Insurance Fraud Warning
Any person who knowingly and with intent to defraud any insurance
company or another person files an application for insurance or statement of claim
containing any materially false information, or conceals for the purpose of misleading
information concerning any fact material thereto, commits a fraudulent insurance act, which
is a crime in certain jurisdictions, and subjects the person to criminal and civil
penalties.
State Specific Fraud Warning Statements
The fraud warnings listed below are applicable in the following states:
AL, AK, AZ, AR, CA, CO, DE, DC, FL, HI, ID, IN, KY, LA, ME, MD, MA, MN,NE, NH, NJ, NM, NY,
OH, OK, OR, PA, TN, TX, VT, VA, WA, or WV. If you are located in one of these states, please
take time to review the appropriate warning prior to submitting your claim.
Alabama: Any person who knowingly presents a false or fraudulent claim for payment of
a
loss or benefit or who knowingly presents false information in an application for insurance
is guilty of a crime and may be subject to restitution, fines, or confinement in prison, or
any combination thereof.
Alaska: Any person who knowingly and with intent to injure, defraud, or deceive an
insurance company files a claim containing false, incomplete, or misleading information may
be prosecuted under state law.
Arizona: For your protection, Arizona law requires the following statement to appear
on this form: Any person who knowingly presents a false or fraudulent claim for payment of a
loss is subject to criminal and civil penalties.
Arkansas: Any person who knowingly presents a false or fraudulent claim for payment of
a loss or benefit or knowingly presents false information in an application for insurance is
guilty of a crime and may be subject to fines and confinement in prison.
California: For your protection, California law requires the following to appear onFor your protection, California law requires the following to appear on this form: Any person who knowingly presents a false or fraudulent information to obtain or amend insurance coverage or to make a claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison.
Colorado: It is unlawful to knowingly provide false, incomplete, or misleading facts
or information to an insurance company for the purpose of defrauding or attempting to
defraud the company. Penalties may include imprisonment, fines, denial of insurance, and
civil damages. Any insurance company or agent of an insurance company who knowingly provides
false, incomplete, or misleading facts or information to a policyholder or claimant for the
purpose of defrauding or attempting to defraud the policyholder or claimant with regard to a
settlement or award payable from insurance proceeds shall be reported to the Colorado
Division of Insurance within the Department of Regulatory Agencies.
Delaware: WARNING: It is a crime to provide false or misleading information to an
insurer for the purpose of defrauding the insurer or any other person. Penalties include
imprisonment and/or fines. In addition, an insurer may deny insurance benefits if false
information materially related to a claim was provided by the applicant.
District of Columbia: Any person who knowingly, and with intent to injure, defraud or
deceive any insurer, files a statement of claim containing any false, incomplete or
misleading information is guilty of a felony.
Florida: Any person who knowingly and with intent to injure, defraud, or deceive any
insurer files a statement of claim or an application containing any false, incomplete, or
misleading information is guilty of a felony of the third degree.
Hawaii: For your protection, Hawaii law requires you to be informed that presenting a
fraudulent claim for payment of a loss or benefit is a crime punishable by fines or
imprisonment, or both.
Idaho: Any person who knowingly, and with intent to defraud or deceive any insurance
company files a statement of claim containing any false, incomplete, or misleading
information is guilty of a felony.
Indiana: A person who knowingly and with intent to defraud an insurer files a
statement of claim containing any false, incomplete, or misleading information commits a
felony.
Kentucky: Any person who knowingly and with intent to defraud any insurance company or
other person files a statement of claim containing any materially false information or
conceals, for the purpose of misleading, information concerning any fact material thereto,
commits a fraudulent insurance act, which is a crime.
Louisiana: Any person who knowingly presents a false or fraudulent claim for payment
of a loss or benefit or knowingly presents false information in an application for insurance
is guilty of a crime and may be subject to fines and confinement in prison.
Maine: It is a crime to knowingly provide false, incomplete, or misleading information
to an insurance company for the purpose of defrauding the company. Penalties may include
imprisonment, fines, or a denial of insurance benefits.
Massachusetts: Any person who knowingly and with intent to defraud any insurance
company or another person files an application for insurance or statement of claim
containing any materially false information, or conceals for the purpose of misleading
information concerning any fact material thereto, may be committing a fraudulent insurance
act, which may be a crime and may subject the person to criminal and civil penalties.
Minnesota: A person who files a claim with intent to defraud, or helps commit a fraud
against an insurer, is guilty of a crime.
Nebraska: Any person who knowingly and with intent to defraud any insurance company or
another person files an application for insurance or statement of claim containing any
materially false information, or conceals for the purpose of misleading information
concerning any fact material thereto, may be committing a fraudulent insurance act, which
may be a crime and may subject the person to criminal and civil penalties.
New Hampshire: Any person who, with a purpose to injure, defraud or deceive any
insurance company, files a statement of claim containing any false, incomplete or misleading
information is subject to prosecution and punishment for insurance fraud, as provided in RSA
638:20.
New Jersey: Any person who knowingly files a statement of claim containing any false
or misleading information is subject to criminal and civil penalties.
New Mexico: Any person who knowingly presents a false or fraudulent claim for payment
of a loss or benefit or knowingly presents false information in an application for insurance
is guilty of a crime and may be subject to civil fines and criminal penalties.
New York: Any person who knowingly and with intent to defraud any insurance company or
other person files an application for insurance or statement of claim containing any
materially false information, or conceals for the purpose of misleading, information
concerning any fact material thereto, commits a fraudulent insurance act, which is a crime,
and shall also be subject to a civil penalty not to exceed five thousand dollars and the
stated value of the claim for each such violation.
Ohio: Any person who, with intent to defraud or knowing that he is facilitating a
fraud against an insurer, submits an application or files a claim containing a false or
deceptive statement is guilty of insurance fraud.
Oklahoma: WARNING: Any person who knowingly, and with intent to injure, defraud or
deceive any insurer, makes any claim for the proceeds of an insurance policy containing any
false, incomplete or misleading information is guilty of a felony.
Oregon: Any person who knowingly and with intent to defraud or solicit another to
defraud an insurer: (1) by submitting an application, or (2) by filing a claim containing a
false statement as to any material fact thereto, may be committing a fraudulent insurance
act, which may be a crime and may subject the person to criminal and civil penalties.
Pennsylvania: Any person who knowingly and with intent to defraud any insurance
company or other person files an application for insurance or statement of claim containing
any materially false information or conceals for the purpose of misleading, information
concerning any fact material thereto commits a fraudulent act, which is a crime and subjects
such person to criminal and civil penalties.
Tennessee: It is a crime to knowingly provide false, incomplete or misleading
information to an insurance company for the purpose of defrauding the company. Penalties
include imprisonment, fines and denial of insurance benefits.
Texas: Any person who knowingly presents a false or fraudulent claim for the payment
of a loss is guilty of a crime and may be subject to fines and confinement in state prison.
Virginia: It is a crime to knowingly provide false, incomplete or misleading
information to an insurance company for the purpose of defrauding the company. Penalties
include imprisonment, fines and denial of insurance benefits.
Washington: It is a crime to knowingly provide false, incomplete, or misleading
information to an insurance company for the purpose of defrauding the company. Penalties may
include imprisonment, fines, or denial of insurance benefits.
West Virginia: Any person who knowingly presents a false or fraudulent claim for
payment of a loss or benefit or knowingly presents false information in an application for
insurance is guilty of a crime and may be subject to fines and confinement in prison.
*APPLIES TO GEORGIA, VIRGINIA APPLICANTS ONLY: The Insured represents that the
information furnished in this application is complete, true and correct. It is further
agreed that if the above described declarations and statements are not true, accurate and
complete, and are deemed material to the issuance of this Policy, any claim arising from any
matter not truthfully, accurately or completely disclosed, or disclosed at all, shall be
excluded from coverage.