New York State Seal
STATE OF NEW YORK
INSURANCE DEPARTMENT
25 BEAVER STREET
NEW YORK, NEW YORK 10004

George E. Pataki
Governor

Howard Mills
Superintendent

The Office of General Counsel issued the following informal opinion on June 20, 2006, representing the position of the New York State Insurance Department.

Re: Fraud Warning

Question Presented

Does Section 86.4 of N.Y. Comp. Codes R. & Regs. tit.11 § 86 (2003) (Regulation 95), require that the fraud warning statement shall be contained on insurance claim forms and applications for specified types of insurance " . . . in connection with insurance policies for issuance or issuance for delivery in this State . . . " ?

Conclusion

Yes, Section 86.4 of N.Y. Comp. Codes R. & Regs. tit.11 § 86 (2003), (Regulation 95), requires that the fraud warning statement shall be contained on insurance claim forms and applications for specified types of insurance " . . . in connection with insurance policies for issuance or issuance for delivery in this State . . . ".

Facts

No facts were provided.

Analysis

Section 86.4 of N.Y. Comp. Codes R. & Regs. tit.11 § 86 (2003), (Regulation 95), specifies that the fraud warning statement be contained on insurance claim forms and applications in connection with insurance policies for issuance or issuance for delivery in New York State. Section 86.4 of N.Y. Comp. Codes R. & Regs. tit.11 § 86 (2003), (Regulation 95), states in relevant part that:

(a) Except with respect to automobile insurance, all claim forms for insurance, and all applications for commercial insurance and accident and health insurance, provided to any person residing or located in this State in connection with insurance policies for issuance or issuance for delivery in this State, shall contain the following statement:

"Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, 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 stated value of the claim for each such violation."

(b) All applications and claim forms for automobile insurance provided to any person residing or located in this State in connection with insurance policies for issuance or issuance for delivery in this State shall contain the following statement:

"Any person who knowingly and with intent to defraud any insurance company or other person files an application for commercial insurance or a statement of claim for any commercial or personal insurance benefits containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, and any person who, in connection with such application or claim, 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."

(Emphasis added.)

For further information one may contact Senior Attorney Susan A. Dess, at the New York City Office.