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1
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3Fraud Warning Notice
For all states
Any person who knowingly and with the intent to defraud any insurance company or other person files an
application for insurance or statement of claim containing any materially false information or conceals for
except those
listed below:
the purpose of misleading information concerning any fact material thereto commits a fraudulent
insurance act, which is a crime and subjects such person to criminal and civil penalties.
Arizona
For your protection Arizona law requires the following statement to appear on this form. Any person who
knowingly presents a false or fraudulent claim for payment of a loss is subject to criminal and civil
penalties.
Arkansas,
Any person who knowingly presents a false or fraudulent claim for payment for a loss or benefit or
Louisiana and
knowingly presents false information in an application for insurance is guilty of a crime and may be
West Virginia
subject to fines and confinement in prison.
Colorado
It is unlawful to knowingly provide false, incomplete or misleading facts or information to an insurance
company for the purpose of defrauding or attempting to defraud the company. Penalties may include
imprisonment, fines and denial of insurance and civil damages. Any insurance company or agent of an
insurance company who knowingly provides false, incomplete or misleading facts or information to a
policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or
claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the
Colorado Division of Insurance within the Department of Regulatory Agencies.
WARNING: It is a crime to provide false or misleading information to an insurer for the purpose of
District of
defrauding the insurer or any other person. Penalties include imprisonment and/or fines. In addition, an
Columbia
insurer may deny insurance benefit if false information materially related to a claim was provided by the
applicant.
Florida
All statements and information found in the application are deemed representations and not
warranties. Any person who knowingly and with intent to injure, defraud, or deceive any insurer
files a statement of claim or an application containing any false, incomplete or misleading
information is guilty of a felony of the third degree.
Kentucky,
Any person who knowingly and with the intent to defraud any insurance company or other person files an
Kansas and
application for insurance or statement of claim containing any materially false information or conceals for
North Carolina
the purpose of misleading information concerning any fact material thereto commits a fraudulent
insurance act, which is a crime and may subject such person to criminal and civil penalties.
Maine and
It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for
Washington
the purpose of defrauding the company. Penalties may include imprisonment, fines or a denial of
insurance benefits.
New Jersey
Any person who includes any false or misleading information on an application for an insurance policy is
subject to criminal and civil penalties.
ANY PERSON WHO KNOWINGLY PRESENTS A FALSE OR FRUADULENT CLAIM FOR PAYMENT
New Mexico
OR LOSS OR BENEFIT OR KNOWINGLY PRESENTS FALSE INFORMATION IN AN APPLICATION
FOR INSURANCE MAY BE SUBJECT TO CIVIL FINES AND CRIMINAL PENALTIES.
Oklahoma
WARNING: Any person who knowingly and with intent to injure, defraud or deceive any insurer, makes
any claim for the proceeds of an insurance policy containing any false, incomplete or misleading
information is guilty of a felony.
Oregon and
Any person who makes an intentional misstatement that is material to the risk may be found guilty of
Texas
insurance fraud by a court of law.
Pennsylvania
Any person who knowingly and with intent to defraud any insurance company or other person files an
application for insurance or statement of claim containing any materially false information or conceals for
the purpose of misleading, information concerning any fact material thereto commits a fraudulent
insurance act, which is a crime and subjects such person to criminal and civil penalties. If coverage is
contested, the company’s only obligation will be to refund all premiums paid.
Tennessee
It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for
the purposes of defrauding the company. Penalties include imprisonment, fines and denial of coverage.
Virginia
Any person who, with the intent to defraud or knowing that he is facilitating a fraud against an insurer,
submits an application or files a claim containing a false or deceptive statement may have violated state
law.
GTL - EnrollP - NC
80162
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