new york state laws: Insurance fraud

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INSURANCE FRAUD - Suffolk County

Section 176.00 Insurance fraud;  definition of terms

 The following definitions are applicable to the article:

 1. "Insurance policy" has the meaning assigned to insurance contract by subsection (a) of section one thousand one hundred one of the insurance law except it shall include reinsurance contracts, purported insurance policies and purported reinsurance contracts.

 2. "Statement" includes, but is not limited to, any notice, proof of loss, bill of lading, invoice, account, estimate of property damages, bill for services, diagnosis, prescription, hospital or doctor records, x-ray, test result, and other evidence of loss, injury or expense.

 3. "Person" includes any individual, firm, association or corporation.

 4. "Personal insurance" means a policy of insurance insuring a natural person against any of the following contingencies:

  (a) loss of or damage to real property used predominantly for residential purposes and which consists of not more than four dwelling units, other than hotels, motels and rooming houses;

  (b) loss of or damage to personal property which is not used in the conduct of a business;

  (c) losses or liabilities arising out of the ownership, operation, or use of a motor vehicle, predominantly used for non-business purposes;

  (d) other liabilities for loss of, damage to, or injury to persons or property, not arising from the conduct of a business;

  (e) death, including death by personal injury, or the continuation of life, or personal injury by accident, or sickness, disease or ailment, excluding insurance providing disability benefits pursuant to article nine of the workers' compensation law.

 A policy of insurance which insures any of the contingencies listed in paragraphs (a) through (e) of this subdivision as well as other contingencies shall be personal insurance if that portion of the annual premium attributable to the listed contingencies exceeds that portion attributable to other contingencies.

 5. "Commercial insurance" means insurance other than personal insurance, and shall also include insurance providing disability benefits pursuant to article nine of the workers' compensation law, insurance providing workers' compensation benefits pursuant to the provisions of the workers' compensation law and any program of self insurance providing similar benefits.
 

Section 176.05 Insurance fraud;  defined - Suffolk County

 1. A fraudulent insurance act is committed by any person who, knowingly and with intent to defraud presents, causes to be presented, or prepares with knowledge or belief that it will be presented to or by an insurer, self insurer, or purported insurer, or purported self insurer, or any agent thereof, any written statement as part of, or in support of, an application for the issuance of, or the rating of a commercial insurance policy, or certificate or evidence of self insurance for commercial insurance or commercial self insurance, or a claim for payment or other benefit pursuant to an insurance policy or self insurance program for commercial or personal insurance which he knows to:  (i) contain materially false information concerning any fact material thereto;  or (ii) conceal, for the purpose of misleading, information concerning any fact material thereto.

 2. A fraudulent health care insurance act is committed by any person who, knowingly and with intent to defraud, presents, causes to be presented, or prepares with knowledge or belief that it will be presented to, or by, an insurer or purported insurer or self-insurer, or any agent thereof, any written statement or other physical evidence as part of, or in support of, an application for the issuance of a health insurance policy, or a policy or contract or other authorization that provides or allows coverage for, membership or enrollment in, or other services of a public or private health care plan, or a claim for payment, services or other benefit pursuant to such policy, contract or plan, which he knows to:

  (a) contain materially false information concerning any material fact thereto; or

  (b) conceal, for purposes of misleading, information concerning any fact material thereto.  Such policy or contract or plan or authorization shall include, but not limited to, those issued or operating pursuant to any public or governmentally-sponsored or supported plan for health care coverage or services or those otherwise issued or operated by entities authorized pursuant to the public health law.  For purposes of this subdivision an “application for the issuance of a health insurance policy” shall not include (a) any application for a health insurance policy or contract approved by the superintendent of insurance pursuant to the provisions of sections three thousand two hundred sixteen, four thousand three hundred four, four thousand three hundred twenty-one or four thousand three hundred twenty-two of the insurance law or any other application for a health insurance policy or contract approved by the superintendent of insurance in the individual or direct payment market; and (b) any application for a certificate evidencing coverage under a self-insured plan or under a group contract approved by the superintendent of insurance.
 

Section 176.10 Insurance fraud in the fifth degree - Suffolk County

 A person is guilty of insurance fraud in the fifth degree when he commits a fraudulent insurance act.

 Insurance fraud in the fifth degree is a class A misdemeanor.
 

Section 176.15 Insurance fraud in the fourth degree - Suffolk County

 A person is guilty of insurance fraud in the fourth degree when he commits a fraudulent insurance act and thereby wrongfully takes, obtains or withholds, or attempts to wrongfully take, obtain or withhold property with a value in excess of one thousand dollars.

 Insurance fraud in the fourth degree is a class E felony.
 

Section 176.20 Insurance fraud in the third degree - Suffolk County

 A person is guilty of insurance fraud in the third degree when he commits a fraudulent insurance act and thereby wrongfully takes, obtains or withholds, or attempts to wrongfully take, obtain or withhold property with a value in excess of three thousand dollars.

 Insurance fraud in the third degree is a class D felony.
 

Section 176.25 Insurance fraud in the second degree - Suffolk County

 A person is guilty of insurance fraud in the second degree when he commits a fraudulent insurance act and thereby wrongfully takes, obtains or withholds, or attempts to wrongfully take, obtain or withhold property with a value in excess of fifty thousand dollars.

 Insurance fraud in the second degree is a class C felony.
 

Section 176.30 Insurance fraud in the first degree - Suffolk County

 A person is guilty of insurance fraud in the first degree when he commits a fraudulent insurance act and thereby wrongfully takes, obtains or withholds, or attempts to wrongfully take, obtain or withhold property with a value in excess of one million dollars.

 Insurance fraud in the first degree is a class B felony.
 

Section 176.35 Aggravated insurance fraud - Suffolk County

 A person is guilty of aggravated insurance fraud in the fourth degree when he commits a fraudulent insurance act, and has been previously convicted within the preceding five years of any offense, an essential element of which is the commission of a fraudulent insurance act.

 Aggravated insurance fraud in the fourth degree is a class D felony.

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