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H0098...........................................................by BUSINESS
INSURANCE - FRAUD - Amends existing law relating to the Idaho Arson and
Fraud Reporting-Immunity Act to revise definitions; and to revise
provisions applicable to insurance fraud.
02/02 House intro - 1st rdg - to printing
02/05 Rpt prt - to Bus
02/28 Rpt out - rec d/p - to 2nd rdg
03/01 2nd rdg - to 3rd rdg
03/02 3rd rdg - PASSED - 64-0-6
AYES -- Anderson, Andrus, Barrett, Bayer, Bedke, Bell, Bilbao, Black,
Block, Bock, Boe, Bolz, Brackett, Bradford, Chadderdon, Chavez, Chew,
Clark, Collins, Crane, Durst, Eskridge, Hagedorn, Hart, Henbest,
Jaquet, Killen, King, Kren, Lake, LeFavour, Luker, Marriott, Mathews,
McGeachin, Mortimer, Moyle, Nielsen, Pasley-Stuart, Patrick, Pence,
Raybould, Ring, Ringo, Roberts, Ruchti, Rusche, Sayler, Schaefer,
Shepherd(2), Shepherd(8), Shirley, Shively, Smith(30), Smith(24),
Snodgrass, Stevenson, Thayn, Trail, Vander Woude, Wills, Wood(27),
Wood(35), Mr. Speaker
NAYS -- None
Absent and excused -- Edmunson, Harwood, Henderson, Labrador,
Loertscher, Nonini
Floor Sponsor - Mathews
Title apvd - to Senate
03/05 Senate intro - 1st rdg - to Com/HuRes
03/16 Rpt out - rec d/p - to 2nd rdg
03/19 2nd rdg - to 3rd rdg
03/20 3rd rdg - PASSED - 34-0-1
AYES -- Andreason, Bair, Bastian, Bilyeu, Broadsword, Burkett,
Cameron, Coiner, Corder, Darrington, Davis, Fulcher, Geddes, Goedde,
Hammond, Heinrich, Hill, Jorgenson, Kelly, Keough, Langhorst, Little,
Lodge, Malepeai, McGee, McKague, McKenzie, Pearce, Richardson,
Schroeder, Siddoway, Stegner, Stennett, Werk
NAYS -- None
Absent and excused -- Gannon
Floor Sponsor - Werk
Title apvd - to House
03/21 To enrol - Rpt enrol - Sp signed
03/22 Pres signed - To Governor
03/28 Governor signed
Session Law Chapter 239
Effective: 07/01/07
]]]] LEGISLATURE OF THE STATE OF IDAHO ]]]]
Fifty-ninth Legislature First Regular Session - 2007
IN THE HOUSE OF REPRESENTATIVES
HOUSE BILL NO. 98
BY BUSINESS COMMITTEE
1 AN ACT
2 RELATING TO THE IDAHO ARSON AND FRAUD REPORTING-IMMUNITY ACT; AMENDING SECTION
3 41-291, IDAHO CODE, TO REVISE A DEFINITION AND TO DEFINE "RUNNER"; AND
4 AMENDING SECTION 41-293, IDAHO CODE, TO REVISE PROVISIONS APPLICABLE TO
5 INSURANCE FRAUD.
6 Be It Enacted by the Legislature of the State of Idaho:
7 SECTION 1. That Section 41-291, Idaho Code, be, and the same is hereby
8 amended to read as follows:
9 41-291. DEFINITIONS. As used in sections 41-290 through and including
10 41-298, Idaho Code:
11 (1) Sections 41-290 through 41-298, Idaho Code, shall be known as the
12 "Idaho Arson and Fraud Reporting-Immunity Act."
13 (2) "Authorized agencies" shall mean:
14 (a) Any law enforcement agency of this state;
15 (b) Any prosecuting attorney who may be responsible for prosecution in
16 the jurisdiction where the fire or fraud occurred;
17 (c) The attorney responsible for the prosecution in the jurisdiction
18 where the fire or fraud occurred as designated by the attorney general;
19 (d) The department of insurance, which includes the state fire marshal.
20 (3) Solely for the purpose of section 41-292(1), Idaho Code, "authorized
21 agencies" shall also include:
22 (a) The United States attorney's office when authorized or charged with
23 investigation or prosecution of the fire or fraud in question;
24 (b) The federal bureau of investigation or any other federal agency,
25 charged with investigation or prosecution of the fire or fraud in ques-
26 tion.
27 (4) "Relevant" means information having any tendency to make the exis-
28 tence of any fact that is of consequence to the investigation or determination
29 of the issue more probable or less probable than it would be without the evi-
30 dence.
31 (5) Material will be "deemed important," if within the sole discretion of
32 the "authorized agency," such material is requested by the "authorized
33 agency."
34 (6) "Action," as used in this chapter, shall include nonaction or the
35 failure to take action.
36 (7) "Immunity" means that no civil action may arise against any person
37 for furnishing information pursuant to section 41-248, 41-258, 41-290, 41-292,
38 41-296 or 41-297, Idaho Code, where actual malice on the part of the insurance
39 company, department of insurance, state fire marshal, authorized agency, their
40 employees or agents, is not present.
41 (8) "Financial loss" includes, but is not limited to, loss of earnings,
42 out-of-pocket and other expenses, repair and replacement costs and claims pay-
43 ments.
2
1 (9) "Person" means a natural person, company, corporation, unincorporated
2 association, partnership, professional corporation and any other legal entity.
3 (10) "Practitioner" means a licensee of this state authorized to practice
4 medicine and surgery, psychology, chiropractic, law or any other licensee of
5 the state whose services are compensated, directly or indirectly, by insurance
6 proceeds, or a licensee similarly licensed in other states and nations or the
7 practitioner of any nonmedical treatment rendered in accordance with a recog-
8 nized religious method of healing.
9 (11) "Statement" includes, but is not limited to, any notice statement,
10 any statement of the following regardless of how it is made and in what format
11 it is contained:
12 (a) Information submitted on an applications for insurance,;
13 (b) Description of policy terms, conditions, benefits or illustrations;
14 (c) Proof of insurance, certificate of insurance, or insurance card;
15 (d) Pproof of claim, proof of loss, bill of lading, receipt for payment,
16 invoice, account, estimate of property damages, bills for services, diag-
17 nosis, prescription, hospital or doctor medical records, X-rays, test
18 results or other evidence of loss, injury or expense;, whether oral, writ-
19 ten or computer generated and
20 (e) Any other notice, correspondence, representation or information
21 relating to an insurance coverage or claim.
22 (12) "Insurer" shall mean any insurance company contemplated by title 41,
23 Idaho Code, any business operating as a self-insured for any purpose, the
24 state insurance fund, and any self-insured as contemplated by title 72, Idaho
25 Code.
26 (13) "Runner" means a person who procures, or persons working in conjunc-
27 tion with each other who procure, clients at the direction of, or in coopera-
28 tion with, a person who, with the intent to deceive or defraud, performs or
29 obtains a service or benefit under a contract of insurance or asserts a claim
30 against an insured.
31 SECTION 2. That Section 41-293, Idaho Code, be, and the same is hereby
32 amended to read as follows:
33 41-293. INSURANCE FRAUD. Insurance fraud includes:
34 (1) (a) Any person who, with the intent to defraud or deceive an insurer
35 for the purpose of obtaining any money or benefit, presents or causes to
36 be presented to any insurer, a purported insurer, broker or agent pro-
37 ducer, practitioner or other person, any written or oral statement includ-
38 ing computer-generated documents as part of, or in support of, a claim for
39 payment or other benefit, knowing that such statement contains false,
40 incomplete, or misleading information concerning any fact or thing mate-
41 rial to such claim; or
42 (b) Any person who, with intent to defraud or deceive an insurer assists,
43 abets, solicits, or conspires with another to prepare or make any written
44 or oral statement that is intended to be presented to any insurer, pur-
45 ported insurer, broker or agent producer, practitioner or other person, in
46 connection with, or in support of, any claim for payment or other benefit,
47 knowing that such statement contains false, incomplete, or misleading
48 information concerning any fact or thing material to such claim;
49 (c) Any insurance agent or other person who, with intent to defraud or
50 deceive, an insurer presents or causes to be presented to or by an
51 insurer, a purported insurer or agent producer, practitioner or other per-
52 son, a materially false or altered application of insurance statement
53 material to an insurance transaction;
3
1 (d) Any insurance agent producer or other person who, with intent to
2 defraud or deceive, willfully takes premium money knowing that insurance
3 coverage will not be affected effected;
4 (e) Any medical practitioner or other person who willfully submits a
5 false or altered bill statement, with the intent of deceiving an insurer
6 or other person in connection with an insurance transaction or claim;
7 (f) Anyone willfully making a false statement or material misrepresenta-
8 tion to an insurer, employer, practitioner or other person, with the
9 intent of deceiving to defraud or deceive an insurer or other person, to
10 obtain or extend worker's compensation benefits;
11 (g) Anyone who offers or accepts a direct or indirect inducement to file
12 or solicits another person to file a false statement, of claim, with
13 intent of deceiving to defraud or deceive an insurer;
14 (h) Any person who, with intent to defraud or deceive, transacts insur-
15 ance of any kind or character, or transmits for a person other than him-
16 self an application for a policy of insurance, without proper licensing or
17 after such license has been suspended or revoked;
18 (i) Any practitioner or any other person who, with intent to defraud or
19 deceive, employs, uses or acts as a runner for the purpose of submitting a
20 claim containing false, incomplete, or misleading information concerning
21 any fact or thing material to such claim;
22 (j) Any employer or other person who, with intent to defraud or deceive,
23 presents or causes to be presented to an insurer, producer or any other
24 person or governmental agency any statement containing the number of
25 employees, amount of payroll, job description or job title or any other
26 statement material to worker's compensation insurance which contains
27 false, misleading or incomplete information; or
28 (k) Any person who, with intent to defraud or deceive, obstructs the
29 director in the conduct of any authorized examination.
30 (2) A fact, statement or representation is "material" if it includes any
31 of the following:
32 (a) Any fact which, if communicated to the producer, insurer, adjuster or
33 representative thereof, would induce him to either decline insurance alto-
34 gether or not accept it unless a higher premium is paid by the insured;
35 (b) Any fact relating to a claim for insurance benefits which, if dis-
36 closed, would be a fair reason for rejecting a claim for insurance bene-
37 fits;
38 (c) Any fact, the knowledge or ignorance of which would naturally influ-
39 ence the insurer in making or refusing the contract, in estimating the
40 degree or character of the risk, or in fixing the rate of premium;
41 (d) Any fact, the knowledge or ignorance of which would naturally influ-
42 ence the insurer in accepting or rejecting a claim for insurance benefits
43 or compensation, or in determining the amount of compensation or insurance
44 benefits to be paid to the insured; or
45 (e) Any fact that necessarily has some bearing on the subject matter of
46 the insurance coverage or claim for benefits under an insurance contract.
47 (23) Any offense committed by use of a telephone, any means of electronic
48 communication or mail as provided by this chapter may be deemed to have been
49 committed at the place from which the telephone call or electronic communica-
50 tion was made, or mail was sent, or the offense may be deemed to have been
51 committed at the place at which the telephone call, electronic communication
52 or mail was received.
53 (34) Any violator of this section is guilty of a felony and shall be sub-
54 ject to a term of imprisonment not to exceed fifteen (15) years, or a fine not
55 to exceed fifteen thousand dollars ($15,000), or both and shall be ordered to
4
1 make restitution to the insurer or any other person for any financial loss
2 sustained as a result of a violation of this section. Each instance of viola-
3 tion may be considered a separate offense.
STATEMENT OF PURPOSE
RS 16482
This proposal amends existing law to clarify the definition of
“statement” and to add a definition of “runner” in the Idaho
Arson and Fraud Reporting-Immunity Act. It also makes technical
corrections, clarifies and expands the scope of what constitutes
insurance fraud. The purpose of the changes is to make the law
more clearly applicable to the wide range of methods used to
defraud and deceive insurers and other parties to insurance
transactions.
FISCAL NOTE
No fiscal impact.
CONTACT
Name: Shad Priest
Agency: Insurance, Dept. of
Phone: 334-4214
STATEMENT OF PURPOSE/FISCAL NOTE H 98