New York Insurance Fraud Laws

Statutes

Definition of General Insurance Fraud

A fraudulent insurance act is committed by any person who, knowingly and with intent to defraud presents, causes to be presented, or prepares with knowledge or belief that it will be presented to or by an insurer, self insurer, or purported insurer, or purported self insurer, or any agent thereof:

1. Any written statement pertaining to a commercial insurance policy or a claim for payment that he or she knows to:

• Contain materially false information concering any fact material thereto; or
• Conceal, for the purpose of misleading , information concerning any fact material thereto; or

2. Any written statement or other physical evidence pertaining to a health insurance policy that he or she knows to:

• Contain materially false information concerning any material fact thereto; or
• Conceal, for the purpose of misleading , information concerning any fact material thereto.

Definition of Life Settlement Fraud

A fraudulent life settlement act is committed by any person who, knowingly and with intent to defraud , presents, causes to be presented, or prepares with knowledge or belief that it will be presented to, or by, a life settlement provider, a claim for payment or other benefit under a life settlement contract, which the person knows to:

• Contain materially false information concerning any material fact thereto; or
• Conceal, for the purpose of misleading, information concerning any fact material thereto.

Crime Classifications

General Insurance Fraud

• Fifth Degree: Commission of a fraudulent insurance act; class A misdemeanor.
• Fourth Degree: Involving the taking or attempted taking of property valued in excess of $1,000; class E felony.
• Third Degree: Involving the taking or attempted taking of property valued in excess of $3,000; class D felony.
• Second Degree: Involving the taking or attempted taking of property valued in excess of $50,000; class C felony.
• First Degree: Involving the taking or attempted taking of property valued in excess of $1 million; class B felony.
• Aggravated Insurance Fraud in the Fourth Degree: When the perpetrator commits insurance fraud and has been previously committed of a similar crime within the preceding 5 years; class D felony.

Life Settlement Fraud

• Fifth Degree: Commission of fraudulent life settlement act; class A misdemeanor.
• Fourth Degree: Involving the taking or attempted taking of property valued in excess of $25,000; class E felony.
• Third Degree: Involving the taking or attempted taking of property valued in excess of $50,000; class D felony.
• Second Degree: Involving the taking or attempted taking of property valued in excess of $100,000; class C felony.
• Second Degree: Involving the taking or attempted taking of property valued in excess of $1 million; class B felony.
• Aggravated Life Settlement Fraud: When the perpetrator commits life settlement fraud and has been previously committed of a similar crime within the preceding 5 years; class D felony.

Penalties

• Class A Misdemeanor: Up to 1 year in jail, up to $1,000 in fines
• Class E Felony: Up to 4 years in prison (min. 1 yr.)
• Class D Felony: Up to 7 years in prison (min. 1 yr.)
• Class C Felony: Up to 15 years in prison (min. 1 yr.)
• Class B Felony: Up to 25 years in prison (min. between 1 yr. and one-third of maximum sentence)