GENERAL ASSEMBLY OF NORTH CAROLINA

SESSION 1993

H	1 

HOUSE BILL 961

Short Title:  Insurance Fraud.	(Public)
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Sponsors: Representatives Brawley; Gardner, Hayes, and C. Wilson.
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Referred to:  Judiciary II.
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April 15, 1993

A BILL TO BE ENTITLED
AN ACT TO STRENGTHEN THE INSURANCE FRAUD LAW.
The General Assembly of North Carolina enacts:
Section 1.  G.S. 58-2-161 reads as rewritten:
"§ 58-2-161.  False statement to procure benefit of insurance policy or certificate.
(a)	For the purposes of this section:
(1)	 'Insurer' includes an entity under Articles 65 through 67 of this Chapter and includes the Teachers' and State Employees' Comprehensive Major Medical Plan under Chapter 135 of the General Statutes.
(2)	'Statement' includes, but is not limited to, any notice, statement, proof of loss, bill of lading, receipt for payment, invoice, account, estimate of property damages, bill for services, diagnosis, prescription, hospital or doctor records, X rays, test result or other evidence of loss, injury, or expense.
(b)	Any person who, with the intent to injure, defraud, or deceive any insurer
(1)	Presents or causes to be presented to any insurer, any written or oral statement including computer-generated documents as part of, or in support of, a claim for payment or other benefit pursuant to an insurance policy, knowing that such statement contains any false, incomplete, or misleading information concerning any fact or thing material to such claim, or
(2)	Assists, abets, solicits, or conspires with another to prepare or make any written or oral statement that is intended to be presented to any insurer in connection with, or in support of, any claim for payment or other benefit pursuant to an insurance policy, knowing that such statement contains any false, incomplete, or misleading information concerning any fact or thing material to such claim
is guilty of a felony and, upon conviction, shall be punished as a Class I felon.  Each claim shall be considered a separate count.  Upon conviction, the court shall also order the defendant to pay restitution to the insurer as well as the insurer's reasonable investigative costs and attorneys fees.
In a civil cause of action of recovery based upon a claim for which a defendant has been convicted under this section, the defendant shall be estopped from denying the elements of the violations for which the defendant was convicted.  If the insurer prevails in the civil action, the court may award the insurer its damages, attorneys' fees, costs, and reasonable investigative costs.  If the insurer can demonstrate to the court that the defendant has engaged in a pattern of violations of this section, the court may award the insurer treble damages from the defendant."
Sec. 2.  This act becomes effective October 1, 1993, and applies to violations occurring on or after that date.