Hatfield Law Fraud

About Fraud

IC 35-43-5-4.5

Sec. 4.5 .(a) A person who, knowingly and with intent to defraud:

(1) Makes, utters, presents, or causes to be presented to an insurer or an insurance claimant, a claim statement that contains false, incomplete, or misleading information concerning the claim;

(2) presents, causes to be presented, or prepares with knowledge or belief that it will be presented to or by an insurer, an oral, a written, or an electronic statement that the person knows to contain materially false information as part of, in support of, or concerning a fact that is material to:

• (a) the rating of an insurance policy;
• (b) a claim for payment or benefit under an insurance policy;
• (c) premiums paid on an insurance policy;
• (d) payments made in accordance with the terms of an insurance policy;
• (e) an application for a certificate of authority;
• (f) the financial condition of an insurer; or
• (g) the acquisition of an insurer;

Or conceals any information concerning a subject set forth in clauses (A) through (G);

(3) Solicits or accepts new or renewal insurance risks by or for an insolvent insurer or other entity regulated Under IC 27;

(4) Removes:

• (a) the assets;
• (b) the record of assets, transactions, and affairs;  or
• (c) a material part of the assets or the record of assets, transactions, and affairs; of an insurer or another entity regulated under IC 27, from the home office, other places of business, or place of safekeeping of the insurer or other regulated entity, or conceals or attempts to conceal from the department of insurance assets or records referred to in clauses (a) through (b);  or

(5) Diverts funds of an insurer or another person in connection with:

• (a) the transaction of insurance or reinsurance;
• (b) the conduct of business activities by an insurer or another entity regulated under IC 27;  or
• (c) the formation, acquisition, or dissolution of an insurer or another entity regulated under IC 27; commits insurance fraud.  Except as provided in subsection (b), insurance fraud is a Level 6 felony. (b) An offense described in subsection (a) is a Level 5 felony if:
• (1) the person who commits the offense has a prior unrelated conviction under this section;  or
• (2) the:
• (a) value of property, services, or other benefits obtained or attempted to be obtained by the person as a result of the offense;  or
• (b) economic loss suffered by another person as a result of the offense;
  is at least two thousand five hundred dollars ($2,500).
• (c) A person who knowingly and with intent to defraud makes a material misstatement in support of an application for the issuance of an insurancepolicy commits insurance application fraud, a Class A misdemeanor.

Fraud is enclosed within both criminal and civil laws. The most apparent difference revolves around the party who takes legal action. Only government prosecutors are able to impose criminal charges. However, a fraud victim can file a civil lawsuit. A person who commits fraud may be criminally prosecuted as well as sued in a civil action.

In the criminal context, fraud must be verified beyond a reasonable doubt. If convicted, a defendant may be sentenced to prison. Any individual, business or entity can be the victim of alleged fraud.

In private civil lawsuits, the standards of proof are lower, and punishment is often in the form of restitution and monetary damages.

There are various forms of fraud and they are:

• Identity theft
• Mail fraud
• Insurance fraud
• Securities fraud
• Credit/debit card fraud
• Wire fraud
• Telemarketing fraud
• Tax evasion
• Bankruptcy fraud

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