Utah Insurance Fraud Laws

The state of Utah specifically outlaws insurance fraud. In the Beehive State, it is a crime to intentionally provide false, incomplete, or misleading information for the purpose of obtaining insurance benefits. The state also outlaws workers' compensation insurance fraud and makes it a crime to intentionally make a false or fraudulent statement or omit material information in order to obtain workers compensation benefits. The following is a quick summary of Utah insurance fraud laws.

Utah Insurance Fraud Laws:

The following table outlines insurance fraud laws in Utah.

Code Sections

UTAH CODE ยงยง 76-6-521, 31A-31-103, and 32A-2-110

What is Prohibited?

Insurance fraud :

Consists of performing any of the following intentional acts:

  • Providing false, incomplete, or misleading information material to an insurance application, either in writing or orally
  • Proving false, incomplete, or misleading information in order to obtain insurance benefits or damages related to a civil claim for personal or bodily injury or property damage
  • Accepting a benefit from insurance fraud proceeds
  • Intentionally or recklessly devising a scheme or device to obtain professional service fees or anything of value through false or fraudulent pretenses, representations, promises, or material omissions
  • Aiding, soliciting, or conspiring with another person to commit insurance fraud
  • Supplying false or fraudulent material information in a document or statement required by the insurance department
  • Failing to forward a premium to an insurer
  • Employing, using, or acting as a "runner" for the purpose of committing insurance fraud

Service providers such as doctors can also commit insurance fraud if they intentionally perform any of the following acts:

  • Submitting a bill for an item or service that is substantially more than the customary charge or containing itemized fees for what is customarily a single procedure or service
  • Providing an item or service to a person that is substantially in excess of the person's needs or of a poor quality

Insurers also commit insurance fraud if they intentionally withhold information or provide false or misleading information regarding an application, coverage, benefits, or claims.

Workers' compensation insurance fraud :

Knowingly or recklessly making a false or fraudulent statement, promise, or omission of material information in order to do any of the following:

  • Obtain workers compensation benefits
  • Avoid paying for a workers compensation insurance premium
  • Deprive an employee of workers compensation benefits
Penalties

Intentionally providing false, incomplete, or misleading information material to an insurance application is a class B misdemeanor punishable by up to 6 months in prison and up to $1,000 in fines.

Intentionally or recklessly devising a scheme or device to obtain professional service fees or anything of value through false or fraudulent pretenses, representations, promises, or material omissions is:

  • A class B misdemeanor if the value of the benefits sought or obtained is less than $500
  • A class A misdemeanor punishable by up to 1 year in prison and up to $2,500 in fines if the benefits sought or obtained is more than $500 but less than $1,500
  • A third-degree felony punishable by up to 5 years in prison and up to $5,000 in fines if the value of the benefits sought or obtained is $1,500 or more but less than $5,000
  • A second-degree felony punishable up to 15 years in prison and up to $10,000 in fines if the value of the benefits sought or obtained is $5,000 or more

The perpetrator is also subject to restitution and other costs such as attorney's fees. The court may also order a civil penalty up to 3 times the value of that which was sought or received from the insurance fraud. A service provider who commits insurance fraud can also have their license suspended or revoked.

Workers compensation fraud is a class A misdemeanor if the value of the benefits sought or obtained is less than $1,000 or the number of employees deprived of benefits is less than 5. It is a third-degree felony if benefits sought or obtained is $1,000 or more, but less than $5,000 or
the number of employees deprived of benefits is 5 or more, but less than 50. It is a second degree-felony if the benefits sought or obtained is $5,000 or more or the number of employees deprived of benefits is 50 or more.

Defenses The insurer or service provider had no knowledge of the insurance fraud and the fraudulent act was committed by an employee who was acting without authority.
How do I File a Complaint Against a Utah Insurance Company?

If you're having problems with an insurance company or agent, a complaint may be filed with the Utah Insurance Department.

Utah Insurance Fraud Law: Related Resources

Insurance fraud laws can sometimes be confusing. If you have been charged with insurance fraud, you may want to consult an experienced Utah criminal defense attorney for questions about your specific situation. You can also visit Findlaw's section on insurance fraud for more information on this topic.

Next Steps: Search for a Local Attorney

Contact a qualified attorney.