The Fraudulent Insurance Act of Utah lays out the crimes of fraud relating to insurance. It is illegal to defraud an insurance company and it is also illegal under this act for an insurance company to cheat in order not to pay a legitimate claim.
For individuals, it is insurance fraud to present false information (oral or written) to an insurer on an application or renewal of an insurance policy, certificate, or contract. It is also illegal to present false information to an insurer in connection with a claim for payment.
The law also targets those that assist, abet, solicit or conspire to commit a fraudulent insurance act. Individuals are also banned from accepting a benefit from proceeds derived from a fraudulent insurance act.
In all cases, the prosecution must prove your intent to deceive or defraud and that you knowingly committed the fraudulent actions.
If you are a service provider doing work based off of an insurance repayment, it is illegal to submit a bill or repayment that contains costs or charges above the actual work performed. This can mean that the work performed could have been done at one time, but was intentionally spread out to cost more than usual. Also, work that was subpar—below professional standards—but billed at a normal rate, is considered insurance fraud.
Again, conspiring to commit a fraudulent insurance act is also considered fraud for a service provider, in addition to accepting benefits from a fraudulent insurance act. The service provider must have intentionally and knowingly performed the fraud.
An insurance provider will be found guilty of insurance fraud if it can be proven they knowingly and intentionally:
- withheld information or provided false or misleading information with respect to an application, coverage, benefits, or claims under a policy or certificate;
- assisted, abetted, solicited, or conspired with another to commit a fraudulent insurance act;
- knowingly accepted a benefit from the proceeds derived from a fraudulent insurance act; or
- knowingly supplied false or fraudulent material information in any document or statement required by the department.
An insurer or service provider is insulated from the illegal actions of her employees unless it is found that the insurer or service provider knew or should have known about the fraudulent insurance act.