States Treatment of Insurance Fraud
June 15, 2015
Insurance fraud costs the industry billions each year. States are working with carriers to try to combat fraud, and have developed statutes making fraud a felony in certain jurisdictions. This chart shows which states have fraud departments, which assess carriers to support state fraud actions, use standardized forms and classify insurance fraud as a felony.
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| Classiï¬cation of Ins fraud as a felony | Uses NAIC Uniform fraud reporting form | Has own fraud referral form | State has fraud department/ bureau/unit | Assess carriers to fund/support fraud division |
| Alabama Code of Ala. §§ 27-12A-1 through 27-12A-42 | x | x |
| x | $200 annually |
| Alaska Alaska Stat. §§21.36.360 through 21.36.410 | x ≥ $500 | x |
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| Arizona A.R.S. §§20-466 through 20-466.04 | x |
| x | x | x |
| Arkansas A.C.A. §§23-66-501 through 23-66-513, 23-100-101 | x | x |
| x | x- fee based on written premium amount-$400 min., $1000 max |
| California Cal Ins Code §§1170(h); 1872.8, 1872.86, 1879.1 through 1879.8 |
x |
| x | x | x- annual assessment to be determined by the commissioner, not to exceed $5,100 |
| Colorado CRS 10-1-128,10-1-129, 10-4-1001 through 10-4-1009, 24-31-104.5; 18-5-211; 3 Colo. Code Regs. § 702-6:6-5-1 | x | x |
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| x- tiered fee schedule, maximum $3000 annual fee |
| Connecticut Conn. Gen. Stat. §§53-440 through 53-445 | x- health ins.
| x | x | x |
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| Delaware 18 Del. C. §§2401 through 2415 | x | x |
| x | $750 annually |
| District of Columbia D.C. Code §§22-3225.01 through 22-3225.13 | x ≥ $1,000 | x | x | x |
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| Florida Fla. Stat. §§626.989, 626.9891, 633.126, 817.234 | x | x |
| x | |
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| Classiï¬cation of Ins fraud as a felony | Uses NAIC Uniform fraud reporting form | Has own fraud referral form | State has fraud department/ bureau/unit | Assess carriers to fund/support fraud division |
| Georgia O.C.G.A. §§33-1-9, 33-1-16, 33-1-17 | x | x |
| x | x- formula based on the kind of company, insurance, income, volume, and other factors the Commissioner determines important |
| Hawaii HRS §§431:2-401 through 431:2-410 | x > $300 |
| x | x |
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| Idaho Idaho Code §§41-268, 41-290 through 41-298 | x | x | x | x | x- portion of the annual continuation fee |
| Illinois 215 ILCS 5/155.23; 740 ILCS 92/1 through 92/45; 820 ILCS 305/25.5 | x ≥ $300 felony w/c |
| x- email | w/c | percentage of funds not awarded to private party |
| Indiana Ind. Code Ann. §§27-1-3-22; 27-2-19-7; 35-43-5-4.5 | x | x |
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| Iowa Iowa Code Ann. §§507E.1 through 507E.8 | x | x |
| x |
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| Kansas K.S.A. §§40-2,118a and 40-2,119 | x ≥ $1,000 | x- | x | x |
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| Kentucky includes w/c KRS §§304.47-010 through 304.47-080 | x > $500 | x |
| x |
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| Louisiana La. R.S. 22:1921 through 22:1929; 40:1425 | x | x |
| x | x- based on premium |
| Maine 24-A M.R.S. §§2186 and 2187 |
| x | x |
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| Classiï¬cation of Ins fraud as a felony | Uses NAIC Uniform fraud reporting form | Has own fraud referral form | State has fraud department/ bureau/unit | Assess carriers to fund/support fraud division |
| Maryland Md. Code Ann., Ins. §§2-401 through 2-408; 6-201 through 6-204; 27-401 through 27-408 | x > $300 |
| x | x | Insurer, health maintenance organization, nonprofit health service plan, fraternal benefit society, or any entity operating other than premium finance company, a fraternal benefit society that collected less than $75,000 premium in preceding year, or a motor club-$1000 by June 30; Producers, public adjusters, insurance adviser, third party administrator-$15 by 6/30; any person with more than one certificate of qualifications, licenses or registrations as producer, public adjuster, insurance adviser or third party administrator- $15 once per renewal period |
| Massachusetts ALM GL ch. 175, §113V; ch. 175H, §§1 through 8; ch. 26, §8B | x | x | x | x | x- auto and workers comp |
| Michigan MCLS §§500.4501 through 500.4511 | x |
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| Minnesota Minn. Stat. §§60A.951 through 60A.956 | x- only misdemeanor | x |
| x |
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| Mississippi Miss. Code Ann. §§7-5-301 through 7-5-309 | x |
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| x | w/c fraud – max 150,000. rest not assessed, from state gen fund |
| Missouri Mo. Ann. Stat. §§375.991 through 375.994 | x |
| x | x |
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| Classiï¬cation of Ins fraud as a felony | Uses NAIC Uniform fraud reporting form | Has own fraud referral form | State has fraud department/ bureau/unit | Assess carriers to fund/support fraud division |
| Nebraska R.R.S. Neb. §§28-631, 44-393, 44-6601 through 44-6608 | x >$500 , 2nd offense any amount | x | x | x | $200 max, w/c & self emp. $1000 max |
| Nevada Nev. Rev. Stat. Ann. §§679B.700; 686A.281 through 686A.295 | x |
| x | x | based on written prem, goes from $500 to $2000 |
| New Hampshire RSA §§400-A:36-b; 402:82; 417:23 through 417:30; 638:20 | x > $1000 |
| x | x |
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| New Jersey N.J. Stat. §§2C:21-4.6; 17:33A-1 through 17:33A-20 | x |
| x | x | max 5% of total cost, based on market share |
| New Mexico N.M. Stat. Ann. §§30-16-6; 59A-16C-1 through 59A-16C-16 | x > $500 |
| x | x | at least $200, no more than 1/10 of direct written premiums |
| New York NY Exec Law §§846-i through 846-m; NY Ins Law §§401 through 409; NY Penal Law §§176.00 through 176.30 | x > $1,000 |
| x | 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 | x | x |
| x |
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| North Dakota N.D. Cent. Code, §§26.1-02.1-01 through 26.1-02-1-11 | x > $1,000 | x |
| x |
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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 > $1,000 |
| x | x |
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| Oklahoma 36 Okl. St. §§361 through 363, 1213, 1219.1, 1219.2, 1220, 1662 | x | x | x | x | $750 annually |
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| Classiï¬cation of Ins fraud as a felony | Uses NAIC Uniform fraud reporting form | Has own fraud referral form | State has fraud department/ bureau/unit | Assess carriers to fund/support fraud division |
| Oregon ORS §§656.360, 657.400, 746.665, 746.685 |
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| Pennsylvania 18 Pa.C.S. §4117, 40 Pa.C.S. §§325.1 through 325.62 | x |
| x | x | x |
| 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- auto |
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| x- handles auto theft and auto fraud |
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| South Carolina S.C. Code Ann. §§38-55-510 through 38-55-590; 38-77-1110 through 38-77-1160 | x ≥ $10,000 first offense. 2nd is felony any amount |
| x | x |
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| South Dakota S.D. Codified Laws §§58-4A-2 and 58-4A-14 | x ≥ $1,000 |
| x | x | each insurer pay a fee of $250 to the Division of Insurance, only when the fund falls below $100,000 |
| Tennessee Tenn. Code Ann. §§56-47-101 through 56-47-112, 56-53-101 through 56-53-112 | x- same as theft |
| x | x |
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| Texas Tex. Ins. Code §§701.001 through 701.003; 701.051 and 701.052; 704.051; Tex. Penal Code §35.02 | x ≥ $1,500 |
| x | x |
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| Utah Utah Code Ann. §§31A-23a-117; 31A-31-101 through 31A-31-111; 31A-36-117; 76-6-521 | x > $1,500 | x |
| x | x- varies based on premiums collected. |
| Vermont 8 V.S.A. §§3671 and 3672, 4750; 13 V.S.A. §§1 and 2031 | x > $900; 2nd offense regardless of value | x | x |
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| Virginia Va. Code Ann. §§18.2-178, 38.2-229, 38.2-415, 38.2-6011, 52-36 through 52-44 | x |
| x | x | x |
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| Classiï¬cation of Ins fraud as a felony | Uses NAIC Uniform fraud reporting form | Has own fraud referral form | State has fraud department/ bureau/unit | Assess carriers to fund/support fraud division |
| Washington Rev. Code Wash. (ARCW) §§48.30A.005 through 48.30A.070; 48.50.010 through 48.50.090 | x |
| x | x |
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| West Virginia W. Va. Code §§33-41-3 through 33-41-12 | x > $1,000 | x |
| x |
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| Wisconsin Wis. Stat. §§895.486 and 943.395 | x > $2,500 |
| x |
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| Wyoming Wyo. Stat. §§26-13-101 through 26-13-125 | x > $1,000 | x |
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