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1. General Insurance Concepts
2. Producer Roles and Receipt Types
3. Principles of Life Insurance
4. Underwriting
5. Term Life Insurance
6. Whole Life Insurance
7. Variable Insurance Products
8. Group Life Insurance
9. Life Insurance Provisions
10. Annuities
11. Taxation of Life Insurance Products
12. Qualified Retirement Plans
13. Health Insurance Basics
14. Required Policy Provisions
15. Optional Policy Provisions
16. Medical Expense Insurance
17. Group Health Insurance
18. The Affordable Care Act (ACA)
19. Disability Income Insurance
20. Accidental Death and Dismemberment Insurance
21. Long Term Care Insurance
22. Dental Insurance
23. Section 125 Plans and Limited Policies
24. Federal Government Programs
25. Medigap and Medicaid
26. Health Insurance Taxation
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Achievable Life & Health
49. California Code and Ethics
49.7. Fraud – CDI-Required Training
49.7.4. Fraud Detection

Legal Consequences of Fraud

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Insurance fraud is not just a civil issue—it carries serious criminal and regulatory penalties in California. The California Insurance Code, together with the Penal Code, clearly outlines the consequences for making, assisting, or even attempting fraudulent acts in connection with insurance.

Perjury and Criminal Penalties

  • Perjury in Insurance Claims: Under CIC §§1871.2–1871.3, signing a fraudulent insurance application or claim form is considered perjury, since claim forms typically require the applicant’s sworn statement of truth.

  • Criminal Charges: Fraud can be prosecuted as either a felony or misdemeanor, depending on the severity of the case. Penalties may include:

    • Fines (often ranging from thousands to tens of thousands of dollars)
    • Restitution (repaying the insurer for fraudulent payouts)
    • Probation or imprisonment (misdemeanor up to 1 year in county jail; felony = up to several years in state prison)

False and Fraudulent Claims Article

  • Defined in CIC §§1871 and 1871.4: This article establishes what constitutes a false or fraudulent claim and sets the framework for penalties. Fraud is broadly defined to include:

    • Staging or inflating accidents or losses
    • Submitting false documentation or invoices
    • Concealing material facts in applications or claims
    • Conspiring with others to commit fraud
  • Applies to All Lines of Insurance: Fraud provisions are not limited to auto or health insurance—they apply equally to life, property, casualty, workers’ compensation, and disability coverage.

  • Proactive Fraud Prevention: These statutes also encourage insurers, agents, and brokers to implement anti-fraud measures, such as training, SIUs, and fraud detection systems.

Why It Matters

  • Fraud drives up premiums for all California consumers.
  • Fraudulent claims undermine public trust in the insurance system.
  • Professionals who fail to report fraud may face regulatory scrutiny or discipline from the California Department of Insurance (CDI).

Fraud isn’t just an ethical violation—it’s a crime with potentially life-changing consequences.

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