Utah Insurance Fraud Laws

UTAH CODE §§ 76-6-521, 31A-31-103, and 32A-2-110

Insurance fraud :

Consists of performing any of the following intentional acts:

• Providing false, incomplete, or misleading information material to an insurance application, either in writing or orally
• Proving false, incomplete, or misleading information in order to obtain insurance benefits or damages related to a civil claim for personal or bodily injury or property damage
• Accepting a benefit from insurance fraud proceeds
• Intentionally or recklessly devising a scheme or device to obtain professional service fees or anything of value through false or fraudulent pretenses, representations, promises, or material omissions
• Aiding, soliciting, or conspiring with another person to commit insurance fraud
• Supplying false or fraudulent material information in a document or statement required by the insurance department
• Failing to forward a premium to an insurer
• Employing, using, or acting as a "runner" for the purpose of committing insurance fraud

Service providers such as doctors can also commit insurance fraud if they intentionally perform any of the following acts:

• Submitting a bill for an item or service that is substantially more than the customary charge or containing itemized fees for what is customarily a single procedure or service
• Providing an item or service to a person that is substantially in excess of the person's needs or of a poor quality

Insurers also commit insurance fraud if they intentionally withhold information or provide false or misleading information regarding an application, coverage, benefits, or claims.

Workers' compensation insurance fraud :

Knowingly or recklessly making a false or fraudulent statement, promise, or omission of material information in order to do any of the following:

• Obtain workers compensation benefits
• Avoid paying for a workers compensation insurance premium
• Deprive an employee of workers compensation benefits

Intentionally providing false, incomplete, or misleading information material to an insurance application is a class B misdemeanor punishable by up to 6 months in prison and up to $1,000 in fines.

Intentionally or recklessly devising a scheme or device to obtain professional service fees or anything of value through false or fraudulent pretenses, representations, promises, or material omissions is:

• A class B misdemeanor if the value of the benefits sought or obtained is less than $500
• A class A misdemeanor punishable by up to 1 year in prison and up to $2,500 in fines if the benefits sought or obtained is more than $500 but less than $1,500
• A third-degree felony punishable by up to 5 years in prison and up to $5,000 in fines if the value of the benefits sought or obtained is $1,500 or more but less than $5,000
• A second-degree felony punishable up to 15 years in prison and up to $10,000 in fines if the value of the benefits sought or obtained is $5,000 or more

The perpetrator is also subject to restitution and other costs such as attorney's fees. The court may also order a civil penalty up to 3 times the value of that which was sought or received from the insurance fraud. A service provider who commits insurance fraud can also have their license suspended or revoked.

Workers compensation fraud is a class A misdemeanor if the value of the benefits sought or obtained is less than $1,000 or the number of employees deprived of benefits is less than 5. It is a third-degree felony if benefits sought or obtained is $1,000 or more, but less than $5,000 or
the number of employees deprived of benefits is 5 or more, but less than 50. It is a second degree-felony if the benefits sought or obtained is $5,000 or more or the number of employees deprived of benefits is 50 or more.

If you're having problems with an insurance company or agent, a complaint may be filed with the Utah Insurance Department.