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Can you summarize HIRS Chapter 431, Article 2, Part IV?
ADMINISTRATION OF INSURANCE LAWS > Insurance Fraud
Short Summary
This part of the Hawaii Revised Statutes governs the administration of insurance laws related to insurance fraud. It establishes the insurance fraud investigations branch within the insurance division, which is responsible for conducting a statewide program for the prevention of insurance fraud, investigating and prosecuting insurance fraud violations, and promoting public and industry-wide education about insurance fraud. The branch has jurisdiction over insurance fraud violations under title 24, excluding workers’ compensation insurance. The document defines insurance fraud as intentionally or knowingly misrepresenting or concealing material facts to obtain or attempt to obtain coverage, benefits, recovery, or compensation. It lists various scenarios where insurance fraud can occur and outlines the penalties for insurance fraud. The document also establishes a civil cause of action for insurance fraud, allowing insurers or other licensees to recover payments or benefits from violators. It provides immunity from civil liability for providing information related to insurance fraud and mandates the reporting of insurance fraud violations by insurers and other licensees. The funding for the branch comes from the compliance resolution fund. Overall, these documents aim to prevent, investigate, and prosecute insurance fraud in Hawaii.
Whom does it apply to?
Entities licensed under and governed by title 24, including insurers, mutual benefit societies, fraternal benefit societies, health maintenance organizations, and their respective agents and employees engaged in the business of the licensee
What does it govern?
Administration of insurance laws related to insurance fraud
What are exemptions?
Insurers and other licensees as defined in this part, licensed attorneys acting in their capacity as attorneys for a claimant other than the licensed attorney
What are the Penalties?
Ranging from a class B felony for cases involving benefits exceeding $20,000 to a misdemeanor for cases involving benefits not exceeding $750
Jurisdiction
Hawaii