Title 33, Chapter 1, Section 16
( 33-1-16)
(a) For the purposes of this Code section, a person commits a
"fraudulent insurance act" if he: (1) Knowingly and with intent to defraud presents, causes to be
presented, or prepares with knowledge or belief that it will be
presented, to or by an insurer, purported insurer, broker, or any
agent thereof, any written statement as part of, or in support of,
an application for the issuance of, or the rating of, an insurance
policy, or a claim for payment or other benefit pursuant to an
insurance policy, which he knows to contain materially false
information concerning any fact material thereto or if he
conceals, for the purpose of misleading another, information
concerning any fact material thereto; or (2) Knowingly and willfully transacts any contract, agreement, or
instrument which violates this title. (b) If, by his own inquiries or as a result of information received,
the Commissioner has reason to believe that a person has engaged in,
or is engaging in, a fraudulent insurance act, the Commissioner may
administer oaths and affirmations, request the attendance of
witnesses or proffering of matter, and collect evidence. The
Commissioner shall not compel the attendance of any person or matter
in any such investigation except pursuant to subsection (d) of this
Code section. (c) If matter that the Commissioner seeks to obtain by request is
located outside the state, the person so requested may make it
available to the Commissioner or his representative to examine the
matter at the place where it is located. The Commissioner may
designate representatives, including officials of the state in which
the matter is located, to inspect the matter on his behalf, and he
may respond to similar requests from officials of other states. (d)(1) The Commissioner may request that an individual who refuses
to comply with any such request be ordered by the superior court
to provide the testimony or matter. The court shall not order
such compliance unless the Commissioner has demonstrated to the
satisfaction of the court that the testimony of the witness or the
matter under request has a direct bearing on the commission of a
fraudulent insurance act or is pertinent or necessary to further
such investigation. (2) Except in a prosecution for perjury, an individual who
complies with a court order to provide testimony or matter after
asserting a privilege against self-incrimination, to which he is
entitled by law, may not be subjected to a criminal proceeding or
to a civil penalty with respect to the act concerning which he is
required to testify or produce relevant matter. (3) In the absence of fraud or bad faith, a person is not subject
to civil liability for libel, slander, or any other relevant tort
by virtue of filing reports, without malice, or furnishing other
information, without malice, required by this Code section or
required by the Commissioner under the authority granted in this
Code section, and no civil cause of action of any nature shall
arise against such person:
(A) For any information relating to suspected fraudulent
insurance acts furnished to or received from law enforcement
officials, their agents, or employees; (B) For any such information relating to suspected fraudulent
insurance acts furnished to or received from other persons
subject to the provisions of this title; or (C) For any such information furnished in reports to the
Commissioner or the National Association of Insurance
Commissioners. (4) The Commissioner or any employee or agent is not subject to
civil liability for libel, slander, or any other relevant tort,
and no civil cause of action of any nature exists against such
persons by virtue of the execution of activities or duties of the
Commissioner under this Code section or by virtue of the
publication of any report or bulletin related to the activities or
duties of the Commissioner under this Code section. (5) This Code section does not abrogate or modify in any way any
common law or statutory privilege or immunity heretofore enjoyed
by any person. (e) The papers, documents, reports, or evidence relative to the
subject of an investigation under this Code section shall not be
subject to public inspection for so long as the Commissioner deems
reasonably necessary to complete the investigation, to protect the
person investigated from unwarranted injury, or to be in the public
interest. Further, such papers, documents, reports, or evidence
relative to the subject of an investigation under this Code section
shall not be subject to subpoena until opened for public inspection
by the Commissioner, unless the Commissioner consents, or until,
after notice to the Commissioner and a hearing, a superior court
determines the Commissioner would not be unnecessarily hindered by
such subpoena. The Commissioner or his employees or agents shall
not be subject to subpoena in civil actions by any court of this
state to testify concerning any matter of which they have knowledge
pursuant to pending investigations of fraudulent insurance acts. (f) Any person, other than an insurer, agent, or other person
licensed under this title, or an employee thereof, having knowledge
of or who believes that a fraudulent insurance act is being or has
been committed may send to the Commissioner a report of information
pertinent to such knowledge of or belief and such additional
information relative thereto as the Commissioner may request. Any
insurer, agent, or other person licensed under this title, or an
employee thereof, having knowledge of or who believes that a
fraudulent insurance act is being or has been committed shall send
to the Commissioner a report or information pertinent to such
knowledge or belief and such additional information relative thereto
as the Commissioner or his employees or agents may require. The
Commissioner or his employees or agents shall review such
information or reports as, in the judgment of the Commissioner or
such employees or agents, may require further investigation. The
Commissioner shall then cause an investigation of the facts
surrounding such information or report to be made to determine the
extent, if any, to which a fraudulent insurance act is being
committed and shall report any alleged violations of law which the
investigations disclose to the appropriate prosecuting attorney
having jurisdiction with respect to any such violation. If
prosecution by the prosecuting attorney is not begun within 90 days
of the report, the prosecuting attorney shall inform the
Commissioner of the reasons for the lack of prosecution. (g) Notwithstanding the provisions of subsection (f) of this Code
section, when an insurer or an insured knows or has reasonable
grounds to believe that a person committed a fraudulent insurance
act and which the insurer reasonably believes not to have been
reported to a law enforcement agency in this state, then, for the
purpose of notification and investigation, the insurer or an agent
authorized by an insurer to act on its behalf or the insured may
notify such law enforcement agency of such knowledge or reasonable
belief and provide such information relevant to the fraudulent
insurance act, including, but not limited to, insurance policy
information, including the application for insurance; policy premium
payment records; history of previous claims made by the insured; and
other information relating to the investigation of the claim,
including statements of any person, proofs of loss, and notice of
loss. In the absence of fraud or bad faith, no insurer or agent
authorized by an insurer to act on its behalf, law enforcement
agency, or their respective employees or an insured shall be subject
to any civil liability for libel, slander, or related cause of
action by virtue of filing reports or for releasing or receiving any
information pursuant to this subsection. For the purposes of this
Code section, the term "law enforcement agency" shall mean and
include any federal, state, county, or consolidated police or law
enforcement department and any prosecuting official of the federal,
state, county, local, or consolidated government. For the purposes
of this Code section, the term "insured" shall mean and include any
person who is a named insured or beneficiary under a policy or
contract of insurance or a person who is not a named insured or
beneficiary under a policy or contract of insurance due to the
fraudulent action of another but who in good faith believes himself
to be such an insured or beneficiary. (h) Personnel employed by the Commissioner under this Code section
shall have the power to make arrests for criminal violations
established as a result of investigations only. The general laws
applicable to arrests by peace officers of this state shall also be
applicable to such personnel. Such personnel shall have the power to
execute arrest warrants and search warrants for the same criminal
violations; to serve subpoenas issued for the examination,
investigation, and trial of all offenses determined by their
investigations; and to arrest upon probable cause without warrant
any person found in the act of violating any of the provisions of
applicable laws. Personnel empowered to make arrests under this
Code section shall be empowered to carry firearms or other weapons
in the performance of their duties. It is unlawful for any person
to resist an arrest authorized by this Code section or in any manner
to interfere, either by abetting or assisting such resistance or
otherwise interfering, with personnel employed by the Commissioner
under this Code section in the duties imposed upon them by law. |