Insurance Fraud; Venue; Penalty; Exemption

1. Law
2. Georgia Code
3. Insurance
4. General Provisions
5. Insurance Fraud; Venue; Penalty; Exemption

1. Any natural person who knowingly or willfully:
   1. Makes or aids in the making of any false or fraudulent statement or representation of any material fact or thing:
      1. In any written statement or certificate;
      2. In the filing of a claim;
      3. In the making of an application for a policy of insurance;
      4. In the receiving of such an application for a policy of insurance; or
      5. In the receiving of money for such application for a policy of insurance

         for the purpose of procuring or attempting to procure the payment of any false or fraudulent claim or other benefit by an insurer;

   2. Receives money for the purpose of purchasing insurance and converts such money to such person's own benefit;
   3. Issues fake or counterfeit insurance policies, certificates of insurance, insurance identification cards, or insurance binders; or
   4. Makes any false or fraudulent representation as to the death or disability of a policy or certificate holder in any written statement or certificate for the purpose of fraudulently obtaining money or benefit from an insurer

      commits the crime of insurance fraud.

2. Any natural person who knowingly and willfully or with reckless disregard engages in the following activities, either directly or indirectly, as an agent for, as a representative of, or on behalf of an insurer not authorized to transact insurance in this state commits the crime of insurance fraud:
   1. Soliciting, negotiating, procuring, or effectuating insurance or annuity contracts or renewals thereof;
   2. Soliciting, negotiating, procuring, or effectuating any contract relating to benefits or services;
   3. Disseminating information as to coverage or rates;
   4. Forwarding applications;
   5. Delivering policies or contracts;
   6. Inspecting or assessing risk;
   7. Fixing of rates;
   8. Investigating or adjusting claims or losses;
   9. Collecting or forwarding of premiums; or
   10. In any other manner representing or assisting such an insurer in the transaction of insurance with respect to subjects of insurance resident, located, or to be performed in this state.
3. Any natural person who knowingly and willfully with intent to defraud subscribes, makes, or concurs in making any annual or other statement required by law to be filed with the Commissioner containing any material statement which is false commits the crime of insurance fraud.
4. In any prosecution under this Code section, the crime shall be considered as having been committed in the county of the purported loss, in the county in which the insurer or the insurer's agent received the fraudulent or false claim or application, in the county in which money was received for the fraudulent application, or in any county where any act in furtherance of the criminal scheme was committed.
5. A natural person convicted of a violation of this Code section shall be guilty of a felony and shall be punished by imprisonment for not less than two nor more than ten years, or by a fine of not more than $10,000.00, or both.
6. Subsection (b) of this Code section shall not apply to a contract of insurance entered into in accordance with Article 2 of Chapter 5 of this title.

(Code 1933, § 56-9910, enacted by Ga. L. 1960, p. 289, § 1; Ga. L. 1985, p. 723, § 1; Ga. L. 1991, p. 1608, § 1.1; Ga. L. 1997, p. 1296, § 1; Ga. L. 1998, p. 1064, § 1; Ga. L. 2003, p. 387, § 1.2; Ga. L. 2003, p. 641, § 1; Ga. L. 2004, p. 754, § 1A.)

Cross references.

- Fraud generally, § 16-9-50 et seq.

Code Commission notes.

- Pursuant to Code Section 28-9-5, in 2003, "Commissioner" was substituted for "commission" in subsection (c).

Editor's notes.

- Ga. L. 1998, p. 1064, § 12, not codified by the General Assembly, provides that the 1998 amendment to this Code section applies to offenses committed on or after July 1, 1998, and shall not apply to or affect conduct or offenses committed prior to July 1, 1998.

Law reviews.

- For review of 1998 legislation relating to insurance, see 15 Ga. St. U.L. Rev. 153 (1998). For note on 1991 amendment of this Code section, see 8 Ga. St. U.L. Rev. 99 (1992).

JUDICIAL DECISIONS

Venue for staged accidents.

- Because a staged wreck was clearly an act in furtherance of a criminal scheme, venue was proper in the county where the wreck occurred. Callaway v. State, 247 Ga. App. 310, 542 S.E.2d 596 (2000).

When the defendant, an attorney, knew that the client had received approximately $15,000 at closing, but told the client's insurer that the client had not been paid for the sale of the property, because the indictment specifically charged the defendant with violating the insurance fraud statute; and the indictment further indicated, tracking the statute's own language, that the fraudulent misrepresentation was the statement of the client that the client had suffered a loss of $117,849.82, the indictment was sufficient to withstand a general demurrer. Sallee v. State, 329 Ga. App. 612, 765 S.E.2d 758 (2014), cert. denied, 136 S. Ct. 199, 193 L. Ed. 2d 128 (U.S. 2015).

Evidence sufficient for conviction.

- Callaway v. State, 247 Ga. App. 310, 542 S.E.2d 596 (2000).

Evidence sufficient to convict attorney for role in insurance scheme.

- Evidence was sufficient to convict the defendant of insurance fraud as the defendant, an attorney, aided the client in making a false or fraudulent written statement for the purpose of procuring or attempting to procure the payment of a false claim because, even though the defendant knew that the client's loan on the property had been paid off on August 4, 2006, at the closing, the defendant nonetheless filed the client's signed proof of loss statement with the client's insurer on December 8, 2008, in which the client falsely claimed a loss of approximately $118,000 under the insurance policy. Sallee v. State, 329 Ga. App. 612, 765 S.E.2d 758 (2014), cert. denied, 136 S. Ct. 199, 193 L. Ed. 2d 128 (U.S. 2015).

Sentencing for violations.

- Defendant was properly sentenced to separate terms for insurance fraud violations committed by several coconspirators; each fraudulent claim made was a separate offense and did not merge under O.C.G.A. § 16-1-7. Crowder v. State, 222 Ga. App. 351, 474 S.E.2d 246 (1996).

Cited in Dover v. State, 192 Ga. App. 429, 385 S.E.2d 417 (1989); McClellan v. Evans, 294 Ga. App. 595, 669 S.E.2d 554 (2008).

OPINIONS OF THE ATTORNEY GENERAL

Dentist violation for filing claim for insurance payment while waiving patient's copayment.

- A dentist who files a claim for third party payment in which the dentist asserts a certain fee charged, when in fact the dentist has waived or intends to waive the patient's copayment for the service, without full disclosure to the third party insurer that such waiver has or will be taking place, may be subject to disciplinary action by the Georgia Board of Dentistry under O.C.G.A. § 43-11-47(a)(2) and may be guilty of a violation of O.C.G.A. § 33-1-9. 1983 Op. Att'y Gen. No. 83-25.

RESEARCH REFERENCES

ALR.

- Criminal offense of obtaining money under false pretenses, or attempting to do so, predicated upon receipt or claim of benefits under insurance policy, 135 A.L.R. 1157.

Insured's cooperation with claimant in establishing valid claim against insurer as breach of cooperation clause, 8 A.L.R.3d 1345.

When does the statute of limitations begin to run in action under the False Claims Act (31 USCS §§ 3729-3733), 139 A.L.R. Fed 645.

Download our app to see the most-to-date content.