(a) No person shall in this state, directly or indirectly, act as agent for, or otherwise represent or aid on behalf of another, any insurer not then authorized to transact such insurance in this state in the solicitation, negotiation, or effectuation of insurance or annuity contracts, forwarding of applications, delivery of policies or contracts, inspection of risks, fixing of rates, investigation or adjustment of losses, collection of premiums, or in any other manner in the transaction of insurance with respect to subjects of insurance resident, located or to be performed in this state. (b) This section shall not apply to: (1) Acceptance of service of process by the commissioner under Section 27-10-52; (2) Surplus lines insurance or coverage specified in Section 27-10-34 and other transactions as to which a certificate of authority is not required of an insurer; (3) Adjustment of losses as authorized in Section 27-10-35; (4) Transactions for which a certificate of authority to do business is not required of an insurer under the laws of this state; (5) Reinsurance effectuated in accordance with this title; or (6) The property and operations of the shipbuilding and/or ship repair industry engaged in interstate or foreign commerce and vessels, cargoes, watercraft, piers, wharves, graven docks, drydocks, marine railways and building ways, commonly known as wet marine. (c) This section shall not be deemed to render invalid, as between the parties thereto, any insurance contract entered into in violation of this section. Credits
A person commits the crime of insurance fraud if, knowingly and with intent to defraud, he or she commits, or conceals any material information concerning, one or more of the following acts: (1) The solicitation or acceptance of new or renewal insurance risks on behalf of an insurer, reinsurer, or other person engaged in the transaction of the business of insurance, by a person who knows the insurer, reinsurer, or other person responsible for the risk is financially unable to pay its claims at the time of the transaction. (4) Presenting, causing to be presented, or preparing with knowledge or belief that it will be presented to or by an insurer, reinsurer, producer, or any of their respective agents, false information as part of, in support of, or concerning a fact material to, one or more of the following: a. An application for the issuance or renewal of an insurance policy or reinsurance agreement. b. The rating of an insurance policy or reinsurance agreement. c. A claim for payment or benefit pursuant to an insurance policy or reinsurance agreement. d. A claim for payment or benefit based on an advertisement or promises to provide a good or service under an insurance policy. e. Premiums paid on an insurance policy or reinsurance agreement. f. Payments made in accordance with the terms of an insurance policy or reinsurance agreement. g. A document filed with the commissioner. i. Audit information submitted to the commissioner or an insurer. j. The formation, acquisition, merger, reconsolidation, or dissolution of one or more insurance entities, or the withdrawal from one or more lines of insurance in all or part of this state by an insurer or reinsurer. k. The issuance of written evidence of insurance. l. The reinstatement of an insurance policy. m. Issuance, acceptance, change, endorsement, or continuance of an insurance policy or reinsurance agreement. n. A construction or structure mitigation inspection report provided for the issuance or renewal of an insurance policy or discounts or credits related to an insurance policy.
A person commits the crime of insurance fraud if, knowingly and with intent to defraud, he or she commits, or conceals any material information concerning, one or more of the following acts: (1) The solicitation or acceptance of new or renewal insurance risks on behalf of an insurer, reinsurer, or other person engaged in the transaction of the business of insurance, by a person who knows the insurer, reinsurer, or other person responsible for the risk is financially unable to pay its claims at the time of the transaction. (2) The removal, concealment, alteration, or destruction of the assets or records relating to the transaction of the business of insurance of an insurer, reinsurer, or other person engaged in the transaction of the business of insurance. This section does not prohibit an insurer, reinsurer, or other person engaged in the transaction of the business of insurance from destroying records or documents relating to the transaction of the business of insurance in accordance with record retention and destruction standards set forth in state or federal law or the record retention policy of the insurer, reinsurer, or other person. (3) The embezzlement, abstraction, theft, or conversion of monies, funds, premiums, credits, or other property relating to the transaction of the business of insurance of an insurer, reinsurer, or other person engaged in the transaction of the business of insurance. (4) Presenting, causing to be presented, or preparing with knowledge or belief that it will be presented to or by an insurer, reinsurer, producer, or any of their respective agents, false information as part of, in support of, or concerning a fact material to, one or more of the following: a. An application for the issuance or renewal of an insurance policy or reinsurance agreement. b. The rating of an insurance policy or reinsurance agreement. c. A claim for payment or benefit pursuant to an insurance policy or reinsurance agreement. d. A claim for payment or benefit based on an advertisement or promises to provide a good or service under an insurance policy. e. Premiums paid on an insurance policy or reinsurance agreement. f. Payments made in accordance with the terms of an insurance policy or reinsurance agreement. g. A document filed with the commissioner. i. Audit information submitted to the commissioner or an insurer. j. The formation, acquisition, merger, reconsolidation, or dissolution of one or more insurance entities, or the withdrawal from one or more lines of insurance in all or part of this state by an insurer or reinsurer. k. The issuance of written evidence of insurance. l. The reinstatement of an insurance policy. m. Issuance, acceptance, change, endorsement, or continuance of an insurance policy or reinsurance agreement. n. A construction or structure mitigation inspection report provided for the issuance or renewal of an insurance policy or discounts or credits related to an insurance policy. (5) The failure to decline or refusal to return an insurance payment for a loss or a recovery to which the person is not entitled by reason of an insurer’s mistake or other facts or circumstances connected with the person’s claim or the coverage provided by an applicable insurance policy. (6) Overcharging an insurer or insured an amount for a good or service that exceeds the usual and customary charge by the person providing the good or performing the service as a part of an insurance claim for damage.
A person commits the crime of insurance fraud if, knowingly and with intent to defraud, he or she commits, or conceals any material information concerning, one or more of the following acts: (4) Presenting, causing to be presented, or preparing with knowledge or belief that it will be presented to or by an insurer, reinsurer, producer, or any of their respective agents, false information as part of, in support of, or concerning a fact material to, one or more of the following: c. A claim for payment or benefit pursuant to an insurance policy or reinsurance agreement. d. A claim for payment or benefit based on an advertisement or promises to provide a good or service under an insurance policy.
A person commits the crime of insurance fraud if, knowingly and with intent to defraud, he or she commits, or conceals any material information concerning, one or more of the following acts: (4) Presenting, causing to be presented, or preparing with knowledge or belief that it will be presented to or by an insurer, reinsurer, producer, or any of their respective agents, false information as part of, in support of, or concerning a fact material to, one or more of the following: e. Premiums paid on an insurance policy or reinsurance agreement. (5) The failure to decline or refusal to return an insurance payment for a loss or a recovery to which the person is not entitled by reason of an insurer’s mistake or other facts or circumstances connected with the person’s claim or the coverage provided by an applicable insurance policy.
Alabama has no State False Claims Act. Though legislation has been proposed. See: https://www.maynardcooper.com/blog/alabama-false-claims-act-legislation-%E2%80%93-cause-concern-businesses-alabama
(a) There is hereby established within the department the Insurance Fraud Unit. The commissioner shall appoint the necessary full-time supervisory and investigative personnel of the unit who shall be qualified by training and experience to perform the duties of their positions. The commissioner shall furnish offices, equipment, operating expenses, and necessary personnel to maintain and operate the unit. (b) The unit shall perform all of the following duties: (1) Initiate independent inquiries and conduct independent investigations when the unit has cause to believe that any insurance fraud may be, is being, or has been, committed. (2) Review reports or complaints of alleged insurance fraud from federal, state, and local law enforcement and regulatory agencies, persons engaged in the business of insurance, and the public to determine whether the reports or complaints require further investigation and, if so, to conduct these investigations. (3) Conduct independent examinations of alleged insurance fraud and undertake independent studies to determine the extent of insurance fraud. (c) In performing its duties, the unit shall have the powers to do all of the following: (1) Inspect, copy, or collect records and evidence. (2) Issue and serve subpoenas. (3) Administer oaths and affirmations. (4) Share records and evidence with federal, state, or local law enforcement and regulatory agencies. (5) Execute arrest warrants for criminal violations of this chapter. (6) Arrest upon probable cause without warrant a person found in the act of violating or attempting to violate this chapter. (7) Make criminal referrals to the Attorney General. (8) Conduct investigations outside of this state. If the information the unit seeks to obtain is located outside of this state, the person from whom the information is sought may make the information available to the unit to examine at the place where the information is located. The unit may designate representatives, including officials of the state in which the matter is located, to inspect the information on behalf of the unit, and the unit may respond to similar requests from officials of other states. (d) Investigators of the unit shall have all the powers vested in law enforcement officers of the State of Alabama, including, but not limited to, the powers of arrest and the power to serve process, but only as necessary to enforce this chapter, and shall perform the duties, responsibilities, and functions as may be required for the unit to carry out its duties and responsibilities pursuant to this chapter. No person shall serve as investigator of the unit who has not met the minimum standards established for law enforcement officers by the Alabama Peace Officers’ Standards and Training Commission, or other standards as may be provided hereafter by law. (e) Information relating to criminal activity discovered in the course of an investigation by the unit shall be provided to the Department of Public Safety.
(a) Except as otherwise provided in subsection (b), there shall be no civil liability imposed on and no cause of action shall arise against a person for furnishing or receiving information concerning suspected, anticipated, or completed insurance fraud. This shall not abrogate or modify common law or statutory privileges or immunities enjoyed by a person, and the limit on civil liability applies only to the act of reporting and does not limit civil liability against a person for committing fraud or other tortuous conduct. (b) Subsection (a) shall not apply to false statements made with actual malice by a person furnishing or receiving information concerning suspected, anticipated, or completed insurance fraud. In any action brought against a person for filing a report or furnishing other information concerning insurance fraud, the party bringing the action shall plead specifically any allegations that subsection (a) shall not apply because the person filing the report or furnishing the information did so with actual malice.