West Virginia Code 33-41-12 – Civil and criminal penalties; injunctive relief; employment disqualification; restitution
(a) A person or entity engaged in the business of insurance or a person or entity making a claim against an insurer who violates any provision of this article may be subject to the following:
Terms Used In West Virginia Code 33-41-12
- Business of insurance: means the writing of insurance, including the writing of workers' compensation insurance under the provisions of §. See West Virginia Code 33-41-2
- Claim: means an application or request for payment or benefits provided under the terms of a policy of insurance. See West Virginia Code 33-41-2
- Commissioner: means the Insurance Commissioner of West Virginia or his or her designee. See West Virginia Code 33-41-2
- Conviction: A judgement of guilt against a criminal defendant.
- Injunction: An order of the court prohibiting (or compelling) the performance of a specific act to prevent irreparable damage or injury.
- Insurance: means a contract or arrangement in which a person undertakes to:
(1) Pay or indemnify another person as to loss from certain contingencies called "risks" including through reinsurance. See West Virginia Code 33-41-2
- Insurer: means a person entering into arrangements or contracts of insurance or reinsurance. See West Virginia Code 33-41-2
- Judgment: includes decrees and orders for the payment of money, or the conveyance or delivery of land or personal property, or some interest therein, or any undertaking, bond or recognizance which has the legal effect of a judgment. See West Virginia Code 2-2-10
- Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
- Offense: includes every act or omission for which a fine, forfeiture, or punishment is imposed by law. See West Virginia Code 2-2-10
- Person: means an individual, a corporation, a limited liability company, a partnership, an association, a joint stock company, a trust, trustees, an unincorporated organization, or any similar business entity, or any combination of the foregoing. See West Virginia Code 33-41-2
- Restitution: The court-ordered payment of money by the defendant to the victim for damages caused by the criminal action.
- State: when applied to a part of the United States and not restricted by the context, includes the District of Columbia and the several territories, and the words "United States" also include the said district and territories. See West Virginia Code 2-2-10
- Unit: means the insurance fraud unit established pursuant to the provisions of this article acting collectively or by its duly authorized representatives. See West Virginia Code 33-41-2
(1) Where applicable, suspension or revocation of license or certificate of authority or a civil penalty of up to $10,000 per violation, or where applicable, both. Suspension or revocation of license or certificate of authority or imposition of civil penalties may be pursuant to an order of the commissioner issued pursuant to the provisions of § 33-2-13 of this code. The commissioner’s order may require a person found to be in violation of this article to make reasonable restitution to persons aggrieved by violations of this article. The commissioner may assess a person sanctioned pursuant to the provisions of this section the cost of investigation;
(2) Notwithstanding any other provision of law, a civil penalty imposed pursuant to the provisions of this section is mandatory and not subject to suspension;
(3) A person convicted of a felony violation law reasonably related to the business of insurance shall be disqualified from engaging in the business of insurance; and
(4) The commissioner may apply for a temporary or permanent injunction in any appropriate circuit court of this state seeking to enjoin and restrain a person from violating or continuing to violate the provisions of this article or rule promulgated under this article, notwithstanding the existence of other remedies at law. The circuit court shall have jurisdiction of the proceeding and have the power to make and enter an order or judgment awarding temporary or permanent injunctive relief restraining any person from violating or continuing to violate any provision of this article or rule promulgated under the article as in its judgment is proper.
(b) Any person who commits a violation of the provisions of § 33-41-11 of this code where the benefit sought is $1,000 or more in value is guilty of a felony and, upon conviction thereof, shall be imprisoned in a correctional facility for not less than one nor more than 10 years, fined not more than $10,000, or both fined and imprisoned, or in the discretion of the court, confined in jail for not more than one year and fined not more than $10,000, or both fined and confined.
(c) Any person who commits a violation of the provisions of § 33-41-11 of this code where the benefit sought is less than $1,000 in value is guilty of a misdemeanor and, upon conviction thereof, shall be confined in jail for not more than one year, or fined not more than $2,500, or both fined and confined.
(d) Any person convicted of a violation of § 33-41-11 of this code is subject to the restitution provisions of § 61-11A-1 of this code.
(e) A court may award to the unit or other law-enforcement agency investigating a violation of § 33-41-11 of this code or other criminal offense related to the business of insurance its cost of investigation.
(f) In addition to the provisions of this section, the offenses enumerated in §61-3-24e through §61-3-24h, inclusive, of this code are applicable to matters concerning workers’ compensation insurance.