RSA 638:20 · Insurance Fraud

638:20 Insurance Fraud. –

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I.

In this section:

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(a)

"Bidding" includes a bid made as any contractor, general contractor, or subcontractor.

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(b)

"Financial interest" means any direct or indirect interest in the entity, whether as an owner, partner, officer, manager, employee, agent, consultant, advisor, or representative, but does not include an employee who does not participate in management of the entity and ownership in a mutual or common investment fund that holds securities unless the person participates in the management of the fund.

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(c)

"Insurance policy" includes an actual or purported insurance policy.

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(d)

"Insurer" includes any insurance company, health maintenance organization, or reinsurance company, or broker or agent thereof, or insurance claims adjuster.

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(e)

"Participating in public works projects" means bidding or working on any public works project or holding any financial interest in any entity bidding or working on any public works project.

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(f)

"Public works project" means any construction project financed by public funds.

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(g)

"Statement" includes, but is not limited to, any notice, statement, proof of loss, bill of lading, receipt of payment, invoice, account, estimate of property damages, bill for service, diagnosis, prescription, hospital or doctor records, x-rays, test results, or other evidence of loss, injury, or expense. I-a. [Repealed.]

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II.

A person is guilty of insurance fraud, if, such person knowingly and with intent to injure, defraud or deceive any insurer, conceals or causes to be concealed from any insurer a material statement, or presents or causes to be presented to any insurer, or prepares with knowledge or belief that it will be so presented, any written or oral statement including computer-generated documents, knowing that such statement contains any false, incomplete or misleading information which is material to:

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(a)

An application for the issuance of any insurance policy.

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(b)

The rating of any insurance policy.

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(c)

A claim for payment or benefit pursuant to any insurance policy.

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(d)

Premiums on any insurance policy.

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(e)

Payments made in accordance with the terms of any insurance policy.

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III.

A person is guilty as an accomplice to insurance fraud, if, with a purpose to injure, defraud or deceive any insurer, the person assists, abets, solicits or conspires with another to commit insurance fraud, as defined in paragraph II of this section.

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IV.

(a) Insurance fraud is:

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(1)

A class A felony if the value of the fraudulent portion of the claim for payment or other benefit pursuant to an insurance policy is more than $1,500.

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(2)

A class B felony if the value of the fraudulent portion of the claim for payment or other benefit pursuant to an insurance policy is more than $1,000, but not more than $1,500.

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(3)

A misdemeanor in all other cases.

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(b)

The value shall be determined according to the provisions of RSA 637:2, V.

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V.

[Repealed.]

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VI.

In addition to any other penalty authorized by law, any person convicted of violating subparagraphs II(a), (b), or (d) relative to a workers' compensation insurance policy shall, as a condition of his or her sentence, be prohibited from participating in any public works projects for a period of no less than one year and no more than 3 years and shall be ordered to pay restitution to its workers' compensation carrier, as determined by the sentencing court. Any person convicted of a third or subsequent violation may, as a condition of his or her sentence, be permanently banned from participating in any public works projects. For the purposes of this paragraph, "restitution" means the difference between the premium actually charged and the premium amount that would have been charged if accurate information had been provided to the carrier, provided that the carrier is not compensated by the offender more than once.

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VII.

The commissioner of the department of administrative services shall maintain a list of persons who have been banned from participating in public works projects under this section. Such list shall be a public record under 91-A. Source. 1991, 248:1. 1993, 239:4, 5. 1996, 285:257. 2001, 224:12, II. 2008, 378:5, 6. 2010, 239:11, eff. July 1, 2010.

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