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ARTICLE 176
INSURANCE FRAUD
Section 176.00 Insurance fraud; definition of terms.
176.05 Insurance fraud; defined.
176.10 Insurance fraud in the fifth degree.
176.15 Insurance fraud in the fourth degree.
176.20 Insurance fraud in the third degree.
176.25 Insurance fraud in the second degree.
176.30 Insurance fraud in the first degree.
176.35 Aggravated insurance fraud.
S 176.00 Insurance fraud; definition of terms.
The following definitions are applicable to this article:
1. "Insurance policy" has the meaning assigned to insurance contract
by subsection (a) of section one thousand one hundred one of the
insurance law except it shall include reinsurance contracts, purported
insurance policies and purported reinsurance contracts.
2. "Statement" includes, but is not limited to, any notice, proof of
loss, bill of lading, invoice, account, estimate of property damages,
bill for services, diagnosis, prescription, hospital or doctor records,
x-ray, test result, and other evidence of loss, injury or expense.
3. "Person" includes any individual, firm, association or corporation.
4. "Personal insurance" means a policy of insurance insuring a natural
person against any of the following contingencies:
(a) loss of or damage to real property used predominantly for
residential purposes and which consists of not more than four dwelling
units, other than hotels, motels and rooming houses;
(b) loss of or damage to personal property which is not used in the
conduct of a business;
(c) losses or liabilities arising out of the ownership, operation, or
use of a motor vehicle, predominantly used for non-business purposes;
(d) other liabilities for loss of, damage to, or injury to persons or
property, not arising from the conduct of a business;
(e) death, including death by personal injury, or the continuation of
life, or personal injury by accident, or sickness, disease or ailment,
excluding insurance providing disability benefits pursuant to article
nine of the workers` compensation law.
A policy of insurance which insures any of the contingencies listed in
paragraphs (a) through (e) of this subdivision as well as other
contingencies shall be personal insurance if that portion of the annual
premium attributable to the listed contingencies exceeds that portion
attributable to other contingencies.
5. "Commercial insurance" means insurance other than personal
insurance, and shall also include insurance providing disability
benefits pursuant to article nine of the workers` compensation law,
insurance providing workers` compensation benefits pursuant to the
provisions of the workers` compensation law and any program of self
insurance providing similar benefits.
S 176.05 Insurance fraud; defined.
1. A fraudulent insurance act is committed by any person who,
knowingly and with intent to defraud presents, causes to be presented,
or prepares with knowledge or belief that it will be presented to or by
an insurer, self insurer, or purported insurer, or purported self
insurer, or any agent thereof, any written statement as part of, or in
support of, an application for the issuance of, or the rating of a
commercial insurance policy, or certificate or evidence of self
insurance for commercial insurance or commercial self insurance, or a
claim for payment or other benefit pursuant to an insurance policy or
self insurance program for commercial or personal insurance which he
knows to: (i) contain materially false information concerning any fact
material thereto; or (ii) conceal, for the purpose of misleading,
information concerning any fact material thereto.
2. A fraudulent health care insurance act is committed by any person
who, knowingly and with intent to defraud, presents, causes to be
presented, or prepares with knowledge or belief that it will be
presented to, or by, an insurer or purported insurer or self-insurer, or
any agent thereof, any written statement or other physical evidence as
part of, or in support of, an application for the issuance of a health
insurance policy, or a policy or contract or other authorization that
provides or allows coverage for, membership or enrollment in, or other
services of a public or private health plan, or a claim for payment,
services or other benefit pursuant to such policy, contract or plan,
which he knows to:
(a) contain materially false information concerning any material fact
thereto; or
(b) conceal, for the purpose of misleading, information concerning any
fact material thereto. Such policy or contract or plan or authorization
shall include, but not be limited to, those issued or operating pursuant
to any public or governmentally-sponsored or supported plan for health
care coverage or services or those otherwise issued or operated by
entities authorized pursuant to the public health law. For purposes of
this subdivision an "application for the issuance of a health insurance
policy" shall not include (a) any application for a health insurance
policy or contract approved by the superintendent of insurance pursuant
to the provisions of sections three thousand two hundred sixteen, four
thousand three hundred four, four thousand three hundred twenty-one or
four thousand three hundred twenty-two of the insurance law or any other
application for a health insurance policy or contract approved by the
superintendent of insurance in the individual or direct payment market;
and (b) any application for a certificate evidencing coverage under a
self-insured plan or under a group contract approved by the
superintendent of insurance.
S 176.10 Insurance fraud in the fifth degree.
A person is guilty of insurance fraud in the fifth degree when he
commits a fraudulent insurance act.
Insurance fraud in the fifth degree is a class A misdemeanor.
S 176.15 Insurance fraud in the fourth degree.
A person is guilty of insurance fraud in the fourth degree when he
commits a fraudulent insurance act and thereby wrongfully takes, obtains
or withholds, or attempts to wrongfully take, obtain or withhold
property with a value in excess of one thousand dollars.
Insurance fraud in the fourth degree is a class E felony.
S 176.20 Insurance fraud in the third degree.
A person is guilty of insurance fraud in the third degree when he
commits a fraudulent insurance act and thereby wrongfully takes, obtains
or withholds, or attempts to wrongfully take, obtain or withhold
property with a value in excess of three thousand dollars.
Insurance fraud in the third degree is a class D felony.
S 176.25 Insurance fraud in the second degree.
A person is guilty of insurance fraud in the second degree when he
commits a fraudulent insurance act and thereby wrongfully takes, obtains
or withholds, or attempts to wrongfully take, obtain or withhold
property with a value in excess of fifty thousand dollars.
Insurance fraud in the second degree is a class C felony.
S 176.30 Insurance fraud in the first degree.
A person is guilty of insurance fraud in the first degree when he
commits a fraudulent insurance act and thereby wrongfully takes, obtains
or withholds, or attempts to wrongfully take, obtain or withhold
property with a value in excess of one million dollars.
Insurance fraud in the first degree is a class B felony.
S 176.35 Aggravated insurance fraud.
A person is guilty of aggravated insurance fraud in the fourth degree
when he commits a fraudulent insurance act, and has been previously
convicted within the preceding five years of any offense, an essential
element of which is the commission of a fraudulent insurance act.
Aggravated insurance fraud in the fourth degree is a class D felony.
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