Insurance Fraud and Consumer Privacy
List 6 most common Fraudulent insurance acts?
1) Presenting or helping others present false statements in an insurance application; 2) Presenting or helping others make false claims to an insurer to receive payments or benefits under a policy; 3) Soliciting or accepting new or renewal insurance risks for an insolvent insurer; 4) Removing, attempting to remove, or concealing an insurer's assets or records of assets and transactions from the Director; 5) Knowingly and willfully assisting or conspiring with a person to violate the insurance laws or to receive proceeds from insurance fraud; 6) Diverting or conspiring to divert funds from an insurer or other person while transacting insurance or reinsurance or while forming, acquiring, or dissolving an insurer
In addition to fines and penalties, a person who commits a fraudulent insurance act may also be ordered to do what?
A person may also be ordered to pay restitution to the injured party.
A person who commits a fraudulent insurance act may be imprisoned for how long?
A person who commits a fraudulent insurance act i may be imprisoned for up to four years.
A person who commits a fraudulent insurance act may be fined up to what amount?
A person who commits a fraudulent insurance act may fined up to $50,000.
A person who enters into an agreement or conspiracy to commit a fraudulent insurance act may be fined up to what amount?
A person who enters into an agreement or conspiracy to commit a fraudulent insurance act may be fined up to $50,000.
A person who enters into an agreement or conspiracy to commit a fraudulent insurance act may be imprisoned for up to how long?
A person who enters into an agreement or conspiracy to commit a fraudulent insurance act may be imprisoned up to ten years.
What are the penalties for a person who enters into an agreement or conspiracy to defraud a HEALTH INSURER by making or helping another person file a false claim for benefit payments?
A person who enters into an agreement or conspiracy to defraud a health insurer by making or helping another person file a false claim for benefit payments is guilty of a felony, punishable by imprisonment for up to 10 years, a fine of up to $50,000, or both.
When is a person who reports insurance fraud immune from liability?
A person who reports insurance fraud is immune from liability (slander, libel, other torts) for providing information to, or cooperating with law enforcement agencies when acting in good faith.
What is the fine for anyone who knowingly makes a false or fraudulent statement in a FRATERNAL BENEFIT SOCIETY membership application in order to obtain money or benefits?
A person who violates this requirement is guilty of a misdemeanor and may be fined between $100 and $500.
What is the term of imprisonment for a person who knowingly makes a false or fraudulent statement in a fraternal benefit society membership application in order to obtain money or benefits?
A person who violates this requirement is guilty of a misdemeanor and may be imprisoned from 30 days to one year
Can a person who knowingly makes a false or fraudulent statement in a FRATERNAL BENEFIT SOCIETY membership application in order to obtain money or benefits be imprisoned and fined?
A person who violates this requirement is guilty of a misdemeanor and may be imprisoned from 30 days to one year, fined between $100 and $500, or both.
When is a producer also not required to provide a privacy notice or notify customers of their right to opt out?
A producer is also not required to provide a privacy notice or notify customers of their right to opt out if the producer is employed by another licensee.
When is a surplus lines broker or insurer required to comply with the notice and opt-out requirements?
A surplus lines broker or insurer is required to comply with the notice and opt-out requirements if the broker or insurer: 1) does not disclose nonpublic personal information to nonaffiliated third parties for any reason 2) gives the consumer a notice when a customer relationship is established stating that neither the broker nor the insurer will disclose nonpublic personal information concerning the buyer to third parties, except as allowed by law
An individual who presents fraudulent claims or false information for benefits to HEALTH INSURERS is guilty of a felony that is punishable by imprisonment for up to how long?
An individual who presents fraudulent claims or false information for benefits to HEALTH INSURERS is guilty of a felony that is punishable by imprisonment for up to four years?
An individual who presents fraudulent claims or false information for benefits to HEALTH INSURERS is guilty of a FELONY that is punishable by a fine of up to how much?
An individual who presents fraudulent claims or false information for benefits to health insurers is guilty of a felony that is punishable by imprisonment for up $50,000.
Under the Privacy Notice Disclosure, what is the Annual Notice Policy?
An insurer or producer must notify its current customers of its privacy policies or practices at least once every year.
An insurer's privacy notice must disclose what six (6) things?
An insurer's privacy notice must disclose: 1) the categories of nonpublic personal financial information collected and disclosed 2) the types of affiliates and nonaffiliated third parties to whom nonpublic personal financial information is disclosed 3) the categories of nonpublic personal financial information disclosed about former customers to third parties 4) the consumer's opt-out rights 5) any disclosures made under the Fair Credit Reporting Act 6) policies to protect the confidentiality and security of nonpublic personal financial information
Anyone who presents a false or fraudulent report or claim for death, sickness, or disability benefits to an insurer may be fined up to what amount?
Anyone who presents a false or fraudulent report or claim for death, sickness, or disability benefits to an insurer may be fined up to $1,000.
Anyone who presents a false or fraudulent report or claim for death, sickness, or disability benefits to an insurer may be imprisoned for up to how long?
Anyone who presents a false or fraudulent report or claim for death, sickness, or disability benefits to an insurer may be imprisoned up to three months.
Anyone who presents a false or fraudulent report or claim for death, sickness, or disability benefits to an insurer is guilty of a felony or misdemeanor?
Anyone who presents a false or fraudulent report or claim is guilty of a misdemeanor.
A person who commits a fraudulent insurance act is guilty of a felony or misdemeanor?
Felony
A person who enters into an agreement or conspiracy to commit a fraudulent insurance act is guilty of a felony or misdemeanor?
Felony
In general, what are the conditions/circumstances that qualify as Exceptions to Requirement for Opt-Out Notice?
In general, an insurer or producer is not required to notify customers of their right to opt out when: 1) the nonpublic personal financial information will be disclosed to nonaffiliated third parties to perform services for the insurer or producer. 2) However, the insurer or producer must give the initial notice about its privacy policies and practices and prohibit the third party from disclosing or using the information for other purposes.
How does insurance fraud laws apply to fraternal benefit societies and individuals transacting insurance on their behalf?
It is illegal for anyone to knowingly make a false or fraudulent statement in a fraternal benefit society membership application in order to obtain money or benefits.
Under what circumstances can an insurance fraud agency, insurer, or agent request or release information pertaining to fraudulent insurance acts?
Only to investigate suspected insurance fraud.
Under the Disclosure of Policy or Account Numbers, Producers may only disclose a policy or account number or other access number for a consumer's policy, credit card account, or deposit account to a consumer reporting agency for what three (3) purposes?
Producers may only disclose a policy or account number or other access number for a consumer's policy, credit card account, or deposit account to a consumer reporting agency to use in: 1) telemarketing; 2) direct mail marketing; 3) or any other e-mail marketing.
When/under what two (2) circumstances does the Disclosure of Policy or Account Numbers rule not apply?
The Disclosure of Policy or Account Numbers rule does not apply if a producer discloses a policy or account number to: 1) the producer's service provider only to perform marketing for the producer's own products and services to another producer only to perform marketing activities; 2) to a participant in an affinity or similar program where the program participants are identified to the customer when the customer enters into the program
The insurance fraud laws also apply to fraternal benefit societies and individuals transacting insurance on their behalf. It is illegal for anyone to knowingly make a false or fraudulent statement in a fraternal benefit society membership application in order to obtain money or benefits. A person who violates this requirement is guilty of a misdemeanor and may be imprisoned from 30 days to one year, fined between $100 and $500, or both. It is also illegal to make a false statement of a material fact in a sworn statement regarding the death or disability of a fraternal benefit society certificate holder in order to obtain benefits. A person who willfully makes a false statement in a verified report under oath is guilty of perjury.
The insurance fraud laws also apply to fraternal benefit societies and individuals transacting insurance on their behalf. It is illegal for anyone to knowingly make a false or fraudulent statement in a fraternal benefit society membership application in order to obtain money or benefits. A person who violates this requirement is guilty of a misdemeanor and may be imprisoned from 30 days to one year, fined between $100 and $500, or both. It is also illegal to make a false statement of a material fact in a sworn statement regarding the death or disability of a fraternal benefit society certificate holder in order to obtain benefits. A person who willfully makes a false statement in a verified report under oath is guilty of perjury.
What is an Insurer or Producer required to do when collecting or using nonpublic personal financial information?
When collecting or using nonpublic personal financial information, an insurer or producer is required to notify individuals about the privacy policies and practices when a customer relationship is established.
When is a person not immune from liability for filing a report or testifying about insurance fraud?
When the person knows that the testimony or report contains false material information.
A person who enters into an agreement or conspiracy to commit a fraudulent insurance act be subject to a combination of both fines and imprisonment?
Yes. A court may order that the person be imprisoned up to ten years, fined up to $50,000, or both.
A person who enters into an agreement or conspiracy to commit a fraudulent insurance be ordered the person to pay restitution to an injured party?
Yes. A court may order that the person pay restitution to an injured party.
Are Unlicensed individuals who solicit FRATERNAL BENEFIT SOCIETY memberships are guilty of a misdemeanor?
Yes. Unlicensed individuals who solicit FRATERNAL BENEFIT SOCIETY memberships are guilty of a misdemeanor and may be fined between $50 and $200.
Can a person who commits a fraudulent insurance act be subject to a combination of both fines and imprisonment?
Yes...A person who commits a fraudulent insurance act is guilty of a felony and may be imprisoned for up to four years, fined up to $50,000, or a combination of both penalties.
