SECTIONS 548-551 - California Statutes

PENAL CODE

SECTION 548-551

548. (a) Every person who willfully injures, destroys, secretes,
abandons, or disposes of any property which at the time is insured
against loss or damage by theft, or embezzlement, or any casualty
with intent to defraud or prejudice the insurer, whether the property
is the property or in the possession of such person or any other
person, is punishable by imprisonment in the state prison for two,
three, or five years and by a fine not exceeding fifty thousand
dollars ($50,000).
For purposes of this section, "casualty" does not include fire.
(b) Any person who violates subdivision (a) and who has a prior
conviction of the offense set forth in that subdivision, in Section
550 of this code, or in former Section 556 or former Section 1871.1
of the Insurance Code, shall receive a two-year enhancement for each
prior conviction in addition to the sentence provided under
subdivision (a). The existence of any fact which would subject a
person to a penalty enhancement shall be alleged in the information
or indictment and either admitted by the defendant in open court, or
found to be true by the jury trying the issue of guilt or by the
court where guilt is established by plea of guilty or nolo contendere
or by trial by the court sitting without a jury.

549. Any firm, corporation, partnership, or association, or any
person acting in his or her individual capacity, or in his or her
capacity as a public or private employee, who solicits, accepts, or
refers any business to or from any individual or entity with the
knowledge that, or with reckless disregard for whether, the
individual or entity for or from whom the solicitation or referral is
made, or the individual or entity who is solicited or referred,
intends to violate Section 550 of this code or Section 1871.4 of the
Insurance Code is guilty of a crime, punishable upon a first
conviction by imprisonment in the county jail for not more than one
year or by imprisonment in the state prison for 16 months, two years,
or three years, or by a fine not exceeding fifty thousand dollars
($50,000) or double the amount of the fraud, whichever is greater, or
by both that imprisonment and fine. A second or subsequent
conviction is punishable by imprisonment in the state prison or by
imprisonment in the state prison and a fine of fifty thousand dollars
($50,000). Restitution shall be ordered, including restitution for
any medical evaluation or treatment services obtained or provided.
The court shall determine the amount of restitution and the person or
persons to whom the restitution shall be paid.

550. (a) It is unlawful to do any of the following, or to aid,
abet, solicit, or conspire with any person to do any of the
following:
(1) Knowingly present or cause to be presented any false or
fraudulent claim for the payment of a loss or injury, including
payment of a loss or injury under a contract of insurance.
(2) Knowingly present multiple claims for the same loss or injury,
including presentation of multiple claims to more than one insurer,
with an intent to defraud.
(3) Knowingly cause or participate in a vehicular collision, or
any other vehicular accident, for the purpose of presenting any false
or fraudulent claim.
(4) Knowingly present a false or fraudulent claim for the payments
of a loss for theft, destruction, damage, or conversion of a motor
vehicle, a motor vehicle part, or contents of a motor vehicle.
(5) Knowingly prepare, make, or subscribe any writing, with the
intent to present or use it, or to allow it to be presented, in
support of any false or fraudulent claim.
(6) Knowingly make or cause to be made any false or fraudulent
claim for payment of a health care benefit.
(7) Knowingly submit a claim for a health care benefit that was
not used by, or on behalf of, the claimant.
(8) Knowingly present multiple claims for payment of the same
health care benefit with an intent to defraud.
(9) Knowingly present for payment any undercharges for health care
benefits on behalf of a specific claimant unless any known
overcharges for health care benefits for that claimant are presented
for reconciliation at that same time.
(10) For purposes of paragraphs (6) to (9), inclusive, a claim or
a claim for payment of a health care benefit also means a claim or
claim for payment submitted by or on the behalf of a provider of any
workers' compensation health benefits under the Labor Code.
(b) It is unlawful to do, or to knowingly assist or conspire with
any person to do, any of the following:
(1) Present or cause to be presented any written or oral statement
as part of, or in support of or opposition to, a claim for payment
or other benefit pursuant to an insurance policy, knowing that the
statement contains any false or misleading information concerning any
material fact.
(2) Prepare or make any written or oral statement that is intended
to be presented to any insurer or any insurance claimant in
connection with, or in support of or opposition to, any claim or
payment or other benefit pursuant to an insurance policy, knowing
that the statement contains any false or misleading information
concerning any material fact.
(3) Conceal, or knowingly fail to disclose the occurrence of, an
event that affects any person's initial or continued right or
entitlement to any insurance benefit or payment, or the amount of any
benefit or payment to which the person is entitled.
(4) Prepare or make any written or oral statement, intended to be
presented to any insurer or producer for the purpose of obtaining a
motor vehicle insurance policy, that the person to be the insured
resides or is domiciled in this state when, in fact, that person
resides or is domiciled in a state other than this state.
(c) (1) Every person who violates paragraph (1), (2), (3), (4), or
(5) of subdivision (a) is guilty of a felony punishable by
imprisonment in the state prison for two, three, or five years, and
by a fine not exceeding fifty thousand dollars ($50,000), or double
the amount of the fraud, whichever is greater.
(2) Every person who violates paragraph (6), (7), (8), or (9) of
subdivision (a) is guilty of a public offense.
(A) When the claim or amount at issue exceeds nine hundred fifty
dollars ($950), the offense is punishable by imprisonment in the
state prison for two, three, or five years, or by a fine not
exceeding fifty thousand dollars ($50,000) or double the amount of
the fraud, whichever is greater, or by both that imprisonment and
fine, or by imprisonment in a county jail not to exceed one year, by
a fine of not more than ten thousand dollars ($10,000), or by both
that imprisonment and fine.
(B) When the claim or amount at issue is nine hundred fifty
dollars ($950) or less, the offense is punishable by imprisonment in
a county jail not to exceed six months, or by a fine of not more than
one thousand dollars ($1,000), or by both that imprisonment and
fine, unless the aggregate amount of the claims or amount at issue
exceeds nine hundred fifty dollars ($950) in any 12-consecutive-month
period, in which case the claims or amounts may be charged as in
subparagraph (A).
(3) Every person who violates paragraph (1), (2), (3), or (4) of
subdivision (b) shall be punished by imprisonment in the state prison
for two, three, or five years, or by a fine not exceeding fifty
thousand dollars ($50,000) or double the amount of the fraud,
whichever is greater, or by both that imprisonment and fine, or by
imprisonment in a county jail not to exceed one year, or by a fine of
not more than ten thousand dollars ($10,000), or by both that
imprisonment and fine.
(4) Restitution shall be ordered for a person convicted of
violating this section, including restitution for any medical
evaluation or treatment services obtained or provided. The court
shall determine the amount of restitution and the person or persons
to whom the restitution shall be paid.
(d) Notwithstanding any other provision of law, probation shall
not be granted to, nor shall the execution or imposition of a
sentence be suspended for, any adult person convicted of felony
violations of this section who previously has been convicted of
felony violations of this section or Section 548, or of Section
1871.4 of the Insurance Code, or former Section 556 of the Insurance
Code, or former Section 1871.1 of the Insurance Code as an adult
under charges separately brought and tried two or more times. The
existence of any fact that would make a person ineligible for
probation under this subdivision shall be alleged in the information
or indictment, and either admitted by the defendant in an open court,
or found to be true by the jury trying the issue of guilt or by the
court where guilt is established by plea of guilty or nolo contendere
or by trial by the court sitting without a jury.
Except when the existence of the fact was not admitted or found to
be true or the court finds that a prior felony conviction was
invalid, the court shall not strike or dismiss any prior felony
convictions alleged in the information or indictment.
This subdivision does not prohibit the adjournment of criminal
proceedings pursuant to Division 3 (commencing with Section 3000) or
Division 6 (commencing with Section 6000) of the Welfare and
Institutions Code.
(e) Except as otherwise provided in subdivision (f), any person
who violates subdivision (a) or (b) and who has a prior felony
conviction of an offense set forth in either subdivision (a) or (b),
in Section 548, in Section 1871.4 of the Insurance Code, in former
Section 556 of the Insurance Code, or in former Section 1871.1 of the
Insurance Code shall receive a two-year enhancement for each prior
felony conviction in addition to the sentence provided in subdivision
(c). The existence of any fact that would subject a person to a
penalty enhancement shall be alleged in the information or indictment
and either admitted by the defendant in open court, or found to be
true by the jury trying the issue of guilt or by the court where
guilt is established by plea of guilty or nolo contendere or by trial
by the court sitting without a jury. Any person who violates this
section shall be subject to appropriate orders of restitution
pursuant to Section 13967 of the Government Code.
(f) Any person who violates paragraph (3) of subdivision (a) and
who has two prior felony convictions for a violation of paragraph (3)
of subdivision (a) shall receive a five-year enhancement in addition
to the sentence provided in subdivision (c). The existence of any
fact that would subject a person to a penalty enhancement shall be
alleged in the information or indictment and either admitted by the
defendant in open court, or found to be true by the jury trying the
issue of guilt or by the court where guilt is established by plea of
guilty or nolo contendere or by trial by the court sitting without a
jury.
(g) Except as otherwise provided in Section 12022.7, any person
who violates paragraph (3) of subdivision (a) shall receive a
two-year enhancement for each person other than an accomplice who
suffers serious bodily injury resulting from the vehicular collision
or accident in a violation of paragraph (3) of subdivision (a).
(h) This section shall not be construed to preclude the
applicability of any other provision of criminal law or equitable
remedy that applies or may apply to any act committed or alleged to
have been committed by a person.
(i) Any fine imposed pursuant to this section shall be doubled if
the offense was committed in connection with any claim pursuant to
any automobile insurance policy in an auto insurance fraud crisis
area designated by the Insurance Commissioner pursuant to Article 4.6
(commencing with Section 1874.90) of Chapter 12 of Part 2 of
Division 1 of the Insurance Code.

551. (a) It is unlawful for any automotive repair dealer,
contractor, or employees or agents thereof to offer to any insurance
agent, broker, or adjuster any fee, commission, profit sharing, or
other form of direct or indirect consideration for referring an
insured to an automotive repair dealer or its employees or agents for
vehicle repairs covered under a policyholder's automobile physical
damage or automobile collision coverage, or to a contractor or its
employees or agents for repairs to or replacement of a structure
covered by a residential or commercial insurance policy.
(b) Except in cases in which the amount of the repair or
replacement claim has been determined by the insurer and the repair
or replacement services are performed in accordance with that
determination or in accordance with provided estimates that are
accepted by the insurer, it is unlawful for any automotive repair
dealer, contractor, or employees or agents thereof to knowingly offer
or give any discount intended to offset a deductible required by a
policy of insurance covering repairs to or replacement of a motor
vehicle or residential or commercial structure. This subdivision does
not prohibit an advertisement for repair or replacement services at
a discount as long as the amount of the repair or replacement claim
has been determined by the insurer and the repair or replacement
services are performed in accordance with that determination or in
accordance with provided estimates that are accepted by the insurer.
(c) A violation of this section is a public offense. Where the
amount at issue exceeds nine hundred fifty dollars ($950), the
offense is punishable by imprisonment in the state prison for 16
months, or 2 or 3 years, by a fine of not more than ten thousand
dollars ($10,000), or by both that imprisonment and fine; or by
imprisonment in a county jail not to exceed one year, by a fine of
not more than one thousand dollars ($1,000), or by both that
imprisonment and fine. In all other cases, the offense is punishable
by imprisonment in a county jail not to exceed six months, by a fine
of not more than one thousand dollars ($1,000), or by both that
imprisonment and fine.
(d) Every person who, having been convicted of subdivision (a) or
(b), or Section 7027.3 or former Section 9884.75 of the Business and
Professions Code and having served a term therefor in any penal
institution or having been imprisoned therein as a condition of
probation for that offense, is subsequently convicted of subdivision
(a) or (b), upon a subsequent conviction of one of those offenses,
shall be punished by imprisonment in the state prison for 16 months,
or 2 or 3 years, by a fine of not more than ten thousand dollars
($10,000), or by both that imprisonment and fine; or by imprisonment
in a county jail not to exceed one year, by a fine of not more than
one thousand dollars ($1,000), or by both that imprisonment and fine.
(e) For purposes of this section:
(1) "Automotive repair dealer" means a person who, for
compensation, engages in the business of repairing or diagnosing
malfunctions of motor vehicles.
(2) "Contractor" has the same meaning as set forth in Section 7026
of the Business and Professions Code.