Group Benefit Services Application For Accidental Death Benefits - Mutual Of Omaha Insurance Company Page 2
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4** Maryland: Any person who knowingly or willfully presents a false or fraudulent claim for payment of a
loss or benefit or who knowingly or willfully presents false information in an application for insurance is
guilty of a crime and may be subject to fines and confinement in prison.
** Minnesota: A person who files a claim with intent to defraud or helps commit a fraud against an insurer is
guilty of a crime.
** 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.
** Oregon: 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 may be a crime and may subject such person to criminal and civil penalties.
** 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.
** Rhode Island: 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.
** 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.
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