§ 27-12A-2 — Insurance Fraud - Definition

A person commits the crime of insurance fraud if, knowingly and with intent to defraud, he or she commits, or conceals any material information concerning, one or more of the following acts:
(1) The solicitation or acceptance of new or renewal insurance risks on behalf of an insurer, reinsurer, or other person engaged in the transaction of the business of insurance, by a person who knows the insurer, reinsurer, or other person responsible for the risk is financially unable to pay its claims at the time of the transaction.
(2) The removal, concealment, alteration, or destruction of the assets or records relating to the transaction of the business of insurance of an insurer, reinsurer, or other person engaged in the transaction of the business of insurance. This section does not prohibit an insurer, reinsurer, or other person engaged in the transaction of the business of insurance from destroying records or documents relating to the transaction of the business of insurance in accordance with record retention and destruction standards set forth in state or federal law or the record retention policy of the insurer, reinsurer, or other person.
(3) The embezzlement, abstraction, theft, or conversion of monies, funds, premiums, credits, or other property relating to the transaction of the business of insurance of an insurer, reinsurer, or other person engaged in the transaction of the business of insurance.
(4) Presenting, causing to be presented, or preparing with knowledge or belief that it will be presented to or by an insurer, reinsurer, producer, or any of their respective agents, false information as part of, in support of, or concerning a fact material to, one or more of the following:
a. An application for the issuance or renewal of an insurance policy or reinsurance agreement.
b. The rating of an insurance policy or reinsurance agreement.
c. A claim for payment or benefit pursuant to an insurance policy or reinsurance agreement.
d. A claim for payment or benefit based on an advertisement or promises to provide a good or service under an insurance policy.
e. Premiums paid on an insurance policy or reinsurance agreement.
f. Payments made in accordance with the terms of an insurance policy or reinsurance agreement.
g. A document filed with the commissioner.
i. Audit information submitted to the commissioner or an insurer.
j. The formation, acquisition, merger, reconsolidation, or dissolution of one or more insurance entities, or the withdrawal from one or more lines of insurance in all or part of this state by an insurer or reinsurer.
k. The issuance of written evidence of insurance.
l. The reinstatement of an insurance policy.
m. Issuance, acceptance, change, endorsement, or continuance of an insurance policy or reinsurance agreement.
n. A construction or structure mitigation inspection report provided for the issuance or renewal of an insurance policy or discounts or credits related to an insurance policy.
(5) The failure to decline or refusal to return an insurance payment for a loss or a recovery to which the person is not entitled by reason of an insurer’s mistake or other facts or circumstances connected with the person’s claim or the coverage provided by an applicable insurance policy.
(6) Overcharging an insurer or insured an amount for a good or service that exceeds the usual and customary charge by the person providing the good or performing the service as a part of an insurance claim for damage.

Legislative History

(Act 2012-429, p. 1170, §2; Act 2013-397, p. 1513, §1.)