31A-31-103 - Fraudulent insurance act. - Utah Statutes

31A-31-103. Fraudulent insurance act.
(1) A person commits a fraudulent insurance act if that person with intent to deceive ordefraud:
(a) knowingly presents or causes to be presented to an insurer any oral or writtenstatement or representation knowing that the statement or representation contains false,incomplete, or misleading information concerning any fact material to an application for theissuance or renewal of an insurance policy, certificate, or contract;
(b) knowingly presents or causes to be presented to an insurer any oral or writtenstatement or representation:
(i) (A) as part of, or in support of, a claim for payment or other benefit pursuant to aninsurance policy, certificate, or contract; or
(B) in connection with any civil claim asserted for recovery of damages for personal orbodily injuries or property damage; and
(ii) knowing that the statement or representation contains false, incomplete, ormisleading information concerning any fact or thing material to the claim;
(c) knowingly accepts a benefit from the proceeds derived from a fraudulent insuranceact;
(d) assists, abets, solicits, or conspires with another to commit a fraudulent insurance act;
(e) knowingly supplies false or fraudulent material information in any document orstatement required by the department;
(f) knowingly fails to forward a premium to an insurer in violation of Section31A-23a-411.1; or
(g) knowingly employs, uses, or acts as a runner for the purpose of committing afraudulent insurance act.
(2) A service provider commits a fraudulent insurance act if that service provider withintent to deceive or defraud:
(a) knowingly submits or causes to be submitted a bill or request for payment:
(i) containing charges or costs for an item or service that are substantially in excess ofcustomary charges or costs for the item or service; or
(ii) containing itemized or delineated fees for what would customarily be considered asingle procedure or service;
(b) knowingly furnishes or causes to be furnished an item or service to a person:
(i) substantially in excess of the needs of the person; or
(ii) of a quality that fails to meet professionally recognized standards;
(c) knowingly accepts a benefit from the proceeds derived from a fraudulent insuranceact; or
(d) assists, abets, solicits, or conspires with another to commit a fraudulent insurance act.
(3) An insurer commits a fraudulent insurance act if that insurer with intent to deceive ordefraud:
(a) knowingly withholds information or provides false or misleading information withrespect to an application, coverage, benefits, or claims under a policy or certificate;
(b) assists, abets, solicits, or conspires with another to commit a fraudulent insurance act;
(c) knowingly accepts a benefit from the proceeds derived from a fraudulent insuranceact; or
(d) knowingly supplies false or fraudulent material information in any document or

statement required by the department.
(4) An insurer or service provider is not liable for any fraudulent insurance actcommitted by an employee without the authority of the insurer or service provider unless theinsurer or service provider knew or should have known of the fraudulent insurance act.

Amended by Chapter 104, 2004 General Session