§ 58‑2‑161. Falsestatement to procure or deny benefit of insurance policy or certificate.
(a) For the purposes ofthis section:
(1) "Insurer"has the same meaning as in G.S. 58‑1‑5(3) and also includes:
a. Any hull insuranceand protection and indemnity club operating under Article 20 of this Chapter.
b. Any surplus linesinsurer operating under Article 21 of this Chapter.
c. Any risk retentiongroup or purchasing group operating under Article 22 of this Chapter.
d. Any local governmentrisk pool operating under Article 23 of this Chapter.
e. Any risk‑sharingplan operating under Article 42 of this Chapter.
f. The North CarolinaInsurance Underwriting Association operating under Article 45 of this Chapter.
g. The North CarolinaJoint Insurance Underwriting Association operating under Article 46 of thisChapter.
h. The North CarolinaInsurance Guaranty Association operating under Article 48 of this Chapter.
i. Any multipleemployer welfare arrangement operating under Article 49 of this Chapter.
j. The North CarolinaLife and Health Insurance Guaranty Association operating under Article 62 ofthis Chapter.
k. Any servicecorporation operating under Article 65 of this Chapter.
l. Any healthmaintenance organization operating under Article 67 of this Chapter.
m. The State Health Planfor Teachers and State Employees and any optional plans or programs operatingunder Part 2 of Article 3 of Chapter 135 of the General Statutes.
n. A group of employersself‑insuring their workers' compensation liabilities under Article 47 ofthis Chapter.
o. An employer self‑insuringits workers' compensation liabilities under Article 5 of Chapter 97 of theGeneral Statutes.
p. The North CarolinaSelf‑Insurance Security Association under Article 4 of Chapter 97 of theGeneral Statutes.
q. Any reinsurerlicensed or accredited under this Chapter.
(2) "Statement"includes any application, notice, statement, proof of loss, bill of lading,receipt for payment, invoice, account, estimate of property damages, bill forservices, diagnosis, prescription, hospital or doctor records, X rays, testresult, or other evidence of loss, injury, or expense.
(b) Any person who,with the intent to injure, defraud, or deceive an insurer or insuranceclaimant:
(1) Presents or causesto be presented a written or oral statement, including computer‑generateddocuments as part of, in support of, or in opposition to, a claim for paymentor other benefit pursuant to an insurance policy, knowing that the statementcontains false or misleading information concerning any fact or matter materialto the claim, or
(2) Assists, abets,solicits, or conspires with another person to prepare or make any written ororal statement that is intended to be presented to an insurer or insuranceclaimant in connection with, in support of, or in opposition to, a claim forpayment or other benefit pursuant to an insurance policy, knowing that thestatement contains false or misleading information concerning a fact or mattermaterial to the claim is guilty of a Class H felony. Each claim shall beconsidered a separate count. Upon conviction, if the court imposes probation,the court may order the defendant to pay restitution as a condition ofprobation. In determination of the amount of restitution pursuant to G.S. 15A‑1343(d),the reasonable costs and attorneys' fees incurred by the victim in theinvestigation of, and efforts to recover damages arising from, the claim, maybe considered part of the damage caused by the defendant arising out of theoffense.
In a civil cause of action forrecovery based upon a claim for which a defendant has been convicted under thissection, the conviction may be entered into evidence against the defendant. Thecourt may award the prevailing party compensatory damages, attorneys' fees,costs, and reasonable investigative costs. If the prevailing party candemonstrate that the defendant has engaged in a pattern of violations of thissection, the court may award treble damages. (1899, c. 54, s. 60; Rev., s. 3487; 1913, c. 89, s.28; C.S., s. 4369; 1937, c. 248; 1967, c. 1088, s. 1; 1979, c. 760, s. 5; 1989(Reg. Sess., 1990), c. 1054, s. 2; 1995, c. 43, s. 1; 1999‑294, s. 3;2005‑400, s. 17; 2007‑298, s. 8.1; 2007‑323, s. 28.22A(o);2007‑345, s. 12.)
§ 58‑2‑161. Falsestatement to procure or deny benefit of insurance policy or certificate.
(a) For the purposes ofthis section:
(1) "Insurer"has the same meaning as in G.S. 58‑1‑5(3) and also includes:
a. Any hull insuranceand protection and indemnity club operating under Article 20 of this Chapter.
b. Any surplus linesinsurer operating under Article 21 of this Chapter.
c. Any risk retentiongroup or purchasing group operating under Article 22 of this Chapter.
d. Any local governmentrisk pool operating under Article 23 of this Chapter.
e. Any risk‑sharingplan operating under Article 42 of this Chapter.
f. The North CarolinaInsurance Underwriting Association operating under Article 45 of this Chapter.
g. The North CarolinaJoint Insurance Underwriting Association operating under Article 46 of thisChapter.
h. The North CarolinaInsurance Guaranty Association operating under Article 48 of this Chapter.
i. Any multipleemployer welfare arrangement operating under Article 49 of this Chapter.
j. The North CarolinaLife and Health Insurance Guaranty Association operating under Article 62 ofthis Chapter.
k. Any servicecorporation operating under Article 65 of this Chapter.
l. Any healthmaintenance organization operating under Article 67 of this Chapter.
m. The State Health Planfor Teachers and State Employees and any optional plans or programs operatingunder Part 2 of Article 3 of Chapter 135 of the General Statutes.
n. A group of employersself‑insuring their workers' compensation liabilities under Article 47 ofthis Chapter.
o. An employer self‑insuringits workers' compensation liabilities under Article 5 of Chapter 97 of theGeneral Statutes.
p. The North CarolinaSelf‑Insurance Security Association under Article 4 of Chapter 97 of theGeneral Statutes.
q. Any reinsurerlicensed or accredited under this Chapter.
(2) "Statement"includes any application, notice, statement, proof of loss, bill of lading,receipt for payment, invoice, account, estimate of property damages, bill forservices, diagnosis, prescription, hospital or doctor records, X rays, testresult, or other evidence of loss, injury, or expense.
(b) Any person who,with the intent to injure, defraud, or deceive an insurer or insuranceclaimant:
(1) Presents or causesto be presented a written or oral statement, including computer‑generateddocuments as part of, in support of, or in opposition to, a claim for paymentor other benefit pursuant to an insurance policy, knowing that the statementcontains false or misleading information concerning any fact or matter materialto the claim, or
(2) Assists, abets,solicits, or conspires with another person to prepare or make any written ororal statement that is intended to be presented to an insurer or insuranceclaimant in connection with, in support of, or in opposition to, a claim forpayment or other benefit pursuant to an insurance policy, knowing that thestatement contains false or misleading information concerning a fact or mattermaterial to the claim is guilty of a Class H felony. Each claim shall beconsidered a separate count. Upon conviction, if the court imposes probation,the court may order the defendant to pay restitution as a condition ofprobation. In determination of the amount of restitution pursuant to G.S. 15A‑1343(d),the reasonable costs and attorneys' fees incurred by the victim in theinvestigation of, and efforts to recover damages arising from, the claim, maybe considered part of the damage caused by the defendant arising out of theoffense.
In a civil cause of action forrecovery based upon a claim for which a defendant has been convicted under thissection, the conviction may be entered into evidence against the defendant. Thecourt may award the prevailing party compensatory damages, attorneys' fees,costs, and reasonable investigative costs. If the prevailing party candemonstrate that the defendant has engaged in a pattern of violations of thissection, the court may award treble damages. (1899, c. 54, s. 60; Rev., s. 3487; 1913, c. 89, s.28; C.S., s. 4369; 1937, c. 248; 1967, c. 1088, s. 1; 1979, c. 760, s. 5; 1989(Reg. Sess., 1990), c. 1054, s. 2; 1995, c. 43, s. 1; 1999‑294, s. 3;2005‑400, s. 17; 2007‑298, s. 8.1; 2007‑323, s. 28.22A(o);2007‑345, s. 12.)
§ 58‑2‑161. Falsestatement to procure or deny benefit of insurance policy or certificate.
(a) For the purposes ofthis section:
(1) "Insurer"has the same meaning as in G.S. 58‑1‑5(3) and also includes:
a. Any hull insuranceand protection and indemnity club operating under Article 20 of this Chapter.
b. Any surplus linesinsurer operating under Article 21 of this Chapter.
c. Any risk retentiongroup or purchasing group operating under Article 22 of this Chapter.
d. Any local governmentrisk pool operating under Article 23 of this Chapter.
e. Any risk‑sharingplan operating under Article 42 of this Chapter.
f. The North CarolinaInsurance Underwriting Association operating under Article 45 of this Chapter.
g. The North CarolinaJoint Insurance Underwriting Association operating under Article 46 of thisChapter.
h. The North CarolinaInsurance Guaranty Association operating under Article 48 of this Chapter.
i. Any multipleemployer welfare arrangement operating under Article 49 of this Chapter.
j. The North CarolinaLife and Health Insurance Guaranty Association operating under Article 62 ofthis Chapter.
k. Any servicecorporation operating under Article 65 of this Chapter.
l. Any healthmaintenance organization operating under Article 67 of this Chapter.
m. The State Health Planfor Teachers and State Employees and any optional plans or programs operatingunder Part 2 of Article 3 of Chapter 135 of the General Statutes.
n. A group of employersself‑insuring their workers' compensation liabilities under Article 47 ofthis Chapter.
o. An employer self‑insuringits workers' compensation liabilities under Article 5 of Chapter 97 of theGeneral Statutes.
p. The North CarolinaSelf‑Insurance Security Association under Article 4 of Chapter 97 of theGeneral Statutes.
q. Any reinsurerlicensed or accredited under this Chapter.
(2) "Statement"includes any application, notice, statement, proof of loss, bill of lading,receipt for payment, invoice, account, estimate of property damages, bill forservices, diagnosis, prescription, hospital or doctor records, X rays, testresult, or other evidence of loss, injury, or expense.
(b) Any person who,with the intent to injure, defraud, or deceive an insurer or insuranceclaimant:
(1) Presents or causesto be presented a written or oral statement, including computer‑generateddocuments as part of, in support of, or in opposition to, a claim for paymentor other benefit pursuant to an insurance policy, knowing that the statementcontains false or misleading information concerning any fact or matter materialto the claim, or
(2) Assists, abets,solicits, or conspires with another person to prepare or make any written ororal statement that is intended to be presented to an insurer or insuranceclaimant in connection with, in support of, or in opposition to, a claim forpayment or other benefit pursuant to an insurance policy, knowing that thestatement contains false or misleading information concerning a fact or mattermaterial to the claim is guilty of a Class H felony. Each claim shall beconsidered a separate count. Upon conviction, if the court imposes probation,the court may order the defendant to pay restitution as a condition ofprobation. In determination of the amount of restitution pursuant to G.S. 15A‑1343(d),the reasonable costs and attorneys' fees incurred by the victim in theinvestigation of, and efforts to recover damages arising from, the claim, maybe considered part of the damage caused by the defendant arising out of theoffense.
In a civil cause of action forrecovery based upon a claim for which a defendant has been convicted under thissection, the conviction may be entered into evidence against the defendant. Thecourt may award the prevailing party compensatory damages, attorneys' fees,costs, and reasonable investigative costs. If the prevailing party candemonstrate that the defendant has engaged in a pattern of violations of thissection, the court may award treble damages. (1899, c. 54, s. 60; Rev., s. 3487; 1913, c. 89, s.28; C.S., s. 4369; 1937, c. 248; 1967, c. 1088, s. 1; 1979, c. 760, s. 5; 1989(Reg. Sess., 1990), c. 1054, s. 2; 1995, c. 43, s. 1; 1999‑294, s. 3;2005‑400, s. 17; 2007‑298, s. 8.1; 2007‑323, s. 28.22A(o);2007‑345, s. 12.)
