Legal Question in Insurance Law in North Carolina

Is this insurance fraud?

A friend of mine cashed a check from his insurance company that was supposed to be used to pay the anesthesiology bill for surgery. The check was made out to him and him alone. His disability insurance was running out and he needed to pay his bills. He called up the anesthesiology people to make payment arrangements and they sent him to a bill collector. The bill collector contacted him and told him that he committed insurance fraud and that if he doesn't pay the whole bill in one month he is going to jail. Are they just trying to scare him or is that the truth?


Asked on 9/18/07, 10:26 pm

1 Answer from Attorneys
John Kirby Law Offices of John M. Kirby

Re: Is this insurance fraud?

Your friend may want to contact an attorney with more facts to investigate this further. Based on the facts presented, this is not clearly insurance fraud. Insurance fraud would typically be when the person ("claimant" or "insured") submits a false claim for payment to the insurer. In this case, there was a legitimate medical bill, and therefore this may not be fraud. The insurance company actually may have an obligation to protect the health care provider's "lien." Your friend can also be sued for the balance on the bill.

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Answered on 9/18/07, 10:49 pm


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