California Penal Code §550 — Insurance Fraud
PC §550 criminalizes knowingly presenting a false or fraudulent claim for the payment of any insurance benefit. Most §550(a) violations are straight felonies punishable by 2, 3, or 5 years in state prison and fines up to $50,000 or double the value of the fraud, whichever is greater. §550(b) violations (false statements, concealment) are wobblers.
Reviewed by Daniel S. Rubin, CA Bar 302093 · Los Angeles Criminal Defense Attorney · Insurance Fraud Cases in All LA County Courts
01 — Quick Facts
PC §550 — Insurance Fraud at a Glance
| Fact | Detail |
|---|---|
| Full Name | California Penal Code §550 — Insurance Fraud |
| Code Type | Penal Code (PC) |
| Classification | §550(a): felony; §550(b) & (c): wobbler |
| Felony Term | 2, 3, or 5 years state prison |
| Misdemeanor Term | Up to 1 year county jail (§550(b) wobbler) |
| Fine | Up to $50,000 or 2x the fraud amount, whichever is greater |
| Restitution | Mandatory — full amount paid by insurer |
| Aggregation | Losses aggregate across multiple claims (§550(d)) |
| Strike | No (not a serious/violent felony) |
| Immigration | Aggravated felony if loss >$10,000 (8 USC §1101(a)(43)(M)) |
| Federal Overlap | 18 USC §1341 mail fraud, §1343 wire fraud commonly charged in parallel |
| If Charged | Call (213) 723-2337 immediately |
01 — What Is PC §550?
What Is California Penal Code §550?
PC §550 Reads:
"It is unlawful to knowingly present or cause to be presented any false or fraudulent claim for the payment of a loss or injury, including payment of a loss or injury under a contract of insurance."
— California Penal Code §550(a)(1)
California's insurance-fraud statute is one of the broadest fraud laws on the books. It reaches auto, health, workers' comp, disability, property, and life insurance claims. §550(a) targets false claims for payment; §550(b) targets false statements made in support of a claim; §550(c) covers repeat conduct and aggregation.
Common §550 Fact Patterns
Staged auto collisions, inflated repair estimates, exaggerated soft-tissue injuries, false theft reports, phantom-provider medical billing, and post-loss policy applications are the recurring fact patterns. The California Department of Insurance Fraud Division investigates alongside DA insurance-fraud units in every major county.
Official Sources
02 — Elements of the Crime
Elements the Prosecution Must Prove Under PC §550
To convict under §550(a)(1), the prosecution must prove each element beyond a reasonable doubt (CALCRIM 2000).
Presentation of a Claim
Defendant presented — or caused to be presented — a claim for insurance benefits.
The Claim Was False or Fraudulent
The claim contained a material misrepresentation of fact or an omission calculated to deceive.
Knowledge of Falsity
Defendant knew the claim was false when it was submitted.
Specific Intent to Defraud
Defendant intended to deceive the insurer to obtain benefits not owed.
04 — Penalties
Penalties for PC §550 Insurance Fraud in California
§550(a) is a straight felony. §550(b) — false statements, concealment of loss circumstances — is a wobbler.
| Charge | Code | Prison Term | Probation | Strike |
|---|---|---|---|---|
| False Claim — Felony | PC §550(a) via §550(c)(1) | 2, 3, or 5 years state prison | Available | No |
| False Statement — Felony Wobbler | PC §550(b) via §550(c)(2) | 16 months, 2, or 3 years county jail (§1170(h)) | Available | No |
| False Statement — Misdemeanor | PC §550(b) | Up to 1 year county jail; up to $10,000 fine | Available | No |
Sentencing Enhancements
Aggravated Loss
PC §12022.6
Additional 1–4 years for loss exceeding $65,000, up to +4 for loss exceeding $3.2 million.
Elder Victim
PC §368
Enhanced treatment where the insured or victim is age 65 or older.
Aggregation
PC §550(d)
Two or more acts within a 12-month period may be aggregated to establish felony status regardless of individual claim size.
Additional Consequences Beyond Prison
- Full restitution to the insurer — often six or seven figures
- Professional license consequences: medical, legal, contractor, insurance-broker
- Federal parallel charges: mail/wire fraud (18 USC §§1341, 1343) common
- Immigration: aggravated felony where loss exceeds $10,000
- Civil liability under Ins. Code §1871.7 — treble damages plus $5k–$10k per claim
Sentencing References
05 — Defense Strategies
How Rubin Law Defends PC §550 Insurance Fraud Charges
§550 cases turn on intent and materiality — the state must prove knowing falsity, not billing error.
No Specific Intent to Defraud
Good-faith belief in entitlement, reliance on adjuster or attorney, or clerical error defeats the intent element.
Intent
Materiality Challenge
Not every misstatement is criminal — the false fact must be material to the insurer's decision to pay.
Materiality
Third-Party Attribution
Attorneys, brokers, and medical providers often prepare the paperwork — the presenter, not the insured, may be the target.
Attribution
Parallel Civil Resolution
Reimbursing the insurer under Ins. Code §1871 civil recovery can undercut criminal exposure at the DA-review stage.
Restitution
Suppress Recorded Statements
SIU-investigator recorded statements taken without Miranda warnings may be inadmissible when custody attached.
Suppression
Constitutional Sources
07 — Court Process
How PC §550 Insurance Fraud Cases Move Through Los Angeles Courts
Insurance-fraud cases are complex, document-heavy, and often involve parallel civil suits.
- 1
Step 1 — SIU Investigation
Insurer's Special Investigations Unit builds the file before referring to CDI or the DA.
- 2
Step 2 — CDI / DA Referral
California Department of Insurance Fraud Division and the county DA insurance-fraud unit review the referral.
- 3
Step 3 — Grand Jury or Complaint
Larger cases proceed by grand-jury indictment; simpler cases by felony complaint.
- 4
Step 4 — Preliminary Hearing
Prosecution must show probable cause on each count — a strong PX challenge can eliminate counts before trial.
- 5
Step 5 — Discovery & Motion Practice
Discovery includes the entire claims file, recorded statements, and often a parallel civil deposition transcript.
- 6
Step 6 — Restitution Negotiation
Full pre-plea restitution often reduces charges to a wobbler misdemeanor or opens the door to diversion.
- 7
Step 7 — Trial or Plea
Jury trials turn on intent; most cases resolve after restitution and mitigation.
Los Angeles Courts That Handle PC §550 Insurance Fraud Cases
LA County insurance-fraud cases are handled at specialized calendars.
Reviewed by Your Attorney
Daniel S. Rubin — Los Angeles Insurance Fraud Defense Attorney
Daniel S. Rubin has defended clients charged with insurance fraud and related offenses in Los Angeles County courts — including Clara Shortridge Foltz, Van Nuys, Compton, and Pomona. He understands that these cases are won in the details: the suppression hearing that eliminates key evidence, the preliminary hearing cross-examination that exposes a weak witness, the penalty phase argument that keeps a client out of the worst outcome.
This page was written and reviewed by Daniel A. Rubin, Los Angeles criminal defense attorney, CA State Bar 302093, with 10+ years of experience defending clients charged under PC §550 in Los Angeles County. Last reviewed: July 2026.
CA Bar 302093 | Whittier Law School | Rising Star — Super Lawyers 2019–2023 | Insurance Fraud Cases Throughout LA County
09 — FAQs
PC §550 Insurance Fraud Questions — Los Angeles
Is PC §550 always a felony?
§550(a) — presenting a false claim — is a straight felony. §550(b) — false statements or concealment — is a wobbler that can be filed as either a felony or misdemeanor.
What is the maximum penalty?
5 years state prison, $50,000 fine or 2x the fraud amount (whichever is greater), plus mandatory full restitution to the insurer.
Does paying back the insurer avoid charges?
Not automatically, but early full restitution frequently reduces the filing decision from felony to misdemeanor and supports plea negotiations.
Can federal charges be filed too?
Yes. Mail fraud (18 USC §1341) and wire fraud (18 USC §1343) are commonly filed in parallel where interstate mail or wires were used.
Available 24/7 — Free Consultation
Charged With PC §550 Insurance Fraud in LA?
Insurance-fraud investigations are document-driven and defensible with the right intent framing. Rubin Law, P.C. — (213) 723-2337.