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Insurance Fraud Prevention Model Act
Edition and licensing notes
Publisher. National Association of Insurance Commissioners (NAIC)
Status. NAIC model, © NAIC. Brief quotations under fair use; not the enacted law of any state until adopted.
What this document is
Insurance Fraud Prevention Model Act is a naic model law published by National Association of Insurance Commissioners (NAIC). It is one of the documents that insurance license exam questions are written from, including life & health, personal lines practice questions. This page summarizes it and points to the official version, which is the text to rely on.
Sections cited in practice questions
Each practice answer shows the exact passage it comes from. These are sections of this document that questions cite, with a short excerpt from the source text.
- Section 2C
“C. “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: (1) Presenting, causing to be presented or preparing with knowledge or belief that it will...”
- Section 3C(2)
“(2) A person in the business of insurance shall not knowingly or intentionally permit a person convicted of a felony involving dishonesty or breach of trust to participate in the business of insurance.”
- Section 4B
“B. The lack of a statement as required in Subsection A of this section does not constitute a defense in any prosecution for a fraudulent insurance act.”
- Section 6A
“A. A person engaged in the business of insurance having knowledge or a reasonable belief that a fraudulent insurance act is being, will be or has been committed shall provide to the commissioner the information required by, and in a manner prescribed by, the commissioner.”
- Section 7B
“B. Subsection A of this section shall not apply to statements made with actual malice. In an action brought against a person for filing a report or furnishing other information concerning a fraudulent insurance act, the party bringing the action shall plead specifically any allegation that...”
- NAIC Model #680, Section 4A-B (Fraud Warning Required)
“A. Claim forms and applications for insurance, regardless of the form of transmission, shall contain the following statement or a substantially similar statement: “Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information...”
- NAIC Model #680, Section 6A-B (Mandatory Reporting of Fraudulent Insurance Acts)
“A. A person engaged in the business of insurance having knowledge or a reasonable belief that a fraudulent insurance act is being, will be or has been committed shall provide to the commissioner the information required by, and in a manner prescribed by, the commissioner. B. Any other person having...”
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