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304.47-050 Reports of possible fraudulent insurance acts -- Investigation -Notification of prosecutor -- Immunity from civil liability.
(1)
(2)
(3)
(4)
(5)
(6)
Any person, other than those specified in subsection (2) of this section, having
knowledge or believing that a fraudulent insurance act or any other act or
practice which, upon conviction, constitutes a felony or misdemeanor under the
subtitle is being or has been committed may send to the division a report of
information pertinent to this knowledge of or belief and any additional relevant
information the commissioner may request.
The following individuals having knowledge or believing that a fraudulent
insurance act or any other act or practice which may constitute a felony or
misdemeanor under this subtitle is being or has been committed shall send to
the division a report or information pertinent to the knowledge or belief and
additional relevant information that the commissioner or the commissioner's
employees or agents may require:
(a) Any professional practitioner licensed or regulated by the
Commonwealth, except as provided by law;
(b) Any private medical review committee;
(c) Any insurer, agent, or other person licensed under this chapter; and
(d) Any employee of the persons named in paragraphs (a) to (c) of this
subsection.
The division or its employees or agents shall review this information or these
reports and select the information or reports that, in the judgment of the
division, may require further investigation. The division shall then cause an
investigation of the facts surrounding the information or report to be made to
determine the extent, if any, to which a fraudulent insurance act or any other
act or practice which, upon conviction, constitutes a felony or misdemeanor
under this subtitle is being committed.
The Department of Workers' Claims shall provide the division access to all
relevant information the commissioner may request.
The division shall report any alleged violations of law which the investigations
disclose to the appropriate licensing agency and the Commonwealth's attorney,
Attorney General, or other prosecuting agency having jurisdiction with respect
to a violation. If prosecution by the Commonwealth's attorney, Attorney
General, or other prosecuting agency is not begun within sixty (60) days of the
report, the prosecuting attorney shall inform the division of the reasons for the
lack of prosecution. In addition to filing a report with the appropriate
prosecuting agency, the commissioner may, through the Attorney General,
prosecute violations of this subtitle in the Circuit Court of the county in which
the alleged wrongdoer resides or has his or her principal place of business, in
the Circuit Court of the county in which the fraudulent insurance act has been
committed, or, with consent of the parties, in the Franklin Circuit Court.
Notwithstanding the provisions of subsections (1) to (5) of this section, any
person having knowledge or believing that a fraudulent insurance act or any
other act that may be prohibited under this subtitle is being or has been
committed, may notify any law enforcement agency of his or her knowledge or
belief and provide information relevant to the act, as may be requested by that
(7)
(8)
agency, 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. Reporting to any other agency does not relieve those listed in subsection
(2) of this section of their mandatory duty to report to the division.
If the information referred to in this section is specifically requested by the
division, any other law enforcement agency, or a prosecuting attorney, the
insurer shall provide certified copies of the requested information within ten
(10) business days of the request or as soon thereafter as reasonable.
In the absence of malice, fraud, or gross negligence, no insurer or agent
authorized by an insurer to act on its behalf, law enforcement agency, the
Department of Workers' Claims, 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.
Effective:July 15, 2010
History: Amended 2010 Ky. Acts ch. 24, sec. 1586, effective July 15, 2010. -Amended 2000 Ky. Acts ch. 253, sec. 6, effective July 14, 2000; and ch. 262,
sec. 32, effective July 14, 2000. -- Amended 1998 Ky. Acts ch. 213, sec. 9,
effective July 15, 1998. -- Amended 1996 (1st Extra. Sess.) Ky. Acts ch. 1,
sec. 88, effective December 12, 1996. -- Created 1994 Ky. Acts ch. 496,
sec. 21, effective July 15, 1994.
Legislative Research Commission Note (12/12/96). Under KRS 7.136(1)(e),
existing internal subsection references in subsections (6) and (7) of this statute
have been adjusted to reflect the insertion of the new subsection (4) in this
statute by 1996 (1st Extra. Sess.) Ky. Acts ch. 1, sec. 88 and the resulting
renumbering of succeeding subsections.
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