Fraud Requirements for Insurance Companies
June 15, 2015
In order to control insurance fraud, states require certain actions by companies. This chart shows which states require carriers to have statements disclaiming fraud on claim submission forms, which states require the submission of formal fraud plans to the state, which states require the existence of fraud plans and which require an annual summary of actions and results of fraud plans.
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| Fraud statement required on claim form | Company must submit fraud plan to state | Company must have fraud plan in place | Annual summary of action of fraud plans required |
| Alabama Code of Ala. 27-12A-1 through 27-12A-42 | x |
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| Alaska Alaska Stat. §§21.36.360 through 21.36.410 | x |
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| Arizona A.R.S. §§20-466.01, 20-466, 20-452.04 |
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| Arkansas A.C.A. §§23-66-501 through 23-66-513, 23-100-101 | x- not reinsurance | x- if have plan, submit | x- or other initiative; hire investigators, etc. |
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| California doesn't apply to reins. Cal Ins Code §§1872.8, 1879.1 through 1879.8 | x | x | x | x |
| Colorado doesn't apply to reins. CRS 10-1-128,10-1-129, 10-4-1001 through 10-4-1009 | x- apps, or pol or claim forms |
| x | x |
| Connecticut Conn. Gen. Stat. §§53-440 through 53-445 |
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| Delaware 18 Del. C. §§2401 through 2415 |
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| Fraud statement required on claim form | Company must submit fraud plan to state | Company must have fraud plan in place | Annual summary of action of fraud plans required |
| District of Columbia Not to reinsurers D.C. Code §§22-3225.01 through 22-3225.13 | x & app | x | x | x |
| Florida Fla. Stat. §§626.989, 626.9891, 633.126, 817.234 |
| x- less than 10 mil dwp, or can opt to set up unit | x | w/c only |
| Georgia O.C.G.A. §§33-1-9, 33-1-16, 33-1-17 |
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| Hawaii HRS §§431:2-401 through 431:2-410 |
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| Idaho Idaho Code §§41-268, 41-290 through 41-298 |
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| Indiana Ind. Code Ann. §§27-1-3-22; 27-2-19-7; 35-43-5-4.5 |
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| Iowa Iowa Code §§507E.1 through 507E.8 |
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| Kansas K.S.A. §§40-2,118a and 40-2,119 |
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| x |
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| Kentucky includes w/c KRS §§304.47-010 through 304.47-080 | x- & apps, does not apply to reins |
| x |
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| Louisiana La. R.S. 22:1921 through 22:1929; 40:1425 |
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| Maine 24-A M.R.S. §§2186 and 2187 | x & app |
| x | x |
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| Fraud statement required on claim form | Company must submit fraud plan to state | Company must have fraud plan in place | Annual summary of action of fraud plans required |
| Maryland Md. INSURANCE Code Ann. §§2-401 through 2-408; 6-201 through 6-204; 27-401 through 27-408 | x- not including reinsurers | x | x |
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| Massachusetts ALM GL ch. 175, §113V; ch. 175H, §§1 through 8; ch. 26, §8B |
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| Michigan MCLS §§500.4501 through 500.4511 |
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| Minnesota Minn. Stat. §§60A.951 through 60A.956 | x | commissioner must be notiï¬ed of plan in writing | x- except rein. excess, w/c, self |
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| Mississippi Miss. Code Ann. §§7-5-301 through 7-5-309 |
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| Missouri §§375.991 through 375.994 R.S.Mo. |
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| Montana §§33-1-1201 through 33-1-1211, 11-1-1301 through 11-1-1303, MCA |
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| Nebraska R.R.S. Neb. §§28-631, 44-393, 44-6601 through 44-6608 | viatical statements -contracts & apps for stmt |
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| Nevada Nev. Rev. Stat. Ann. §§686A.281 through 686A.295 |
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| New Hampshire RSA §§400-A:36-b; 402:82; 417:23 through 417:30; 638:20 | x | x- unless writes only credit, home warranty, travel, title | x- unless writes only credit, home warranty, travel, title |
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| Fraud statement required on claim form | Company must submit fraud plan to state | Company must have fraud plan in place | Annual summary of action of fraud plans required |
| New Jersey N.J. Stat. §§2C:21-4.6; 17:33A-1 through 17:33A-20 | x & apps | health and pp auto | health and pp auto |
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| New Mexico N.M. Stat. Ann. §§30-16-6; 59A-16C-1 through 59A-16C-16 | x & app | x- if prior year had 10 mil wp | x |
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| New York NY CLS Exec §§846-i through 846-m; NY CLS Ins §§401 through 409; NY CLS Penal §§176.00 through 176.30 | x & apps | >3000 pol | x |
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| North Carolina N.C. Gen. Stat. §§58-2-155 through 58-2-163; 58-2-180 through 58-2-230 |
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| North Dakota N.D. Cent. Code, §§26.1-02.1-01 through 26.1-02-1-11 |
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| Ohio Viatical settlements separately listed ORC Ann. 2913.47; 3901.44; 3916.18; 3999.21, 3999.31, 3999.41, 3999.42 | x- & app & viatical settlement app/ contract | may req viatical settlement | all insurers |
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| Oklahoma 36 Okl. St. §§361 through 363, 1213, 1219.1, 1219.2, 1220, 1662 |
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| Oregon ORS §§656.360, 657.400, 746.665, 746.685 |
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| Fraud statement required on claim form | Company must submit fraud plan to state | Company must have fraud plan in place | Annual summary of action of fraud plans required |
| Pennsylvania 18 Pa.C.S. §4117, 40 Pa.C.S. §§325.1 through 325.62 | App & claims |
| x |
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| Rhode Island R.I. Gen. Laws §§11-18-1.1; 11-41-29; 27-49-1 through 27-49-6; 27-54-1 through 27-54-4; 27-54.1-3; 27-63-1; 31-50-1
| x & app. |
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| South Carolina S.C. Code Ann. §§38-55-510 through 38-55-590; 38-77-1110 through 38-77-1160 |
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| South Dakota S.D. Codified Laws §§58-4A-2 and 58-4A-14 |
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| Tennessee Tenn. Code Ann. §§56-47-101 through 56-47-112, 56-53-101 through 56-53-112 | app & claims – not reinsurance |
| x- over 10 mil dwp |
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| Texas Tex. Ins. Code §§701.001 through 701.003; 701.051 and 701.052; 701.101 through 701.109; 701.151 through 701.154; 704.051; Tex. Penal Code §35.02 |
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| x- for plan issuers who collect direct written premiums | x- for plan issuers who collect direct written premiums |
| Utah Utah Code Ann. §§31A-23a-117; 31A-31-101 through 31A-31-111; 31A-36-117; 76-6-521 |
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| x- viatical settlements |
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| Fraud statement required on claim form | Company must submit fraud plan to state | Company must have fraud plan in place | Annual summary of action of fraud plans required |
| Vermont 8 V.S.A. §§3671 and 3672, 4750; 13 V.S.A. §§1 and 2031 |
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| x | may require for plan issuers who collect direct written premiums |
| Virginia Va. Code Ann. §§18.2-178, 38.2-229, 38.2-415, 38.2-6011, 52-36 through 52-44 | x- & app |
| viatical |
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| Washington Rev. Code Wash. (ARCW) §§48.30A.005 through 48.30A.070; 48.50.010 through 48.50.090 |
| x- with certain exceptions | x | x |
| West Virginia W. Va. Code §§33-41-3 through 33-41-12 | x- & app- may, not req |
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| Wisconsin Wis. Stat. §§895.486 and 943.395 |
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| Wyoming Wyo. Stat. §§26-13-101 through 26-13-125 |
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