The following shall establish and maintain antifraud initiatives which are reasonably calculated to prevent, detect, and assist in the prosecution of violations of Section 31A-36-113:
Terms Used In Utah Code 31A-36-117
Agency: means :
(a)
a person other than an individual, including a sole proprietorship by which an individual does business under an assumed name; and
Fraud: Intentional deception resulting in injury to another.
Insurance: includes :
(i)
a risk distributing arrangement providing for compensation or replacement for damages or loss through the provision of a service or a benefit in kind;
(ii)
a contract of guaranty or suretyship entered into by the guarantor or surety as a business and not as merely incidental to a business transaction; and
(iii)
a plan in which the risk does not rest upon the person who makes an arrangement, but with a class of persons who have agreed to share the risk. See Utah Code 31A-1-301
Life settlement: includes :
(i)
the transfer for compensation or value of ownership or beneficial interest in a trust or other entity that owns a policy if the trust or other entity is formed or operated for the principal purpose of acquiring one or more policies; or
(ii)
a premium finance loan made for a policy by a lender to an owner on, before, or after the date of issuance of the policy if the owner:
(A)
receives on the date of the premium finance loan a guarantee of a future life settlement value of the policy; or
(B)
agrees on the date of the premium finance loan to sell the policy or any portion of the policy's death benefit on a date following the issuance of the policy. See Utah Code 31A-36-102
Life settlement producer: means a person licensed in the state as a life insurance producer that on behalf of an owner and for consideration offers or attempts to negotiate a life settlement between the owner and one or more life settlement providers. See Utah Code 31A-36-102
Life settlement provider: means a person other than an owner that enters into or effectuates a life settlement. See Utah Code 31A-36-102
producer: means a person licensed or required to be licensed under the laws of this state to sell, solicit, or negotiate insurance. See Utah Code 31A-1-301
Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
(a)
a life settlement provider; and
(b)
an agency that is a life settlementproducer.
(2)
The commissioner may order, or a licensee may request and the commissioner may approve, modifications of the measures otherwise required under this section, more or less restrictive than those measures, as necessary to protect against fraud.
(3)
Antifraud initiatives shall include:
(a)
fraud investigators, that may be either:
(i)
employees of a life settlement provider or life settlement producer; or
(ii)
independent contractors;
(b)
an antifraud plan submitted to the commissioner, which shall include:
(i)
a description of the procedures for:
(A)
detecting and investigating possible violations of Section 31A-36-113; and
(B)
resolving material inconsistencies between medical records and applications for insurance;
(ii)
a description of the procedures for reporting possible violations to the commissioner;
(iii)
a description of the plan for educating and training underwriters and other personnel against fraud; and
(iv)
a description or chart of the organizational arrangement of the personnel responsible for detecting and investigating possible violations of Section 31A-36-113 and for resolving material inconsistencies between medical records and applications for insurance.
