Texas Penal Code - Section 35.02. Insurance Fraud
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§ 35.02. INSURANCE FRAUD. (a) A person commits an
offense if, with intent to defraud or deceive an insurer, the
person, in support of a claim for payment under an insurance policy:
(1) prepares or causes to be prepared a statement
that:
(A) the person knows contains false or misleading
material information; and
(B) is presented to an insurer; or
(2) presents or causes to be presented to an insurer a
statement that the person knows contains false or misleading
material information.
(a-1) A person commits an offense if the person, with intent
to defraud or deceive an insurer and in support of an application
for an insurance policy:
(1) prepares or causes to be prepared a statement
that:
(A) the person knows contains false or misleading
material information; and
(B) is presented to an insurer; or
(2) presents or causes to be presented to an insurer a
statement that the person knows contains false or misleading
material information.
(b) A person commits an offense if, with intent to defraud
or deceive an insurer, the person solicits, offers, pays, or
receives a benefit in connection with the furnishing of goods or
services for which a claim for payment is submitted under an
insurance policy.
(c) An offense under Subsection (a) or (b) is:
(1) a Class C misdemeanor if the value of the claim is
less than $50;
(2) a Class B misdemeanor if the value of the claim is
$50 or more but less than $500;
(3) a Class A misdemeanor if the value of the claim is
$500 or more but less than $1,500;
(4) a state jail felony if the value of the claim is
$1,500 or more but less than $20,000;
(5) a felony of the third degree if the value of the
claim is $20,000 or more but less than $100,000;
(6) a felony of the second degree if the value of the
claim is $100,000 or more but less than $200,000; or
(7) a felony of the first degree if:
(A) the value of the claim is $200,000 or more;
or
(B) an act committed in connection with the
commission of the offense places a person at risk of death or
serious bodily injury.
(d) An offense under Subsection (a-1) is a state jail
felony.
(e) The court shall order a defendant convicted of an
offense under this section to pay restitution, including court
costs and attorney's fees, to an affected insurer.
(f) If conduct that constitutes an offense under this
section also constitutes an offense under any other law, the actor
may be prosecuted under this section, the other law, or both.
(g) For purposes of this section, 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.
(h) If it is shown on the trial of an offense under this
section that the actor submitted a bill for goods or services in
support of a claim for payment under an insurance policy to the
insurer issuing the policy, a rebuttable presumption exists that
the actor caused the claim for payment to be prepared or presented.
Added by Acts 1995, 74th Leg., ch. 621, § 1, eff. Sept. 1, 1995.
Amended by Acts 2003, 78th Leg., ch. 605, § 1, eff. Sept. 1,
2003; Acts 2005, 79th Leg., ch. 1162, § 4, eff. Sept. 1, 2005.
Section: 33.05 34.01 34.02 34.021 34.03 35.01 35.015 35.02 35.025 35.03 35.04 33A.01 33A.02 33A.03 33A.04
Last modified: August 11, 2007
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