Insurance Fraud – Part 2

VALUE OF CLAIM.   

If the value of a claim is not readily ascertainable, the value of the claim is: 

–  the fair market value, at the time and place of the offense, of the goods or services that are the subject of the claim; or 

–  the cost of replacing the goods or services that are the subject of the claim within a reasonable time after the claim. 

–  If goods or services that are the subject of a claim cannot be reasonably ascertained, the goods or services are considered to have a value of $750 or more but less than $2,500. 

–  If the actor proves by a preponderance of the evidence that a portion of the claim for payment under an insurance policy resulted from a valid loss, injury, expense, or service covered by the policy, the value of the claim is equal to the difference between the total claim amount and the amount of the valid portion of the claim. 

AGGREGATION AND MULTIPLE OFFENSES.   

When separate claims in violation of this chapter are communicated to an insurer or group of insurers pursuant to one scheme or continuing course of conduct, the conduct may be considered as one offense and the value of the claims aggregated in determining the classification of the offense.   

When three or more separate claims are communicated to an insurer or group of insurers pursuant to one scheme or continuing course of conduct, the conduct may be considered as one offense, and the classification of the offense shall be one category higher than the most serious single offense proven from the separate claims, except that if the most serious offense is a felony of the first degree, the offense is a felony of the first degree.  
 

JURISDICTION OF ATTORNEY GENERAL.  

The attorney general may offer to an attorney representing the state in the prosecution of an offense, the investigative, technical, and litigation assistance of the attorney general’s office. 

The attorney general may prosecute or assist in the prosecution of an offense at the request of the attorney representing the state. 
 

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