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United of Omaha Life Insurance Company

A Mutual of Omaha Company

Group Claim Fraud Statements

The following fraud language is attached to, and made part of this claim form. Please read and do not remove

these pages from this claim form.

** Alaska: 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: Any person who knowingly presents a false or fraudulent claim for payment of a loss is subject to

criminal and civil penalties.

** California: For your protection California law requires the following to appear on this form. 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.

** 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, 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: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, files a

statement of claim containing any false, incomplete or misleading information is guilty of a felony.

** District of Columbia: WARNING: It is a crime to provide false or misleading information to an 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: 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.

** Idaho: Any person who knowingly, and with intent to defraud or deceive any insurance company, files a

statement containing any false, incomplete, or misleading information is guilty of a felony.

** Kentucky: Any person who knowingly and with intent to defraud any insurance company or other person

files an application for insurance 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.

** Maryland: Any person who knowingly and willfully presents a false or fraudulent claim for payment of a

loss or benefit or who knowingly and willfully presents false information in an application for insurance is

guilty of a crime and may be subject to fines and confinement in prison.

** Maine: 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: A person who files a claim with intent to defraud or helps commit a fraud against an insurer is

guilty of a crime.

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Group Claim Fraud Statements - United Of Omaha Life Insurance Company/proof Of Death Form