Colorado § 18-5-211 - Insurance fraud - definitions.

§ 18-5-211. Insurance fraud - definitions.

(1) A person commits insurance fraud if the person does any of the following:

(a) With an intent to defraud presents or causes to be presented in written, verbal, or digital form an application or request for the issuance, modification, or renewal of an insurance policy, which application or request, or documentation in support of such application or request, contains false material information or withholds material information that is requested by the insurer and results in the issuance of an insurance policy or insurance coverage for the applicant or another;

(b) With an intent to defraud presents or causes to be presented any insurance claim, which claim contains false material information or withholds material information;

(c) With an intent to defraud causes or participates, or purports to be involved, in a vehicular collision, or any other vehicular accident, for the purpose of presenting any false or fraudulent insurance claim;

(d) With an intent to defraud presents or causes to be presented an insurance claim where the loss or damage claimed occurred outside of the period of time that coverage was in effect for the applicable contract of insurance or policy unless otherwise permitted under the contract of insurance or policy; or

(e) With an intent to defraud presents or causes to be presented any written, verbal, or digital material or statement as part of, in support of or in opposition to, a claim for payment or other benefit pursuant to an insurance policy, knowing that the material or statement contains false material information or withholds material information.

(2) A person commits insurance fraud if he or she knowingly moves, diverts, or misappropriates premium funds belonging to an insurer or unearned premium funds belonging to an insured or applicant for insurance from a trust or other account without the authorization of the owner of the funds or other lawful justification.

(3) A person commits insurance fraud if he or she with an intent to defraud makes, alters, presents, or causes to be presented a certificate or other evidence of the existence of insurance in any form that contains false material information or omits material information.

(4) (a) Insurance fraud committed in violation of subsection (1)(a) of this section is a class 2 misdemeanor.

(b) Insurance fraud committed in violation of subsections (1)(b) to (1)(e) or subsection (3) of this section is a class 6 felony.

(c) Insurance fraud committed in violation of subsection (2) of this section is a class 5 felony.

(5) The commissioner of insurance shall revoke the license to conduct business in this state of any licensed insurance producer under article 2 of title 10, C.R.S., who is convicted of any provision under this section.

(6) No provision of this article 5 may be interpreted to supersede, limit, abrogate, or impair the ability of the prosecuting authority to concurrently bring charges for any other state criminal offense that is otherwise applicable in addition to any offenses described by this section.

(7) As used in this section, unless the context otherwise requires:

(a) "Claim" means a demand for money, property, or services pursuant to a contract of insurance as well as any documentation in support of such claim whether submitted contemporaneously with the claim or at a different time. A claim and any supporting information may be in written, verbal, or digital form.

(b) "Insurance" has the same meaning as defined in section 10-1-102 (12), C.R.S.

(c) "Insurance producer" has the same meaning as defined in section 10-2-103 (6), C.R.S.

(d) "Insurer" has the same meaning as defined in section 10-1-102 (13), C.R.S.

(e) "Material information" is a statement or assertion directly pertaining to an application for insurance or an insurance claim that a reasonable person making such an assertion knows or should know will affect the action, conduct, or decision of the person who receives or is intended to receive the asserted information in a manner that would directly or indirectly benefit the person making the assertion.

Source: L. 2014: Entire section added, (SB 14-092), ch. 190, p. 708, § 1, effective July 1. L. 2017: (1)(a), (1)(b), (1)(d), (1)(e), (2), (3), (6), and (7)(a) amended, (HB 17-1048), ch. 68, p. 214, § 1, effective August 9. L. 2021: (4) amended, (SB 21-271), ch. 462, p. 3186, § 239, effective March 1, 2022. L. 2023: (4) amended, (HB 23-1293), ch. 298, p. 1786, § 19, effective October 1.

ANNOTATION

When a defendant is convicted under subsection (1)(b) for presenting a fraudulent insurance claim and subsection (1)(e) for making false statements in support of the same insurance claim, the prohibition against double jeopardy and multiplicity will generally require the conviction under subsection (1)(e) to merge into the conviction under subsection (1)(b). People v. Robinson, 2022 COA 124, 524 P.3d 300.

By joining alternatives disjunctively in subsections (1)(a) to (1)(e), the general assembly intended to describe alternate ways of committing a single crime rather than to create separate offenses. People v. Robinson, 2022 COA 124, 524 P.3d 300.

PART 3

FRAUDULENT AND DECEPTIVE SALES AND BUSINESS PRACTICES