2001. Insurance Fraud: Multiple Claims
The defendant is charged [in Count ______] with submitting multiple insurance claims with intent to defraud.
To prove that the defendant is guilty of this crime, the People must prove that:
1. The defendant presented two or more claims for (the same (loss/ [or] injury)/payment of the same health-care benefit) to (the same/ [or] more than one) insurer;
2. The defendant knew that (he/she) was submitting two or more claims for the same ((loss/ [or] injury)/health-care benefit);
3. When the defendant presented the claims, (he/she) intended to defraud.
Someone intends to defraud if he or she intends to deceive another person either to cause a loss of (money[,]/ [or] goods[,]/ [or] services[,]/ [or] something [else] of value), or to cause damage to, a legal, financial, or property right.
[For the purpose of this instruction, a person includes (a governmental agency/a corporation/a business/an association/the body politic).]
[It is not necessary that anyone actually be defrauded or actually suffer a financial, legal, or property loss as a result of the defendant's acts.]
A person presents a claim for payment by demanding payment under a contract of insurance for (a/an) ((loss/ [or] injury)/ health-care benefit).
[A claim for payment of a health-care benefit includes a claim submitted by or on behalf of the provider of a workers' compensation health benefit defined in the Labor Code.]
The court has a sua sponte duty to give this instruction defining the elements of the crime. Use this instruction if a violation of Penal Code section 550(a)(2) or (8) is alleged.
If the defendant is charged with a felony violation of Penal Code section 550(a)(8), give CALCRIM No. 2003, Insurance Fraud: Health-Care Claims—Total Value, with this instruction.
Give the bracketed sentence that begins with "For the purpose of this instruction" if the evidence shows an intent to defraud an entity or association rather than a natural person. (Pen. Code, § 8.)
Give the bracketed sentence that begins with "It is not necessary" if the evidence shows that the defendant did not succeed in defrauding anyone.
CALCRIM No. 2000, Insurance Fraud: Fraudulent Claims.
CALCRIM No. 2002, Insurance Fraud: Vehicle Accident.
CALCRIM No. 2003, Insurance Fraud: Health-Care Claims—Total Value.
Elements. Pen. Code, § 550(a)(2) & (8).
Intent to Defraud Element of Offense. People v. Scofield (1971) 17 Cal.App.3d 1018, 1025-1026 [95 Cal.Rptr. 405]; People v. Benson (1962) 206 Cal.App.2d 519, 529 [23 Cal.Rptr. 908], overruled on other grounds in People v. Perez (1965) 62 Cal.2d 769, 776, fn. 2 [44 Cal.Rptr. 326, 401 P.2d 934].
Intent to Defraud—Defined. People v. Pugh (2002) 104 Cal.App.4th 66, 72 [127 Cal.Rptr.2d 770]; People v. Gaul-Alexander (1995) 32 Cal.App.4th 735, 745 [38 Cal.Rptr.2d 176].
Intent to Defraud Entity. Pen. Code, § 8.
2 Witkin & Epstein, California Criminal Law (3d ed. 2000) Crimes Against Property, §§ 185-186.
6 Millman, Sevilla & Tarlow, California Criminal Defense Practice, Ch. 143, Crimes Against Property, § 143.01[f] (Matthew Bender).
Lesser Included Offenses
Fraudulent claims for health-care benefits, under Penal Code section 550(a)(6) to (9), are misdemeanors if the total amount of the claims does not exceed $400. (Pen. Code, § 550(c)(2).) If the defendant is charged with a felony, then the misdemeanor offense is a lesser included offense. The court must provide the jury with a verdict form on which the jury will indicate if the total amount of the claims exceeds $400. If the jury finds that the amount does not exceed $400, then the offense should be set at a misdemeanor.
(New January 2006)