§ 58-58-268. Viatical settlement antifraud initiatives. - North Carolina Statutes

§ 58‑58‑268. Viatical settlement antifraud initiatives.

(a)        Viatical settlementproviders and viatical settlement brokers shall have in place antifraudinitiatives reasonably calculated to detect, prosecute, and prevent fraudulentviatical settlement acts. At the discretion of the Commissioner, theCommissioner may order, or a licensee may request and the Commissioner maygrant, such modifications of the following required initiatives as necessary toensure an effective antifraud program. The modifications may be more or lessrestrictive than the required initiatives so long as the modifications mayreasonably be expected to accomplish the purpose of this section.

(b)        Antifraudinitiatives shall include:

(1)        Fraud investigators,who may be viatical settlement provider employees or viatical settlement brokeremployees or independent  contractors; and

(2)        An antifraud plan,which shall be submitted to the Commissioner. The antifraud plan shall include,but not be limited to:

a.         A description of theprocedures for detecting and investigating possible fraudulent viaticalsettlement acts and procedures for resolving material inconsistencies betweenmedical records and insurance applications;

b.         A description of theprocedures for reporting possible fraudulent viatical settlement acts to theCommissioner;

c.         A description of theplan for antifraud education and training of underwriters and other personnel;and

d.         A description orchart outlining the organizational arrangement of the antifraud personnel whoare responsible for the investigation and reporting of possible fraudulentviatical settlement acts and investigating unresolved material inconsistenciesbetween medical records and insurance applications.

(c)        Antifraud planssubmitted to the Commissioner are privileged and confidential, are not publicrecords, and are not subject to discovery or subpoena in a civil or criminalaction. (2001‑436,s. 3.)