|
Alaska Fraud Warning A person who knowingly and with intent [o injure, defraud or deceive an insurance conpany files a claim containing
<br />-false, incom le[e or misleadin information ma be rosecuted under state law. Alaska Slat. ' 21.36.380
<br />Arizona Fraud Warning For your protec[iort Arizona law requires the following statement to appear on this form. Anlperson who knowingly
<br />presents a false or fraudulent claim for payment of a loss is subject to criminal and civil penalties. (A.R.S. § 20-466.03)
<br />Arkansas Fraud Warning: Any person who knowingly presents a false or fraudulent claim for payment of a loser benefit or knowingly presents
<br />false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison, (A.C.A. § 23.66-
<br />503
<br />Califomia Fraud Warning For your protection Califomia law requires [hefollowing [o appear on [his form. Any person who knowingly presents
<br />a false or fraudulent claim for [he payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison.(Ins. §
<br />1879.2
<br />Colorado Fraud Warning It is unlawful [o knowingly provide false, incomplete, or misleading facts or infomtation [o an insurance company for
<br />the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance and civil
<br />damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete, or misleading facts or
<br />information [o a policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or claimant with regat [o a
<br />settlement or award payable from insurance proceeds shall be reported [o [he Colorado Division of Insurance within the Department of
<br />Regulatory Agencies.
<br />C.R.S. 10-1-128
<br />Delaware Fraud Warning Any person who knowingly and with intent to inpre, defraud or deceive any insurer, files a statement of claim
<br />containin an false, incom lete or misleadin information is uil of a felon I1 DeI. C. 913 6
<br />District of Columbia It is a crime ro provide false or misleading information [o aninsurer for the purpose of defrauding the insurer or any other
<br />person. Penalties include imprisonment and/or fines. In addition, an insurer may deny insurance benefits if false information materially related to
<br />a claim was rovided b the a licant. D.C. Code § 22-3225.09 d
<br />Florida Fraud Warning Any person who knowingly and with intent to injure, defraud or deceive any insurer files a statement of claim or an
<br />a lica[ion containin an false, incom lete or misleadin information is uil of a feAn of [he third de ree. Fla. Slat. § 817.234 1) b
<br />Idaho Fraud Warning: Any person who knowingly, and with intent to defraud or deceive any insurance company, files a statement containing
<br />any false, incomplete or misleading information is guilty of afelony.
<br />(Idaho Code § 41-1331)
<br />Indiana Fraud Warning: A person who knowingly and with intent to defraud an insurer files a statement of claim containing any false,
<br />incomplete or misleading information commits a felony.
<br />(Bums Ind. Code Ann. § 27-2-16-3)
<br />Kentucky Fraud Wazning Any person who knowingly and with intent to defraud any insurance company or other person files a statement of
<br />claim containing any materially false infortna[ion or conceals, for the purpose of misleading, infortna[ion concerrig any fact material thereto
<br />commits a fraudulent insurance ac[, which is a crime. KRS 304.47-030
<br />Louisiana Fraud Warning Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents
<br />false infortna[ion in an application for insurance is guilty of a crime and may be subject m fines and confinement in prison. R.S. 40:1424 (B).
<br />La. R.S. 40:1424
<br />Maine Fraud Warning: I[ is a crime to knowingly provide false, incomplete, or misleading informatmn [o an insurance company for [he purpose
<br />of defraudin the corn an .Penalties ma include im risonment, fines or a denial of insurance benefits. 24-A M.R.S. ' 2186
<br />Minnesota Fraud Warning: A person who files a claim with intent to defraud or helps mmmit a fraud against an insurer is guilty of a crime.
<br />Minn. Star ' 60A.955
<br />New Hampshire Fraud Warning Any person who, with a purpose to injure, defraud or deceive any insurance company, files a statement of
<br />claim containing any false, incomplete a misleading information is subject [o prosecution and punishment for insurance fraud, as provided in
<br />RSA 638:20. RSA 402:82
<br />New Jersey Fraud Warning Any person who knowingly files a statement of claim containing any false or misleading inforna[ions subject to
<br />criminal and civil enal[ies. NJAC I1:IGl.2. .1. Slat. 17:33A-6
<br />New Mexico Fraud Warning Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly
<br />presents false information in an application for insurance is guilty of a crime and may be subject to civil fines and criminal penalties. (N.M.
<br />S[a[. Ann. 59A-16C-8
<br />New York Fraud Warning Any person who knowingly and with intent to defraud any insurance company or other person files a application
<br />for insurance or settlement of claim containing any materially false information, or conceals for the purpose of misleading, information
<br />concerning any fact material thereto, commits a fraudulent insurance ac[, which is a crime, and shall ala be subject to a civil penalty not [o
<br />exceed five thousand dollars and the stated value ofthe claim for each such violation.
<br />(11 NYCRR § 86.4(a))
<br />Ohio Fraud Warning: Any person who, with intent [o defraud or knowing that he is facilitating a fraud alpinst an insurer, submits an application
<br />or files a claim containin a false or dece live statement is uil of insurance fraud. ORC Ann. 3999.21
<br />Oklahoma Fraud Warning Any person who knowingly, and with intent to injure, defraud or deceive any insner, makes any claim for [he
<br />roceeds of an insurance olic containin an false, incom le[e or misleadin information is uil of a felon . 36 Okl. SL ' 3613.1
<br />Pennsylvania Fraud Warning Any person who knowingly and with intent to defraud any innrance company or other person files an application
<br />for insurance or statement of claim containing any materially false or conceals for the purpose of misleading, information concemimg any fact
<br />material thereto wmmits a fraudulent insurance act, which isa crime and subjec6 such person to criminal and civil penalties.
<br />18 Pa.C.S. 4117 k 1
<br />Tennessee Fraud Warning I[ is a crime to knowingly provide false, incomplete or misleading infortna[ion to an insurance company for the
<br />u ose of defraudin the corn an .Penalties include im risonment, fines and denial of insurance benefits. Tenn. Code Ann. ' 56-53-I1 l
<br />Virginia Fraud Warning: It is a crime [o knowingly provide false, incomplete or misleading information [o an insurance company for [he
<br />u ose of defraudin the corn an .Penalties include im risonment, fines and denial of insurance benefits. Va. Code Ann. 52-40 B
<br />Claim No.: s6a S 26633 Page 3 of 3
<br />
|