Form Gen-1720 Involuntary Unemployment Claim - Claims Service Center Page 3
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3STATE SPECIFIC FRAUD WARNINGS
Alaska Residents: A person who knowingly and with intent to injure, defraud, or deceive an insurance company files a claim containing false,
incomplete, or misleading information may be prosecuted under state law.
Arizona Residents: 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 and New Mexico Residents: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or
knowingly presents false information in an application for insurance is guilty of a crime and may be subject to civil fines and criminal penalties.
California Residents: For your protection California law requires the following to appear on this form: Any person who knowingly presents false
or fraudulent claim for payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison.
Colorado Residents: 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, 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.
Delaware and Idaho Residents: Any person who knowingly and with intent to injure, defraud, or deceive an insurer files a statement of a claim
containing any false, incomplete, or misleading information is guilty of a felony.
District of Columbia and Washington DC Residents: WARNING: It is a crime to provide false or misleading information to an insurer for the
purpose of defrauding the insurer or any other person. Penalties include imprisonment and/or fines. In addition, an insurer may deny insurance
benefits if false information materially related to a claim was provided by the applicant.
Florida Residents: Any person who knowingly and with intent to injure, defraud or deceive any insurance company files a statement of claim
containing any false, incomplete, or misleading information is guilty of a felony of the third degree.
Hawaii Residents: For your protection, Hawaii law requires you to be informed that presenting a fraudulent claim for payment of a loss or benefit
is a crime punishable by fines or imprisonment, or both.
Indiana Residents: A person who knowingly and with intent to defraud an insurer files a statement of claim containing any false, incomplete, or
misleading information commits a felony.
Kentucky Residents: Any person who knowingly and with intent to defraud any insurance company or other person files a 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.
Louisiana and Maryland Residents: Any person who knowingly and willingly presents a false or fraudulent claim for payment of a loss or benefit
or knowingly and willingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and
confinement in prison.
Tennessee and Virginia Residents: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for
the purpose of defrauding the company. Penalties include imprisonment, fines or a denial of insurance benefits.
Maine Residents: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of
defrauding the company. Penalties may include imprisonment, fines or a denial of insurance benefits.
Minnesota Residents: A person who submits an application or files a claim with intent to defraud or helps commit a fraud against an insurer is
guilty of a crime.
New Hampshire Residents: Any person who, with a purpose to injure, defraud or deceive any insurance company, files a statement of claim
containing any false, incomplete or misleading information is subject to prosecution and punishment for insurance fraud, as provided in R.S.A.
§638:20.
New Jersey Residents: Any person who knowingly files a statement of claim containing any false or misleading information is subject to criminal
and civil penalties.
New York Residents: 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 shall also be subject to a civil penalty not to exceed five
thousand dollars and the stated value of the claim for each violation.
Ohio Residents: Any person who, with 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 is guilty of insurance fraud.
Oklahoma Residents: 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 Residents: Any person who knowingly and with intent to defraud any insurance company or other person files a statement of claim or
application containing any materially false information or conceals, for the purpose of misleading, information concerning any material fact may
be guilty of an insurance fraud, which is a crime, and may be subject to prosecution.
Pennsylvania Residents: 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.
Texas and West Virginia Residents: Any person who knowingly presents a false or fraudulent claim for the payment of a loss is guilty of a crime
and may be subject to fines and confinement in state prison.
All Other States: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false
information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.
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