The Office of General Counsel issued the following informal opinion on November 7, 2001, representing the position of the New York State Insurance Department.Re: Fraud Warning Statement on Automobile Repair Appraisal Claim Forms
Which of the warning statements found in N.Y. Ins. Law § 403(e) (McKinney 2000) and N.Y. Comp. Codes, R. & Regs., tit.11, § 86.4(b) (1998) (Regulation 95), would be required on automobile insurance claim forms?
The Insurance Frauds Bureau has approved a warning statement similar to the one found in N.Y. Comp. Codes, R. & Regs., tit.11, § 86.4(b) (1998) (Regulation 95) for use on both commercial and personal automobile insurance claim forms.
The inquirers company provides automated automobile repair appraisal services to the insurance industry. The inquirer wishes to include the appropriate fraud warning and other disclosure statements on the repair appraisal forms produced by the company.
The fraud warning statement found in N.Y. Comp. Codes, R. & Regs., tit.11, § 86.4(b) (1998) (Regulation 95) contains a slight mistake. The word (benefits), which should appear directly after the word (insurance) in the portion of the sentence that reads, "or other person files an application for insurance containing" was inadvertently left out during the 1998 amendment to § 86.4(b) of Regulation 95. The Insurance Department plans to revise N.Y. Comp. Codes, R. & Regs., tit.11, § 86.4(b) (1998) (Regulation 95) to include the word "benefits".
In the interim, the Insurance Frauds Bureau has approved the warning statement found below for use on both commercial and personal automobile insurance claim forms. N.Y. Comp. Codes, R. & Regs., tit.11, § 86.4(e) (1998) (Regulation 95) states that, "notwithstanding the provisions of subdivisions (a) and (b) of this section, insurers may use substantially similar warning statements provided such statements are submitted to the Insurance Frauds Bureau for prior approval."
Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance benefits containing any materially false information, or conceals for the purpose of misleading, information concerning any facts material thereto, and any person who knowingly makes or knowingly assists, abets, solicits or conspires with another to make a false report of the theft, destruction, damage or conversion of any motor vehicle to a law enforcement agency, the department of motor vehicles or an insurance company, commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the value of the subject motor vehicle or stated claim for each violation."
I trust that this has been responsive to your inquiry. Please contact me if I can be of further assistance.
For further information you may contact Senior Attorney Adiza J. Mohammed at the New York City Office.