(a) Any person who, knowingly and with intent to defraud, and for the purpose of depriving another of property or for pecuniary gain, commits or participates in or permits its employees or its agents to commit any of the following acts, has committed a fraudulent insurance act:

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Terms Used In Tennessee Code 56-47-103

  • Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
  • Department: means the department of commerce and insurance. See Tennessee Code 56-1-102
  • Insurance policy: means the written instrument in which are set forth the terms of any binder of coverage or contract of insurance, including a binder or contract issued by a state-assigned risk plan, or other forms of workers' compensation insurance. See Tennessee Code 56-47-102
  • Insurance professional: means sales agents, managing general agents, brokers, producers, adjusters and third party administrators. See Tennessee Code 56-47-102
  • Insurance transaction: means a transaction by, between or among an:
    (A) Insurer or a person who acts on behalf of an insurer. See Tennessee Code 56-47-102
  • Insurer: means any person purporting to engage in the business of insurance or authorized to do business in this state or subject to regulation by the state, who undertakes to indemnify another against loss, damage or liability arising from a contingent or unknown event related to causes arising under title 50, chapter 6. See Tennessee Code 56-47-102
  • Pattern or practice: means repeated, routine or generalized in nature, and not merely isolated or sporadic. See Tennessee Code 56-47-102
  • Person: means a natural person, company, corporation, unincorporated association, partnership, professional corporation, agency of government or any other entity. See Tennessee Code 56-47-102
  • Practitioner: means a licensee of this state authorized to practice medicine and surgery, psychology, chiropractic or law or any other licensee of state or person required to be licensed in this state whose services are compensated either in whole or in part, directly or indirectly, by insurance proceeds. See Tennessee Code 56-47-102
  • Property: includes both personal and real property. See Tennessee Code 1-3-105
(1) Presents, causes to be presented or prepares with knowledge or belief that it will be presented, by or on behalf of an insured, insurer, claimant or applicant to an insurer or insurance professional in connection with an insurance transaction any information that contains false representations as to any material fact, or that withholds or conceals a material fact concerning any of the following:

(i) The application for, rating of or renewal of, any insurance policy;
(ii) A claim for payment or benefit pursuant to any insurance policy; or
(iii) Payments made in accordance with the terms of any insurance policy;
(2) Presents, causes to be presented or prepares with knowledge or belief that it will be presented, to or by an insurer or insurance professional in connection with an insurance transaction, any information that contains false representations as to any material fact, or that withholds or conceals a material fact, concerning any of the following:

(i) The solicitation for sale of any insurance policy or purported insurance policy;
(ii) An application for certificate of authority; or
(iii) The financial condition of any insurer;
(3) Solicits or accepts new or renewal insurance risks by or for an insolvent insurer;
(4) Removes the assets or records of assets, transactions and affairs or the material part of the assets or records of assets, transactions and affairs from the home office or other place of business of the insurer, or from the place of safekeeping of the insurer, or destroys or sequesters the same from the department of commerce and insurance;
(5) Diverts, misappropriates, converts or embezzles funds of an insurer, an insured, claimant or applicant for insurance in connection with:

(i) An insurance transaction; or
(ii) The conduct of business activities by an insurer or insurance professional; or
(6) Presents, causes to be presented or prepares with knowledge or belief that it will be presented, by or on behalf of an insured or insurer, or insurance professional, to a claimant or any other person in connection with an insurance transaction, any information that contains false representations as to any material fact, or that withholds or conceals a material fact concerning any of the following:

(i) A claim for payment or benefit pursuant to any insurance policy; or
(ii) Payments made in accordance with the terms of any insurance policy.
(b) It is unlawful for any person to commit, or to attempt to commit, or to aid, assist, abet or solicit another to commit, or to conspire to commit a fraudulent insurance act.
(c) A practitioner violates this section only if the practitioner has been engaged in conduct that constitutes a pattern or practice of violation of this section.
(d) It is unlawful for an employer subject to the Workers’ Compensation Law, compiled in title 50, chapter 6, to intentionally fail to secure payment of compensation by providing workers’ compensation insurance coverage or by qualifying as a self-insurer pursuant to the workers’ compensation law.
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