(a) A person is considered to be engaging in an unfair method of competition and unfair and deceptive act or practice in the business of insurance if that person commits or performs with such frequency as to indicate a general business practice any of the following unfair claims settlement practices: (i) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue; (ii) Failing to acknowledge and act reasonably promptly upon communications with respect to claims arising under insurance policies; (iii) Failing to adopt and implement reasonable standards for the prompt investigation of claims arising under insurance policies; (iv) Refusing to pay claims without conducting a reasonable investigation based upon all available information; (v) Failing to affirm or deny coverage of claims within a reasonable time after proof of loss statements have been completed; (vi) Not attempting in good faith to effectuate prompt, fair and equitable settlements of claims in which liability has become reasonably clear; (vii) Compelling insureds to institute litigation to recover amounts due under an insurance policy by offering substantially less than the amounts ultimately recovered in actions brought by such insureds; (viii) Attempting to settle a claim for less than the amount to which a reasonable person would have believed he was entitled by reference to written or printed advertising material accompanying or made part of an application; (ix) Attempting to settle claims on the basis of an application which was altered without notice to, or knowledge or consent of, the insured; (x) Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which the payments are being made; (xi) Making known to insureds or claimants a policy of appealing from arbitration awards in favor of insureds or claimants for the purpose of compelling them to accept settlements or compromises less than the amount awarded in arbitration; (xii) Delaying the investigation or payment of claims by requiring an insured, claimant or the physician of either to submit a preliminary claim report and then requiring the subsequent submission of formal proof of loss forms, both of which submissions contain substantially the same information; (xiii) Failing to promptly settle claims, where liability has become reasonably clear, under one (1) portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage; (xiv) Failing to promptly provide a reasonable explanation of the basis in the insurance policy in relation to the facts or applicable law for denial of a claim or for the offer of a compromise settlement; (xv) Denying or failing to timely pay disability insurance claims for medically necessary services, procedures or supplies as required by W.S. 26-40-201; (xvi) Failing to comply with the external review procedures required by W.S. 26-40-201; or (xvii) Failing to pay a claim after an external review organization has declared such claim to be a benefit covered under the terms of the insurance policy..
No statue found.
No person shall by misrepresentations or by misleading comparisons, induce or tend to induce any insured to lapse, terminate, forfeit, surrender, retain, or convert any insurance policy.
(b) Fraudulent insurance act. No person shall, with intent to defraud: (1) present or cause to be presented a claim for payment or benefit, pursuant to any insurance policy, that contains false representations as to any material fact or which conceals a material fact; or (2) present or cause to be presented any information which contains false representations as to any material fact or which conceals a material fact concerning the solicitation for sale of any insurance policy or purported insurance policy, an application for certificate of authority, or the financial condition of any insurer.
(2) A service provider commits a fraudulent insurance act if that service provider with intent to deceive or defraud: (a) knowingly submits or causes to be submitted a bill or request for payment: (i) containing charges or costs for an item or service that are substantially in excess of customary charges or costs for the item or service; or (ii) containing itemized or delineated fees for what would customarily be considered a single procedure or service; (b) knowingly furnishes or causes to be furnished an item or service to a person: (i) substantially in excess of the needs of the person; or (ii) of a quality that fails to meet professionally recognized standards;(3) An insurer commits a fraudulent insurance act if that insurer with intent to deceive or defraud: (a) knowingly withholds information or provides false or misleading information with respect to an application, coverage, benefits, or claims under a policy or certificate; (b) assists, abets, solicits, or conspires with another to commit a fraudulent insurance act; (c) knowingly accepts a benefit from the proceeds derived from a fraudulent insurance act; or (d) knowingly supplies false or fraudulent material information in any document or statement required by the department. (4) An insurer or service provider is not liable for any fraudulent insurance act committed by an employee without the authority of the insurer or service provider unless the insurer or service provider knew or should have known of the fraudulent insurance act.
(a) A person commits an offense if, with intent to defraud or deceive an insurer, the person, in support of a claim for payment under an insurance policy: (1) prepares or causes to be prepared a statement that: (A) the person knows contains false or misleading material information; and (B) is presented to an insurer; or (2) presents or causes to be presented to an insurer a statement that the person knows contains false or misleading material information. (a-1) A person commits an offense if the person, with intent to defraud or deceive an insurer and in support of an application for an insurance policy: (1) prepares or causes to be prepared a statement that: (A) the person knows contains false or misleading material information; and (B) is presented to an insurer; or (2) presents or causes to be presented to an insurer a statement that the person knows contains false or misleading material information. (b) A person commits an offense if, with intent to defraud or deceive an insurer, the person solicits, offers, pays, or receives a benefit in connection with the furnishing of goods or services for which a claim for payment is submitted under an insurance policy.
(a) The commissioner may place on probation, cancel, terminate, suspend, revoke or refuse to issue or renew a public adjuster’s license, or may levy a civil penalty, in accordance with this section, or any combination of actions, for any one (1) or more of the following causes: (1) Providing materially incorrect, misleading, incomplete, or untrue information in the license application; (2) Violating any laws administered by the commissioner, or violating lawful regulations, or final orders of the commissioner or of another state’s insurance commissioner; (3) Obtaining or attempting to obtain a license through misrepresentation or fraud; (4) Improperly withholding, misappropriating, or converting to the licensee’s own use any moneys or properties received in the course of conducting business under this license; (5) Intentionally misrepresenting the terms of an actual or proposed insurance contract or application for insurance; (6) Having been convicted of a felony or other offense involving dishonesty, fraud, deceit or misrepresentation, in a final decision of a court of competent jurisdiction; (7) Having committed any insurance unfair trade practice or insurance fraud prohibited under chapters 8 and 53 of this title; (8) Using fraudulent, coercive or dishonest practices, or demonstrating incompetence, untrustworthiness or financial irresponsibility in the conduct of business in this state or elsewhere; (9) Having an insurance producer license, or its equivalent, suspended or revoked in any other state, province, district or territory; (10) Forging another’s name to an application for insurance or to any document related to an insurance transaction; (11) Cheating on an examination for an insurance license; (12) Knowingly accepting insurance business from an individual who is not licensed by the commissioner but who is required to be so licensed; (13) Allowing a person not licensed under this part to perform actions requiring licensure under this part; (14) Failing to comply with a final administrative or court order imposing a child support obligation; or (15) Failing to notify the insured, verbally and in writing, of the statutory requirements of this part, as they pertain to solicitation, contracting, and recission and the timeframes contained in this part. (b) Any action by the commissioner to put on probation, suspend, revoke or deny the renewal of a license pursuant to this part shall be governed by the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. (c) In the event that the action of the commissioner is to deny an application for a license, the commissioner shall notify the applicant and advise, in writing, the applicant of the denial of the applicant’s application within thirty (30) days. (d) The license of a business entity may be suspended, revoked or refused, if the commissioner finds that an individual’s violation was known or should have been known by one (1) or more of the partners, officers or managers acting on behalf of the business entity, and the violation was not timely reported to the commissioner and corrective action was not taken. (e) In addition to, or in lieu of, any applicable denial, suspension, cancellation, termination, or revocation of a license, a person may, after a hearing, be subject to a civil penalty in an amount not less than one hundred dollars ($100), nor more than one thousand dollars ($1,000), for each separate violation of the grounds in subsection (a). Each day of continued violation shall constitute a separate violation. (f) The commissioner shall retain the authority to enforce this part and impose any penalty or remedy authorized by this part, or any other provision of this title against any person who is under investigation for or charged with a violation of this part, even if the person’s license or registration has been surrendered or has lapsed by operation of law. (g) The commissioner may serve a notice or order in any action arising under this part by registered or certified mail to the public adjuster or applicant at the address of record on file with the commissioner. Notwithstanding any law to the contrary, service in the manner set forth in this subsection (g) shall be deemed to constitute actual service on the public adjuster or applicant.
For purposes of this chapter, a person commits a fraudulent insurance act if the person: (3) Willfully embezzles, abstracts, steals, misappropriates, or converts money, funds, premiums, credits, or other property of an insurer or person engaged in the business of insurance or of an insured or prospective insured; (4) Knowingly and with intent to defraud or deceive makes any false entry of a material fact in or pertaining to any document or statement filed with or required by the Division of Insurance; (5) Knowingly and with intent to defraud or deceive removes, conceals, alters, diverts, or destroys assets or records of an insurer or other person engaged in the business of insurance or attempts to remove, conceal, alter, divert, or destroy assets or records of an insurer or other person engaged in the business of insurance;
(D) “False statement or misrepresentation” means a statement or representation made by a person that is false, material, made with the person’s knowledge of the falsity of the statement and made with the intent of obtaining or causing another to obtain or attempting to obtain or causing another to obtain an undeserved economic advantage or benefit or made with the intent to deny or cause another to deny any benefit or payment in connection with an insurance transaction, and such shall constitute fraud. “False statement or misrepresentation” specifically includes, but is not limited to, an intentional: (1) false report of business activities; (2) miscount or misclassification by an employer of its employees; (3) failure to timely reduce reserves; (4) failure to account for Second Injury Fund reimbursements or subrogation reimbursements; or (5) failure to provide verifiable information to public or private rating bureaus and the Department of Insurance. An undeserved economic benefit or advantage includes, but is not limited to, a favorable insurance premium, payment schedule, insurance award, or insurance settlement.
(3) “Fraudulent insurance act” means an act or omission committed by a person who, knowingly and with intent to defraud, commits, or conceals any material information concerning, one or more of the following: (E) Payments made in accordance with the terms of an insurance policy or reinsurance contract; (F) A document filed with the commissioner or the chief insurance regulatory official of another jurisdiction; (G) The financial condition of an insurer or reinsurer; (H) The formation, acquisition, merger, reconsolidation, dissolution or withdrawal from one or more lines of insurance or reinsurance in all or part of this state by an insurer or reinsurer; (I) The issuance of written evidence of insurance; or (J) The reinstatement of an insurance policy; (ii) Solicitation of acceptance of new or renewal insurance risks on behalf of an insurer, reinsurer or other person engaged in the business of insurance by a person who knows or should know that the insurer or other person responsible for the risk is insolvent at the time of the transaction; (iii) Removal, concealment, alteration or destruction of the assets or records of an insurer, reinsurer or other person engaged in the business of insurance; (iv) Willful embezzlement, abstracting, purloining, or conversion of monies, funds, premiums, credits or other property of an insurer, reinsurer or person engaged in the business of insurance; (v) Transaction of the business of insurance in violation of laws requiring a license, certificate of authority or other legal authority for the transaction of the business of insurance; or (vi) Attempt to commit, aiding or abetting in the commission of, or conspiracy to commit the acts or omissions specified in this subsection.