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** New Hampshire: 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 of insurance fraud, as provided in RSA 638:20.

** New Jersey: Any person who knowingly files a statement of claim containing any false or misleading

information is subject to criminal and civil penalties.

** New Mexico: ANY PERSON WHO KNOWINGLY PRESENTS A FALSE OR FRAUDULENT CLAIM

FOR PAYMENT OF A LOSS OR BENEFIT OR KNOWINGLY PRESENTS FALSE INFORMATION IN

APPLICATION FOR INSURANCE IS GUILTY OF A CRIME AND MAY BE SUBJECT TO CIVIL FINES

AND PENALTIES.

** Ohio: 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: 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.

** 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.

** Puerto Rico: Any person who knowingly, and with intent to defraud or deceive any insurance company

includes false information in an application for insurance or files, assists, or abets in the filing of a

fraudulent claim to obtain payment of a loss or other benefits, or files more than one claim for the same

loss or damage, may be guilty of a felony. Upon conviction, that person will be fined between $5,000 and

$10,000, imprisoned for three (3) years or both. Aggravating or attenuating circumstances may result in

the prison term being increased to five (5) years or reduced to two (2) years.

Cualquier persona quien con conocimiento y con la intensión de defraudar o engañar a cualquier

compañía de seguros, incluye información falsa en una solicitud para seguro o introduce, o instiga en

la introducción de una reclamación fraudulenta para obtener pago por una pérdida u otro beneficio, o

presenta más de una reclamación por la misma pérdida o daño puede ser culpable de cometer un acto

criminal. Al ser convicto, ese persona será multada con una cantidad de $5,000 a $10,000, encarcelamiento

por tres (3) años o ambos. Circunstancias agravantes o atenuantes podrían resultar en que el período de

tiempo de prisión aumente a cinco (5) años o se reduzca a dos (2) años en concordancia.

** Arkansas and Louisiana: 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.

** Indiana: 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.

** Rhode Island: Any person who knowingly presents a false or fraudulent claim for the payment of a loss

or knowingly presents false information in an application for insurance, is guilty of a crime and may be

subject to fines and confinement in state prison.

** Tennessee, Virginia, and Washington: 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 and denial of insurance benefits.

** Texas: 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.

** If you live in a state other than mentioned above, the following statement applies to you: Any person

who knowingly, and with intent to injure, defraud or deceive any insurer or insurance company, files a

statement of claim containing any materially false, incomplete, or misleading information or conceals any

fact material thereto, may be guilty of a fraudulent act, may be prosecuted under state law and may be

subject to civil and criminal penalties. In addition, any insurer or insurance company may deny benefits if

false information is related to a claim by the claimant.

Group Claim Fraud Statements - United Of Omaha Life Insurance Company/proof Of Death Form Page 2

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