41-293. INSURANCE FRAUD. Insurance fraud includes:
(1) (a) Any person who, with the intent to defraud or deceive an insurer for the purpose of obtaining any money or benefit, presents or causes to be presented to any insurer, producer, practitioner or other person, any statement as part of, or in support of, a claim for payment or other benefit, knowing that such statement contains false, incomplete, or misleading information concerning any fact or thing material to such claim; or
(b) Any person who, with intent to defraud or deceive an insurer assists, abets, solicits, or conspires with another to prepare or make any statement that is intended to be presented to any insurer, producer, practitioner or other person, in connection with, or in support of, any claim for payment or other benefit, knowing that such statement contains false, incomplete, or misleading information concerning any fact or thing material to such claim;
(c) Any person who, with intent to defraud or deceive, presents or causes to be presented to or by an insurer, a producer, practitioner or other person, a false or altered statement material to an insurance transaction;
(d) Any insurance producer or other person who, with intent to defraud or deceive, willfully takes premium money knowing that insurance coverage will not be effected;
(e) Any practitioner or other person who willfully submits a false or altered statement, with the intent of deceiving an insurer or other person in connection with an insurance transaction or claim;
(f) Anyone willfully making a false statement or material misrepresentation to an insurer, employer, practitioner or other person, with the intent to defraud or deceive an insurer or other person, to obtain or extend worker’s compensation benefits;
(g) Anyone who offers or accepts a direct or indirect inducement to file or solicits another person to file a false statement, with intent to defraud or deceive an insurer;
(h) Any person who, with intent to defraud or deceive, transacts insurance of any kind or character, or transmits for a person other than himself an application for a policy of insurance, without proper licensing or after such license has been suspended or revoked;
(i) Any practitioner or any other person who, with intent to defraud or deceive, employs, uses or acts as a runner for the purpose of submitting a claim containing false, incomplete, or misleading information concerning any fact or thing material to such claim;
(j) Any employer or other person who, with intent to defraud or deceive, presents or causes to be presented to an insurer, producer or any other person or governmental agency any statement containing the number of employees, amount of payroll, job description or job title or any other statement material to worker’s compensation insurance which contains false, misleading or incomplete information; or
(k) Any person who, with intent to defraud or deceive, obstructs the director in the conduct of any authorized examination.
(2) A fact, statement or representation is "material" if it includes any of the following:
(a) Any fact which, if communicated to the producer, insurer, adjuster or representative thereof, would induce him to either decline insurance altogether or not accept it unless a higher premium is paid by the insured;
(b) Any fact relating to a claim for insurance benefits which, if disclosed, would be a fair reason for rejecting a claim for insurance benefits;
(c) Any fact, the knowledge or ignorance of which would naturally influence the insurer in making or refusing the contract, in estimating the degree or character of the risk, or in fixing the rate of premium;
(d) Any fact, the knowledge or ignorance of which would naturally influence the insurer in accepting or rejecting a claim for insurance benefits or compensation, or in determining the amount of compensation or insurance benefits to be paid to the insured; or
(e) Any fact that necessarily has some bearing on the subject matter of the insurance coverage or claim for benefits under an insurance contract.
(3) Any offense committed by use of a telephone, any means of electronic communication or mail as provided by this chapter may be deemed to have been committed at the place from which the telephone call or electronic communication was made, or mail was sent, or the offense may be deemed to have been committed at the place at which the telephone call, electronic communication or mail was received.
(4) Any violator of this section is guilty of a felony and shall be subject to a term of imprisonment not to exceed fifteen (15) years, or a fine not to exceed fifteen thousand dollars ($15,000), or both and shall be ordered to make restitution to the insurer or any other person for any financial loss sustained as a result of a violation of this section. Each instance of violation may be considered a separate offense.
History:
[(41-293) 41-271, added 1981, ch. 23, sec. 3, p. 41; am. and redesig. 1994, ch. 219, sec. 5, p. 699; am. 1997, ch. 122, sec. 2, p. 368; am. 2007, ch. 239, sec. 2, p. 709.]
Structure Idaho Code
Chapter 2 - THE DEPARTMENT OF INSURANCE
Section 41-201 - DEPARTMENT OF INSURANCE.
Section 41-202 - DIRECTOR — APPOINTMENT — TERM — QUALIFICATIONS.
Section 41-203 - TERMS CONSTRUED.
Section 41-204 - DIRECTOR’S OATH AND BOND.
Section 41-205 - OFFICIAL SEAL.
Section 41-206 - DIVISIONS AND EMPLOYEES.
Section 41-207 - DELEGATION OF POWERS.
Section 41-208 - PROHIBITED INTERESTS, REWARDS.
Section 41-209 - PROFESSIONAL SERVICES.
Section 41-210 - GENERAL POWERS, DUTIES.
Section 41-212 - ORDERS, NOTICES.
Section 41-214 - RECORDS — REPRODUCTION — DESTRUCTION.
Section 41-215 - USE OF REPRODUCTIONS AND CERTIFIED COPIES AS EVIDENCE.
Section 41-216 - DIRECTOR’S ANNUAL REPORT.
Section 41-217 - PUBLICATIONS AUTHORIZED.
Section 41-218 - PUBLICATIONS — SALE.
Section 41-219 - EXAMINATION OF INSURERS.
Section 41-220 - EXAMINATION OF AGENTS, BROKERS, CONSULTANTS, MANAGERS, ADJUSTERS, PROMOTERS.
Section 41-221 - PLACE OF EXAMINATION.
Section 41-222 - EXAMINATION COOPERATION WITH OTHER STATES.
Section 41-224 - EXAMINATION — APPRAISAL OF ASSET.
Section 41-225 - OBSTRUCTION OF EXAMINATION — PENALTY.
Section 41-226 - EXAMINERS — QUALIFICATIONS.
Section 41-227 - EXAMINATION REPORT.
Section 41-228 - EXAMINATION EXPENSE.
Section 41-229 - WITNESSES AND EVIDENCE.
Section 41-230 - TESTIMONY COMPELLED — IMMUNITY FROM PROSECUTION.
Section 41-231 - HEARINGS AND APPEAL — SCOPE OF PROVISIONS.
Section 41-232 - HEARINGS IN GENERAL.
Section 41-234 - PLACE OF HEARING — ADMISSION OF PUBLIC.
Section 41-235 - NOTICE OF HEARING.
Section 41-236 - SHOW CAUSE NOTICE.
Section 41-237 - ADJOURNED HEARING.
Section 41-238 - NONATTENDANCE.
Section 41-240 - ORDER ON HEARING.
Section 41-247 - INQUIRY POWERS OF DIRECTOR.
Section 41-248 - INTERSTATE RELATIONS.
Section 41-253 - STATEMENT OF PURPOSE — ADOPTION OF INTERNATIONAL FIRE CODE.
Section 41-255 - DUTIES OF STATE FIRE MARSHAL.
Section 41-256 - ASSISTANTS TO STATE FIRE MARSHAL — LOCAL APPEAL PROCEDURE.
Section 41-257 - STATE FIRE MARSHAL AS CHIEF ARSON INVESTIGATION OFFICER.
Section 41-258 - REPORT OF LOSSES BY FIRE INSURANCE COMPANIES TO STATE FIRE MARSHAL.
Section 41-259 - INSPECTION OF BUILDINGS — ORDER OF REMEDY OR REMOVAL — SERVICE OF ORDER.
Section 41-260 - APPEAL FROM ORDER OF REMEDY OR REMOVAL — APPEAL FROM LOCAL APPEAL DECISION.
Section 41-263 - FAILURE TO PAY EXPENSE OF REPAIR OR DEMOLITION — ASSESSMENT.
Section 41-264 - INVESTIGATIVE HEARINGS — SUBPOENA OF WITNESSES — CONDUCT OF HEARING.
Section 41-265 - WITNESS FEES — CHARGE FOR SERVICE OF PROCESS.
Section 41-266 - ADMISSION OF INTERNATIONAL FIRE CODE IN EVIDENCE.
Section 41-268 - ARSON, FIRE AND FRAUD PREVENTION ACCOUNT.
Section 41-269 - LIBERAL CONSTRUCTION OF ACT.
Section 41-286 - UNIFORM CLAIMS PROCESSING.
Section 41-288 - RETALIATORY REQUIREMENT.
Section 41-290 - FRAUDULENT CLAIMS.
Section 41-292 - DISCLOSURE OF INFORMATION BY INSURERS.
Section 41-293 - INSURANCE FRAUD.
Section 41-294 - DAMAGE TO OR DESTRUCTION OF INSURED PROPERTY.
Section 41-295 - DUTIES OF THE INVESTIGATION SECTION.
Section 41-296 - CONFIDENTIALITY — COMPULSORY TESTIMONY.