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Summary Of H.B. 4004
 

W.Va. Code §33-41 (H.B. 4004) establishes a Fraud Unit in the Commissioner’s office.

Allows a fraud warning to be placed on certain forms so the public will be aware that certain activities may constitute insurance fraud.

Authorizes the Commissioner’s Fraud Unit to investigate suspected fraud.

Provides that the Prosecuting Attorney with jurisdiction will prosecute the cases, but if unable he/she will petition the Circuit Court for appointment of a special prosecutor from the Prosecuting Attorney’s Institute.

Provides that the Commissioner’s attorneys may assist as special prosecutors if assistance is sought by the prosecutor.

Provides that persons/entities engaged in insurance business must report suspected insurance fraud.

Provides immunity from civil liability for reporting suspected insurance fraud.

Provides that documents/information obtained in fraud investigations are confidential and not subject to FOIA.

Authorizes the Fraud Unit to investigate suspected violations of Chapter 33 relating to fraud and violations of Chapter 61 of the WV Code as they relate to insurance fraud.

Creates the crime of fraudulent insurance claim:

  • If the benefit sought exceeds $1,000, the crime is a felony and subject to a fine of not more than $10,000 and/or not less than one nor more than ten years imprisonment.
  • If the benefit sought is less than $1,000, the crime is a misdemeanor and subject to a fine of no more than $2,500 and no more than one year imprisonment.

Permits court ordered restitution under Chapter 61 of the WV Code as applicable from those convicted.

Provides that the court may award the Fraud Unit the cost of its investigation.

Allows the Commissioner to assess civil penalties in addition to suspension/revocation of licenses.

 
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