GENERAL ASSEMBLY OF NORTH CAROLINA

SESSION 1995

H	1 

HOUSE BILL 103

Short Title:  Insurance Fraud.	(Public)

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Sponsors: Representatives Brawley; Buchanan, Shubert, Gardner, Justus, and J. Brown.

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Referred to:  Insurance.

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February 2, 1995

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 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 an insurer
(1)	Presents or causes to be presented to any insurer a 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 the statement contains false, incomplete, or misleading information concerning any fact or matter material to the 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 an insurer in connection with, or in support of, a claim for payment or other benefit pursuant to an insurance policy, knowing that the statement contains false, incomplete, or misleading information concerning a fact or matter material to the claim
is guilty of a Class I felony.  Each claim shall be considered a separate count.  Upon conviction, the court shall order the defendant to pay restitution as a condition of probation or parole.  Restitution shall include reasonable costs and attorneys' fees incurred by the insurer in the investigation of, and efforts to recover damages arising from, the claim.
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 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."
Sec. 2.  This act becomes effective October 1, 1995, and applies to violations occurring on or after that date.