2010 California Code
Insurance Code
Article 1. False And Fraudulent Claims

INSURANCE CODE
SECTION 1871-1871.9



1871.  The Legislature finds and declares as follows:
   (a) The business of insurance involves many transactions that have
the potential for abuse and illegal activities. There are numerous
law enforcement agencies on the state and local levels charged with
the responsibility for investigating and prosecuting fraudulent
activity. This chapter is intended to permit the full utilization of
the expertise of the commissioner and the department so that they may
more effectively investigate and discover insurance frauds, halt
fraudulent activities, and assist and receive assistance from
federal, state, local, and administrative law enforcement agencies in
the prosecution of persons who are parties in insurance frauds.
   (b) Insurance fraud is a particular problem for automobile
policyholders; fraudulent activities account for 15 to 20 percent of
all auto insurance payments. Automobile insurance fraud is the
biggest and fastest growing segment of insurance fraud and
contributes substantially to the high cost of automobile insurance
with particular significance in urban areas.
   (c) Prevention of automobile insurance fraud will significantly
reduce the incidence of severity and automobile insurance claim
payments and will therefore produce a commensurate reduction in
automobile insurance premiums.
   (d) Workers' compensation fraud harms employers by contributing to
the increasingly high cost of workers' compensation insurance and
self-insurance and harms employees by undermining the perceived
legitimacy of all workers' compensation claims.
   (e) Prevention of workers' compensation insurance fraud may reduce
the number of workers' compensation claims and claim payments
thereby producing a commensurate reduction in workers' compensation
costs. Prevention of workers' compensation insurance fraud will
assist in restoring confidence and faith in the workers' compensation
system, and will facilitate expedient and full compensation for
employees injured at the workplace.
   (f) The actions of employers who fraudulently underreport payroll
or fail to report payroll for all employees to their insurance
company in order to pay a lower workers' compensation premium result
in significant additional premium costs and an unfair burden to
honest employers and their employees.
   (g) The actions of employers who fraudulently fail to secure the
payment of workers' compensation as required by Section 3700 of the
Labor Code harm employees, cause unfair competition for honest
employers, and increase costs to taxpayers.
   (h) Health insurance fraud is a particular problem for health
insurance policyholders. Although there are no precise figures, it is
believed that fraudulent activities account for billions of dollars
annually in added health care costs nationally. Health care fraud
causes losses in premium dollars and increases health care costs
unnecessarily.



1871.1.  Insurers and their agents, while they are investigating
suspected fraud claims, shall have access to all relevant public
records that are required to be open for inspection under Chapter 3.5
(commencing with Section 6250) of Division 7 of Title 1 of the
Government Code, and any regulations thereunder. This section
restates existing law, and the Legislature does not intend to grant
insurers or their agents access to public records other than to those
public records available to them under existing law.



1871.2.  (a) Any insurer who, in connection with any insurance
contract or provision of contract described in Section 108, prints,
reproduces, or furnishes a form to any person upon which that person
gives notice to the insurer or makes claim against it by reason of
accident, injury, death, or other noticed or claimed loss, or on a
rider attached thereto, shall cause to be printed or displayed in
comparative prominence with other content the statement: "Any person
who knowingly presents 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." This statement shall be preceded by the
words: "For your protection California law requires the following to
appear on this form" or other explanatory words of similar meaning.
   (b) This section is not applicable to a contract of reinsurance as
defined in Section 620.



1871.3.  (a) In the case of any claim arising from the theft of an
insured vehicle, prior to the settlement of the claim, the insurer
shall secure from the insured a claim form which shall contain, among
other things, the following:
   (1) A warning that false representations made on the signed claim
form by the insured subject the insured to a penalty of perjury.
   (2) A detailed description of the insured vehicle including the
interior, exterior, and any special equipment.
   (3) The purchase location of the insured vehicle, the purchase
date, and the name of the seller.
   (4) A detailed statement of the circumstances surrounding the
theft.
   (5) The current driver's license number of the insured, except
where the vehicle is owned by a person that is not a natural person,
or the claimant is a financial institution and the vehicle is insured
pursuant to an insurance policy issued to the financial institution
to protect vehicles that are collateral securing any loan made by the
financial institution. A financial institution shall provide, to the
extent it has the information, the current driver's license number
of the registered owner of the vehicle or the debtor who has obtained
the loan.
   (b) For purposes of complying with the requirements of subdivision
(a), the insured shall do either of the following:
   (1) Sign the claim form in the presence of the insurance agent,
broker, adjuster, or other claims representative, who shall verify
the driver's license number of the insured who is signing the claim
form.
   (2) Submit a claim form with a notarized signature.
   (c) The claim form shall be signed under penalty of perjury.
   (d) The insurer shall retain the following for at least three
years:
   (1) All settlement checks in settlement of the theft of an
automobile, or an electronic copy thereof.
   (2) The original claim form provided for in subdivision (a), or an
electronic copy thereof.
   (3) A legible copy of the police report of the vehicle theft, or
an electronic copy thereof.



1871.4.  (a) It is unlawful to do any of the following:
   (1) Make or cause to be made a knowingly false or fraudulent
material statement or material representation for the purpose of
obtaining or denying any compensation, as defined in Section 3207 of
the Labor Code.
   (2) Present or cause to be presented a knowingly false or
fraudulent written or oral material statement in support of, or in
opposition to, a claim for compensation for the purpose of obtaining
or denying any compensation, as defined in Section 3207 of the Labor
Code.
   (3) Knowingly assist, abet, conspire with, or solicit a person in
an unlawful act under this section.
   (4) Make or cause to be made a knowingly false or fraudulent
statement with regard to entitlement to benefits with the intent to
discourage an injured worker from claiming benefits or pursuing a
claim.
   For the purposes of this subdivision, "statement" includes, but is
not limited to, a notice, proof of injury, bill for services,
payment for services, hospital or doctor records, X-ray, test
results, medical-legal expense as defined in Section 4620 of the
Labor Code, other evidence of loss, injury, or expense, or payment.
   (5) Make or cause to be made a knowingly false or fraudulent
material statement or material representation for the purpose of
obtaining or denying any of the benefits or reimbursement provided in
the Return-to-Work Program established under Section 139.48 of the
Labor Code.
   (6) Make or cause to be made a knowingly false or fraudulent
material statement or material representation for the purpose of
discouraging an employer from claiming any of the benefits or
reimbursement provided in the Return-to-Work Program established
under Section 139.48 of the Labor Code.
   (b) Every person who violates subdivision (a) shall be punished by
imprisonment in the county jail for one year, or in the state
prison, for two, three, or five years, or by a fine not exceeding one
hundred fifty thousand dollars ($150,000) or double the value of the
fraud, whichever is greater, or by both that imprisonment and fine.
Restitution shall be ordered, including restitution for any medical
evaluation or treatment services obtained or provided. The court
shall determine the amount of restitution and the person or persons
to whom the restitution shall be paid. A person convicted under this
section may be charged the costs of investigation at the discretion
of the court.
   (c) A person who violates subdivision (a) and who has a prior
felony conviction of that subdivision, of former Section 556, of
former Section 1871.1, or of Section 548 or 550 of the Penal Code,
shall receive a two-year enhancement for each prior conviction in
addition to the sentence provided in subdivision (b).
   The existence of any fact that would subject a person to a penalty
enhancement shall be alleged in the information or indictment and
either admitted by the defendant in open court, or found to be true
by the jury trying the issue of guilt or by the court where guilt is
established by plea of guilty or nolo contendere or by trial by the
court sitting without a jury.
   (d) This section may not be construed to preclude the
applicability of any other provision of criminal law that applies or
may apply to a transaction.



1871.5.  Any person convicted of workers' compensation fraud
pursuant to Section 1871.4 or Section 550 of the Penal Code shall be
ineligible to receive or retain any compensation, as defined in
Section 3207 of the Labor Code, where that compensation was owed or
received as a result of a violation of Section 1871.4 or Section 550
of the Penal Code for which the recipient of the compensation was
convicted.



1871.6.  The provisions of Section 781 of the Penal Code are
applicable to any prosecutions for violations of Section 1871.4. This
section is declaratory of existing law and shall not be interpreted
to limit the applicability of Section 781 of the Penal Code to any
other criminal provisions.



1871.7.  (a) It is unlawful to knowingly employ runners, cappers,
steerers, or other persons to procure clients or patients to perform
or obtain services or benefits pursuant to Division 4 (commencing
with Section 3200) of the Labor Code or to procure clients or
patients to perform or obtain services or benefits under a contract
of insurance or that will be the basis for a claim against an insured
individual or his or her insurer.
   (b) Every person who violates any provision of this section or
Section 549, 550, or 551 of the Penal Code shall be subject, in
addition to any other penalties that may be prescribed by law, to a
civil penalty of not less than five thousand dollars ($5,000) nor
more than ten thousand dollars ($10,000), plus an assessment of not
more than three times the amount of each claim for compensation, as
defined in Section 3207 of the Labor Code or pursuant to a contract
of insurance. The court shall have the power to grant other equitable
relief, including temporary injunctive relief, as is necessary to
prevent the transfer, concealment, or dissipation of illegal
proceeds, or to protect the public. The penalty prescribed in this
paragraph shall be assessed for each fraudulent claim presented to an
insurance company by a defendant and not for each violation.
   (c) The penalties set forth in subdivision (b) are intended to be
remedial rather than punitive, and shall not preclude, nor be
precluded by, a criminal prosecution for the same conduct. If the
court finds, after considering the goals of disgorging unlawful
profit, restitution, compensating the state for the costs of
investigation and prosecution, and alleviating the social costs of
increased insurance rates due to fraud, that such a penalty would be
punitive and would preclude, or be precluded by, a criminal
prosecution, the court shall reduce that penalty appropriately.
   (d) The district attorney or commissioner may bring a civil action
under this section. Before the commissioner may bring that action,
the commissioner shall be required to present the evidence obtained
to the appropriate local district attorney for possible criminal or
civil filing. If the district attorney elects not to pursue the
matter due to insufficient resources, then the commissioner may
proceed with the action.
   (e) (1) Any interested persons, including an insurer, may bring a
civil action for a violation of this section for the person and for
the State of California. The action shall be brought in the name of
the state. The action may be dismissed only if the court and the
district attorney or the commissioner, whichever is participating,
give written consent to the dismissal and their reasons for
consenting.
   (2) A copy of the complaint and written disclosure of
substantially all material evidence and information the person
possesses shall be served on the district attorney and commissioner.
The complaint shall be filed in camera, shall remain under seal for
at least 60 days, and shall not be served on the defendant until the
court so orders. The local district attorney or commissioner may
elect to intervene and proceed with the action within 60 days after
he or she receives both the complaint and the material evidence and
information. If more than one governmental entity elects to
intervene, the district attorney shall have precedence.
   (3) The district attorney or commissioner may, for good cause
shown, move the court for extensions of the time during which the
complaint remains under seal under paragraph (2). The motions may be
supported by affidavits or other submissions in camera. The defendant
shall not be required to respond to any complaint filed under this
section until 20 days after the complaint is unsealed and served upon
the defendant.
   (4) Before the expiration of the 60-day period or any extensions
obtained under paragraph (3), the district attorney or commissioner
shall either:
   (A) Proceed with the action, in which case the action shall be
conducted by the district attorney or commissioner.
   (B) Notify the court that it declines to take over the action, in
which case the person bringing the action shall have the right to
conduct the action.
   (5) When a person or governmental agency brings an action under
this section, no person other than the district attorney or
commissioner may intervene or bring a related action based on the
facts underlying the pending action unless that action is authorized
by another statute or common law.
   (f) (1) If the district attorney or commissioner proceeds with the
action, he or she shall have the primary responsibility for
prosecuting the action, and shall not be bound by an act of the
person bringing the action. That person shall have the right to
continue as a party to the action, subject to the limitations set
forth in paragraph (2).
   (2) (A) The district attorney or commissioner may dismiss the
action notwithstanding the objections of the person initiating the
action if the person has been notified by the district attorney or
commissioner of the filing of the motion, and the court has provided
the person with an opportunity for a hearing on the motion.
   (B) The district attorney or commissioner may settle the action
with the defendant notwithstanding the objections of the person
initiating the action if the court determines, after a hearing, that
the proposed settlement is fair, adequate, and reasonable under all
the circumstances. Upon a showing of good cause, the hearing may be
held in camera.
   (C) Upon a showing by the district attorney or commissioner that
unrestricted participation during the course of the litigation by the
person initiating the action would interfere with or unduly delay
the district attorney's or commissioner's prosecution of the case, or
would be repetitious, irrelevant, or for purposes of harassment, the
court may, in its discretion, impose limitations on the person's
participation, including, but not limited to, the following:
   (i) Limiting the number of witnesses the person may call.
   (ii) Limiting the length of the testimony of those witnesses.
   (iii) Limiting the person's cross-examination of witnesses.
   (iv) Otherwise limiting the participation by the person in the
litigation.
   (D) Upon a showing by the defendant that unrestricted
participation during the course of the litigation by the person
initiating the action would be for purposes of harassment or would
cause the defendant undue burden or unnecessary expense, the court
may limit the participation by the person in the litigation.
   (3) If the district attorney or commissioner elects not to proceed
with the action, the person who initiated the action shall have the
right to conduct the action. If the district attorney or commissioner
so requests, he or she shall be served with copies of all pleadings
filed in the action and shall be supplied with copies of all
deposition transcripts, at the district attorney's or commissioner's
expense. When a person proceeds with the action, the court, without
limiting the status and rights of the person initiating the action,
may nevertheless permit the district attorney or commissioner to
intervene at a later date upon a showing of good cause.
   (4) If at any time both a civil action for penalties and equitable
relief pursuant to this section and a criminal action are pending
against a defendant for substantially the same conduct, whether
brought by the government or a private party, the civil action shall
be stayed until the criminal action has been concluded at the trial
court level. The stay shall not preclude the court from granting or
enforcing temporary equitable relief during the pendency of the
actions. Whether or not the district attorney or commissioner
proceeds with the action, upon a showing by the district attorney or
commissioner that certain actions of discovery by the person
initiating the action would interfere with a law enforcement or
governmental agency investigation or prosecution of a criminal or
civil matter arising out of the same facts, the court may stay
discovery for a period of not more than 180 days. A hearing on a
request for the stay shall be conducted in camera. The court may
extend the 180-day period upon a further showing in camera that the
agency has pursued the criminal or civil investigation or proceedings
with reasonable diligence and any proposed discovery in the civil
action will interfere with the ongoing criminal or civil
investigation or proceedings.
   (5) Notwithstanding subdivision (e), the district attorney or
commissioner may elect to pursue its claim through any alternate
remedy available to the district attorney or commissioner.
   (g) (1) (A) (i) If the district attorney proceeds with an action
brought by a person under subdivision (e), that person shall, subject
to subparagraph (B), receive at least 30 percent but not more than
40 percent of the proceeds of the action or settlement of the claim,
depending upon the extent to which the person substantially
contributed to the prosecution of the action.
   (ii) If the commissioner has brought an action or has proceeded
with an action brought by another person under this section on or
after January 1, 2006, the commissioner shall be entitled to attorney'
s fees and costs in addition to any judgment, regardless of the date
that judgment is entered. The court shall determine and award the
commissioner the amount of reasonable attorney's fees, including, but
not limited to, reasonable fees for time expended by attorneys
employed by the department and for costs incurred. Any attorney's
fees or costs awarded to the commissioner and collected shall be
deposited in the Insurance Fund. In cases in which the commissioner
has intervened, the commissioner and the person bringing the claim
may stipulate to an allocation. The court may allocate the funds
pursuant to the stipulation if, after the court's ruling on objection
by the district attorney, if any, the court finds it is in the
interests of justice to follow the stipulation.
   (iii) If the commissioner has proceeded with an action, if there
is no stipulation regarding allocation, and if a judgment has been
obtained or a settlement has been reached with the defendants, the
court shall determine the allocation, upon motion of the commissioner
or the person bringing the action, according to the following
priority:
   (I) The person bringing the action, regardless of whether that
person paid money to the defendants as part of the acts alleged in
the complaint, shall first receive the amount the court determines is
reasonable for attorney's fees, costs, and expenses that the court
determines to have been necessarily incurred.
   (II) The commissioner shall receive the amount the court
determines for reasonable attorney's fees and costs.
   (III) If the person bringing the suit has paid moneys to the
defendants as part of the acts alleged in the complaint, that person
shall receive the amount paid to the defendants.
   (IV) At least 30 percent, but not more than 40 percent, of the
remaining assets or moneys, shall be allocated to the person bringing
the action, depending upon the extent to which the person
substantially contributed to the prosecution of the action.
   (iv) Those portions of a judgment or settlement not distributed
pursuant to this subdivision shall be paid to the General Fund of the
state and, upon appropriation by the Legislature, shall be
apportioned between the Department of Justice and the Department of
Insurance for enhanced fraud investigation and prevention efforts.
   (B) Where the action is one that the court finds to be based
primarily on disclosures of specific information, other than
information provided by the person bringing the action, relating to
allegations or transactions in a criminal, civil, or administrative
hearing, in a legislative or administrative report, hearing, audit,
or investigation, or from the news media, the court may award those
sums that it considers appropriate, but in no case more than 10
percent of the proceeds, taking into account the significance of the
information and the role of the person bringing the action in
advancing the case to litigation.
   (C) Any payment to a person under subparagraph (A) or under
subparagraph (B) shall be made from the proceeds. The person shall
also receive an amount for reasonable expenses that the court finds
to have been necessarily incurred, plus reasonable attorney's fees
and costs. All of those expenses, fees, and costs shall be awarded
against the defendant.
   (2) (A) If the district attorney or commissioner does not proceed
with an action under this section, the person bringing the action or
settling the claim shall receive an amount that the court decides is
reasonable for collecting the civil penalty and damages. Except as
provided in subparagraph (B), the amount shall not be less than 40
percent and not more than 50 percent of the proceeds of the action or
settlement and shall be paid out of the proceeds. That person shall
also receive an amount for reasonable expenses that the court finds
to have been necessarily incurred, plus reasonable attorney's fees
and costs. All of those attorney's fees and costs shall be imposed
against the defendant. The parties shall serve the commissioner and
the local district attorney with complete copies of any and all
settlement agreements, and terms and conditions, for actions brought
under this article at least 10 days prior to filing any motion for
allocation with the court under this paragraph. The court may
allocate the funds pursuant to the settlement agreement if, after the
court's ruling on objection by the commissioner or the local
district attorney, if any, the court finds it is in the interests of
justice to follow the settlement agreement.
   (B) If the person bringing the action, as a result of a violation
of this section has paid money to the defendant or to an attorney
acting on behalf of the defendant in the underlying claim, then he or
she shall be entitled to up to double the amount paid to the
defendant or the attorney if that amount is greater than 50 percent
of the proceeds. That person shall also receive an amount for
reasonable expenses that the court finds to have been necessarily
incurred, plus reasonable attorney's fees and costs. All of those
expenses, fees, and costs shall be awarded against the defendant.
   (3) If a local district attorney has proceeded with an action
under this section, one-half of the penalties not awarded to a
private party, as well as any costs awarded shall go to the treasurer
of the appropriate county. Those funds shall be used to investigate
and prosecute fraud, augmenting existing budgets rather than
replacing them. All remaining funds shall go to the state and be
deposited in the General Fund and, when appropriated by the
Legislature, shall be apportioned between the Department of Justice
and the Department of Insurance for enhanced fraud investigation and
prevention efforts.
   (4) Whether or not the district attorney or commissioner proceeds
with the action, if the court finds that the action was brought by a
person who planned and initiated the violation of this section, that
person shall be dismissed from the civil action and shall not receive
any share of the proceeds of the action. The dismissal shall not
prejudice the right of the district attorney or commissioner to
continue the action on behalf of the state.
   (5) If the district attorney or commissioner does not proceed with
the action, and the person bringing the action conducts the action,
the court may award to the defendant its reasonable attorney's fees
and expenses if the defendant prevails in the action and the court
finds that the claim of the person bringing the action was clearly
frivolous, clearly vexatious, or brought primarily for purposes of
harassment.
   (h) (1) In no event may a person bring an action under subdivision
(e) that is based upon allegations or transactions that are the
subject of a civil suit or an administrative civil money penalty
proceeding in which the Attorney General, district attorney, or
commissioner is already a party.
   (2) (A) No court shall have jurisdiction over an action under this
section based upon the public disclosure of allegations or
transactions in a criminal, civil, or administrative hearing in a
legislative or administrative report, hearing, audit, or
investigation, or from the news media, unless the action is brought
by the Attorney General or the person bringing the action is an
original source of the information.
   (B) For purposes of this paragraph, "original source" means an
individual who has direct and independent knowledge of the
information on which the allegations are based and has voluntarily
provided the information to the district attorney or commissioner
before filing an action under this section that is based on the
information.
   (i) Except as provided in subdivision (j), the district attorney
or commissioner is not liable for expenses that a person incurs in
bringing an action under this section.
   (j) In civil actions brought under this section in which the
commissioner or a district attorney is a party, the court shall
retain discretion to impose sanctions otherwise allowed by law,
including the ability to order a party to pay expenses as provided in
Sections 128.5 and 1028.5 of the Code of Civil Procedure.
   (k) Any employee who is discharged, demoted, suspended,
threatened, harassed, or in any other manner discriminated against in
the terms and conditions of employment by his or her employer
because of lawful acts done by the employee on behalf of the employee
or others in furtherance of an action under this section, including
investigation for, initiation of, testimony for, or assistance in, an
action filed or to be filed under this section, shall be entitled to
all relief necessary to make the employee whole. That relief shall
include reinstatement with the same seniority status the employee
would have had but for the discrimination, two times the amount of
backpay, interest on the backpay, and compensation for any special
damages sustained as a result of the discrimination, including
litigation costs and reasonable attorney's fees. An employee may
bring an action in the appropriate superior court for the relief
provided in this subdivision. The remedies under this section are in
addition to any other remedies provided by existing law.
   (l) (1) An action pursuant to this section may not be filed more
than three years after the discovery of the facts constituting the
grounds for commencing the action.
   (2) Notwithstanding paragraph (1) no action may be filed pursuant
to this section more than eight years after the commission of the act
constituting a violation of this section or a violation of Section
549, 550, or 551 of the Penal Code.



1871.8.  An insurer or self-insured employer shall provide the
following notice, in both English and Spanish, to an injured worker
on or with a check for temporary disability benefits:

   WARNING: You are required to report to your employer or the
insurance company any money that you earned for work during the time
covered by this check, and before cashing this check. If you do not
follow these rules, you may be in violation of the law and the
penalty may be jail or prison, a fine, and loss of benefits.

   ADVERTENCIA: Es necesario que usted le avise a su patrón o a su
compañía de seguro todo dinero que usted ha ganado por trabajar,
durante el tiempo cubierto por éste cheque, y antes de cambiar éste
cheque. Si usted no sigue estos reglamentos, Usted puede estar en
violación de la ley y el castigo podría ser carcel o prisión, una
multa, y pérdida de beneficios.



1871.9.  The department shall post all of the following information
on its Internet Web site for each person, as defined in Section 19,
convicted of a violation of this article, Section 11760 or 11880,
Section 3700.5 of the Labor Code, or Section 487 or 550 of the Penal
Code, if the violation involved workers' compensation insurance,
services, or benefits:
   (a) The name, case number, county or court, and other identifying
information with respect to the case.
   (b) The full name of the defendant.
   (c) The city and county of the defendant's last known residence or
business address.
   (d) The date of conviction.
   (e) A description of the offense.
   (f) The amount of money alleged to have been defrauded.
   (g) A description of the punishment imposed, including the length
of any sentence of imprisonment and the amount of any fine imposed.
   The information required to be posted under this section shall be
maintained on the department's Web site for a period of five years
from the date of conviction or until the department is notified in
writing by the person that the conviction has been reversed or
expunged.


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