsp; Texas Penal Code \u00a735.02 grades insurance fraud by the value of the claim, from misdemeanors up to a first-degree felony if the value is $300,000 or more. A Texas first-degree felony can be punished by 5\u201399 years or life, plus a possible fine up to $10,000 (Texas Penal Code \u00a712.32).<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-common-red-flags-that-lead-to-fraud-investigations\"><strong>Common Red Flags That Lead to Fraud Investigations<\/strong><\/h2>\n\n\n\n<p>Insurance carriers are trained to spot fraud patterns. These might include:<\/p>\n\n\n\n<p>\u00b7 &nbsp; &nbsp; &nbsp; Payroll reports that don\u2019t match IRS filings<\/p>\n\n\n\n<p>\u00b7 &nbsp; &nbsp; &nbsp; Sudden large claims right after a policy is established<\/p>\n\n\n\n<p>\u00b7 \u00a0 \u00a0 \u00a0 Conflicting descriptions of operations from various coverage areas<\/p>\n\n\n\n<p>\u00b7 &nbsp; &nbsp; &nbsp; Businesses that change their names but continue to operate in the same way as before after a policy cancellation.<\/p>\n\n\n\n<p>\u00b7 &nbsp; &nbsp; &nbsp; Equipment or inventory lists that don\u2019t match purchase records<\/p>\n\n\n\n<p>Modern underwriting utilizes AI and data-matching tools to cross-check records with the Department of Labor, tax records, and even social media.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-gray-areas-and-honest-mistakes\"><strong>Gray Areas and Honest Mistakes<\/strong><\/h2>\n\n\n\n<p>Not every discrepancy in a claim is an attempt to commit fraud. Sometimes, poor bookkeeping or a lack of understanding can lead to false claims data.<\/p>\n\n\n\n<p>\u00b7 &nbsp; &nbsp; &nbsp; A <a href=\"https:\/\/www.businessinsuranceusa.com\/business-insurance-general-contractors\" target=\"_blank\" rel=\"noreferrer noopener\">contractor<\/a> adds a new type of work to the roster and forgets to notify the insurer<\/p>\n\n\n\n<p>\u00b7 \u00a0 \u00a0 \u00a0 A <a href=\"https:\/\/www.businessinsuranceusa.com\/fine-dining-restaurant-insurance\" target=\"_blank\" rel=\"noreferrer noopener\">restaurant<\/a> hires more staff mid-year, and payroll goes up, but insurance is not notified.<\/p>\n\n\n\n<p>\u00b7 &nbsp; &nbsp; &nbsp; A small business starts offering a delivery service but doesn\u2019t add <a href=\"https:\/\/www.businessinsuranceusa.com\/business-auto-insurance\" target=\"_blank\" rel=\"noreferrer noopener\">commercial auto coverage<\/a>.<\/p>\n\n\n\n<p>In these cases, honest communication can typically resolve the problems. Fraud is categorized by intent, and insurance companies are good at figuring out the difference between honest mistakes and real intent to defraud.<\/p>\n\n\n\n<p>When you realize there is an issue with your company\u2019s reporting, it is best to come clean right away to your insurer to make certain that claims are not denied and fraud is not suspected in the future.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-how-honest-business-owners-proceed\"><strong>How Honest Business Owners Proceed<\/strong><\/h2>\n\n\n\n<p>If you want to save on your premiums, these are the legal, ethical ways to do so:<\/p>\n\n\n\n<p>1. &nbsp; &nbsp; Ask for loss control or risk management discounts. Many insurance companies offer credits for things like installing alarms, safety programs, and fleet telematics.<\/p>\n\n\n\n<p>2. &nbsp; &nbsp; Bundle your policies. Combining <a href=\"https:\/\/www.businessinsuranceusa.com\/general-liability-insurance\" target=\"_blank\" rel=\"noreferrer noopener\">general liability<\/a>, property, and commercial policies may save you some money.<\/p>\n\n\n\n<p>3. &nbsp; &nbsp; Adjust deductibles smartly. <a href=\"https:\/\/www.businessinsuranceusa.com\/news\/insurance\/what-are-commercial-insurance-policy-limits-endorsements-and-deductibles\/\" target=\"_blank\" rel=\"noreferrer noopener\">Higher deductibles<\/a> may often reduce premiums without having to lie about your operational practices.<\/p>\n\n\n\n<p>4. &nbsp; &nbsp; Review class codes and payroll on a routine basis. If your business grows or changes, you need to review reporting to be sure that it is accurate.<\/p>\n\n\n\n<p>5. &nbsp; &nbsp; Work with a <a href=\"https:\/\/www.businessinsuranceusa.com\/contact-business-insurance-usa\" target=\"_blank\" rel=\"noreferrer noopener\">reputable broker<\/a> to be sure that your application is accurate, and who can defend you if there is a question about your intent.<\/p>\n\n\n\n<p>Illustrative scenario: A small construction firm in <a href=\"https:\/\/www.businessinsuranceusa.com\/ohio-small-business-insurance\" target=\"_blank\" rel=\"noreferrer noopener\">Ohio<\/a> that reported four clerical staff members to their <a href=\"https:\/\/www.businessinsuranceusa.com\/artisan-contractor-workers-comp-insurance\" target=\"_blank\" rel=\"noreferrer noopener\">workers\u2019 comp insurers<\/a>, but they actually had twelve people on payroll. When an employee was injured, the investigation turned up the real payroll records for the business.<\/p>\n\n\n\n<p>The insurer <a href=\"https:\/\/www.businessinsuranceusa.com\/news\/insurance\/reasons-business-insurance-claim-denied\/\" target=\"_blank\" rel=\"noreferrer noopener\">denied the claim<\/a> and sent the case information on to the state\u2019s fraud bureau. The owner had to face felony charges, fines in excess of $100,000, and was barred from obtaining a new commercial policy for three years.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-the-bottom-line\"><strong>The Bottom Line<\/strong><\/h2>\n\n\n\n<p>At the end of the day, fraud isn\u2019t just about lying. Fraud is about breaking trust. Insurance companies build policy information based on the application details that you submit. They are trusting you to be honest with them so that they can protect you to the best of their ability. When you lie about the nature of your business, trust is broken and cannot be recovered.<\/p>\n\n\n\n<p>Misrepresentation might save you some cash in the short term, but the consequences of being caught committing fraud are very serious and costly. There is no reality wherein the small amount of money that you have saved on premiums will ever be of more value than the penalties that you will face if you are caught.<\/p>\n\n\n\n<p>Best advice?<\/p>\n\n\n\n<p>Be honest, document everything, and let your qualified agent get you set up with the proper coverage that is affordable and within your budget. This is not just smart business\u2014it\u2019s honest business that provides you with insurance protection you can trust.<\/p>\n\n\n\n<ul class=\"wp-block-yoast-seo-related-links yoast-seo-related-links\">\n<li><a href=\"https:\/\/www.businessinsuranceusa.com\/news\/insurance\/history-of-commercial-liability-insurance\/\">How General Liability Insurance Protects American Businesses<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.businessinsuranceusa.com\/news\/workers-comp\/workers-compensation-insurance-for-manufacturers\/\">Workers\u2019 Compensation Insurance For Manufacturers<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.businessinsuranceusa.com\/news\/cyber-attack\/avoid-financial-scams\/\">Avoiding Common Financial Scams To Protect Your Business<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.businessinsuranceusa.com\/news\/insurance\/bundling-vs-splitting-liability-workers-comp-insurance\/\">Why Bundling Isn\u2019t Always a Bargain<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.businessinsuranceusa.com\/news\/cyber-attack\/digital-age-increase-cyber-crime\/\">Digital Age And The Increase in Cyber Crime<\/a><\/li>\n<\/ul>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Understanding insurance fraud matters. If you have a business policy that you might one day&#8230;<\/p>\n","protected":false},"author":9,"featured_media":9084,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[737],"tags":[45],"class_list":{"0":"post-9077","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-insurance","8":"tag-small-business-insurance"},"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.1 (Yoast SEO v28.1) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>What Counts as Business Insurance Fraud<\/title>\n<meta name=\"description\" content=\"What qualifies as business insurance fraud, including application and claims fraud, red flags insurers look for.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" 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