Chapter 3999. CRIMES RELATING TO INSURANCE
Effective Date:
01-01-1974 .
No medical examiner for a life insurance company or for an
applicant for insurance therein shall knowingly make a false statement or
report to such company or to an officer thereof concerning the health or
physical condition of an applicant for insurance, or other matter or thing
affecting the granting of such insurance.
Effective Date:
10-01-1953 .
No trustee, officer, agent, or employee of a corporation,
company, or association organized to transact the business of life or accident
or life and accident insurance on the assessment plan shall knowingly insure a
person, or permit him to be insured without that person's knowledge or consent,
or insure a fictitious person, a person over sixty-five or under fifteen years
of age, or a sickly or infirm person.
No physician or other person shall knowingly aid or abet any
person in effecting insurance described in this section, or in effecting
insurance of his own life.
Effective Date:
10-01-1953 .
No life insurance company doing business in this state, or an
agent thereof, shall make a contract of insurance, or an agreement as to such
contract, other than is plainly expressed in the policy issued thereon.
Effective Date:
10-01-1953 .
No life insurance company doing business in this state, or an
officer, agent, solicitor, or representative thereof, shall pay, allow, or
give, or offer to pay, allow, or give, directly or indirectly, as an inducement
to insurance, a rebate of the premium payable on a policy, or a special favor
or advantage in the dividends or other benefits to accrue thereon, or a paid
employment or contract for services of any kind, or any valuable consideration
or inducement not specified in the policy of insurance, or give, sell, or
purchase, or offer to give, sell, or purchase, as an inducement for insurance,
any stocks, bonds, or securities of an insurance company or other corporation,
association, or partnership, or any dividends or profits to accrue thereon, or
anything of value not specified in the policy.
Effective Date:
10-01-1953 .
Effective Date:
01-01-1974 .
No person, having accepted a premium note in payment of the
purchase price of a policy of insurance, shall sell or assign such note prior
to the delivery and acceptance of such policy.
Effective Date:
10-01-1953 .
No person for himself or as an officer, director, agent,
solicitor, or representative of any insurance company, except fire insurance
companies or associations or fraternal benefit societies, doing business in
this state, shall issue, circulate, or cause or permit to be issued or
circulated any estimate, illustration, circular, or statement of any sort
misrepresenting the terms of the policy issued or to be issued by such company
or the benefits or advantages promised thereby or the dividends or shares or
surplus to be received thereon. No person shall use any name or title of any
policy or class of policies misrepresenting the true nature thereof, or make,
circulate, use, or cause to be made, circulated, or used, any illustration,
circular, or statement, whether written or oral, misrepresenting the terms of
any policy issued by any such corporation, or the benefits or advantages
promised thereby, or any misleading estimate of the dividends or shares of
surplus to be received therefrom. No person shall make any misleading
representations or incomplete comparison of policies or certificates of
insurance to any person insured in any such corporation for the purpose of
inducing or tending to induce such person to lapse, forfeit, or surrender his
said insurance. Fines collected for violations of this section shall be paid to
the county treasurer for the use of the schools as provided in sections
3315.31 and
3315.32 of the Revised Code.
Upon any such conviction the superintendent of insurance shall
revoke, for not more than one year, the license of the person, firm,
corporation, or association so offending. The superintendent, when he is of the
opinion that any company or association writing life insurance in this state,
on any plan, is knowingly permitting any of its agents to violate this section,
shall give such company or association reasonable notice of a hearing upon the
charge of knowingly permitting this section to be violated, and if he finds
said company or association guilty of the offense, he shall revoke its license.
Effective Date:
10-01-1953 .
No company doing business in this state, or any officer,
director, clerk, employee, or agent thereof, shall make, orally or otherwise,
publish, print, distribute, or circulate, or cause the same to be done, or aid,
abet, or encourage the making, printing, publishing, distributing, or
circulating of, any pamphlet, circular, article, literature, or statement of
any kind which is defamatory of any insurance company doing business in this
state, or which contains any false and malicious criticism or false and
malicious statement calculated to injure such company in its reputation or
business. No officer, director, clerk, employee, or agent of any company shall
violate this section.
Effective Date:
10-01-1953 .
No insurance company, corporation, or association authorized to
transact business in this state, or an agent thereof, by advertisement in a
newspaper, magazine, or periodical or by a sign, circular, card, policy of
insurance, certificate, or renewal thereof, or otherwise, shall state or
represent that funds or assets are in its possession, not actually possessed by
it and available for the payment of losses and claims and held for the
protection of its policyholders or creditors, or advertise a subscribed capital
not actually paid up in cash.
Effective Date:
10-01-1953 .
No insurance company, corporation, or association authorized to
transact business in this state shall purport to make known its financial
standing by advertisement, public announcement, or by making or issuing a
circular or card, which fails to correspond, in all the particulars which it so
purports to make known, with the last preceding verified statement made by it
to the insurance department of any state.
Effective Date:
10-01-1953 .
No domestic life insurance company making a disbursement of one
hundred dollars or more shall fail to have it evidenced by a voucher signed by
or on behalf of the person, firm, or corporation receiving the money and
correctly describing the consideration thereof; if such expenditure is for both
services and disbursements, such company shall not fail to set forth in such
voucher, the service rendered and an itemized statement of the disbursement
made; if such expenditure was in connection with a matter pending before a
legislative or public body or a department or officer of any state or
government, in addition to the foregoing information, such corporation shall
not fail to describe correctly in such voucher the nature of the matter and of
the interest of such company therein.
If such voucher cannot be obtained, such expenditures must be
evidenced by an affidavit describing the character and object of the
expenditure and stating the reasons for not obtaining such voucher.
Effective Date:
10-01-1953 .
No officer, director, or stockholder of a company organized
under the laws of this state to do the business of life, accident, or health
insurance, either on the stock, mutual, stipulated premiums, assessment, or
fraternal plan, shall violate or consent to a violation of any law governing or
forbidding the reinsurance of the risks, or any part thereof, or the
consolidation of such company with any other company or association, or the
assumption of reinsurance of the whole or any portion of the risks of another
company by such company.
Effective Date:
10-01-1953 .
No officer or agent of a corporation, company, or association
organized under the laws of any other state of the United States to transact
the business of life or accident insurance or life and accident insurance on
the assessment plan, shall violate or fail to comply with any law relating to
such corporation, company, or association.
Effective Date:
10-01-1953 .
No company organized under the laws of this state for the
special purpose of insuring against accidental personal injury and loss of life
sustained while traveling by railroad, steamboat, or other mode of conveyance,
against accidental personal injury and loss of life sustained by accident of
every description, and against expenses and loss of time occasioned by injury
or sickness, on such terms, and for such periods of time, and confined to such
countries and localities and to such persons as from time to time may be
provided in the bylaws of such company, or any officer of such company, shall
violate any law relating to such company.
Effective Date:
10-01-1953 .
No officer, director,
trustee, agent, or employee of any insurance company, corporation, or
association authorized to transact business in this state shall knowingly use
underwriting standards or rates that result in unfair discrimination against
any handicapped person. This section does not prevent reasonable
classifications of handicapped persons for determining insurance rates.
As used in this section,
"handicapped" means a medically diagnosable, abnormal condition which is
expected to continue for a considerable length of time, whether correctable or
uncorrectable by good medical practice, which can reasonably be expected to
limit the person's functional ability, including but not limited to seeing,
hearing, thinking, ambulating, climbing, descending, lifting, grasping,
sitting, rising, any related function, or any limitation due to weakness or
significantly decreased endurance, so that the person
cannot perform the person's everyday routine living and working
without significantly increased hardship and vulnerability to what are
considered the everyday obstacles and hazards encountered by the
nonhandicapped.
Amended by
133rd General Assembly File No. TBD, HB 339, §1,
eff. 1/1/2021.
Effective Date:
07-23-1976 .
Effective Date:
07-01-1996 .
| (A) |
No person
shall establish, operate, or maintain any entity that delivers, issues for
delivery, or renews any policy of sickness and accident insurance or contract
for health care services in this state if the entity is required to, but does
not, have a valid certificate of authority under Chapter 1751. or Title IX of
the Revised Code. |
| (B) |
No
insurance agent, broker, or other person shall advertise, solicit, negotiate,
collect a premium on, or sell any policy of sickness and accident insurance or
contract for health care services in this state unless the entity that
delivers, issues for delivery, or renews the policy or contract is subject to
and has complied with division (A) of this section. |
Effective Date:
07-02-2004 .
| (A) |
As used in
this section:
| (1) |
"Deceptive," "insurer,"
"policy," and "statement" have the same meanings as in section
2913.47 of the Revised Code.
|
| (2) |
"Defraud" has the same meaning
as in section
2913.01 of the Revised Code.
|
|
| (B) |
All applications
for group or individual insurance issued by an insurer and all claim forms
issued by an insurer, for use by persons in applying for insurance or
submitting a claim for payment pursuant to a policy or a claim for any other
benefit pursuant to a policy, shall clearly contain a warning substantially as
follows: "Any person who, with intent to defraud or knowing that he is
facilitating a fraud against an insurer, submits an application or files a
claim containing a false or deceptive statement is guilty of insurance fraud."
|
| (C) |
An insurer may comply with
division (B) of this section by including the warning on an addendum to any
application or claim form described in that division, if the addendum is
attached to the form and satisfies the requirements set forth in that division.
|
| (D) |
The absence of a warning as
described in division (B) of this section does not constitute a defense in a
prosecution for a violation of section
2913.47 or any other section of
the Revised Code. |
Effective Date:
10-23-1991 .
| (A) |
As used in
this section:
| (1) |
"Claim" means any attempt
to cause a health care insurer to make payment of a health care benefit.
|
| (2) |
"Health care benefit" means
the right under a contract or a certificate or policy of insurance to have a
payment made by a health care insurer for a specified health care service.
|
| (3) |
"Health care insurer" means
any person that is authorized to do the business of sickness and accident
insurance, any health insuring corporation, and any legal entity that is
self-insured and provides health care benefits to its employees or members.
|
|
| (B) |
No person shall
knowingly solicit, offer, pay, or receive any kickback, bribe, or rebate,
directly or indirectly, overtly or covertly, in cash or in kind, in return for
referring an individual for the furnishing of health care services or goods for
which whole or partial reimbursement is or may be made by a health care
insurer, except as authorized by the health care or health insurance contract,
policy, or plan. This division does not apply to any of the following:
| (1) |
Deductibles, copayments, or similar
amounts owed by the person covered by the health care or health insurance
contract, policy, or plan; |
| (2) |
Discounts or similar reductions in prices; |
| (3) |
Any amount paid within a bona fide legal
entity, or within legal entities under common ownership or control, including
any amount paid to an employee in a bona fide employment relationship;
|
| (4) |
Any amount paid as part of a
bona fide lease, management, or other business contract. |
|
| (C) |
Nothing in this section shall be
construed to apply to any of the following:
| (1) |
A provider who provides goods or services
requested by an individual that are not covered by the individual's health care
or health insurance contract, policy, or plan; |
| (2) |
A provider who, in good faith, provides
goods or services ordered by another health care provider; |
| (3) |
A provider who, in good faith, resubmits
a claim previously submitted that has not been paid or denied within thirty
days of the original submission, if the provider notifies the payor or returns
any duplicate payment within sixty days after receipt of the duplicate payment;
|
| (4) |
A provider who, in good faith,
makes a diagnosis that differs from the interpretation of a diagnosis reached
by a health care insurer in the payment of claims. |
|
| (D) |
Whoever violates this section is guilty
of a felony of the fifth degree on a first offense and a felony of the fourth
degree on each subsequent offense. |
Effective Date:
03-22-1999 .
Effective Date:
07-18-1990 .
| (A) |
As used in
this section:
| (1) |
"Fraudulent insurance act"
means an act committed by a person who, knowingly and with intent to defraud,
presents, causes to be presented, or prepares with knowledge or belief that it
will be presented to or by an insurer, purported insurer, broker, or any agent
thereof, any written statement as part of, or in support of, an application for
the issuance of, or the rating of a policy or contract for property insurance,
casualty insurance, life insurance, sickness and accident insurance, or an
annuity, or a claim for payment or other benefit pursuant to such a policy or
contract, that the person knows to contain materially false information
concerning any fact material thereto, or conceals, for the purpose of
misleading, information concerning any fact material thereto. "Fraudulent
insurance act" also includes any such written statement, claim, or concealment
in relation to such an insurance policy or contract that constitutes a criminal
offense under Title XXIX [29] or XXXIX [39] of the Revised Code. |
| (2) |
"Person" includes, but is not limited to,
the superintendent of insurance, the national association of insurance
commissioners, any insurer, any organization established to detect or prevent
fraudulent insurance acts, and any officer, director, trustee, representative,
agent, broker, or employee of the superintendent, association, insurer,
organization, or person. |
|
| (B) |
In the absence of fraud or bad faith, no person is
subject to liability for damages or any other civil liability for libel,
slander, or other relevant tort cause of action by virtue of filing reports,
without malice, or furnishing other information, without malice, required under
Title XXXIX [39] of the Revised Code or required by the superintendent under
authority granted by that title, and no liability for damages or any other
civil cause of action of any nature arises against a person for providing or
receiving information relating to suspected fraudulent insurance acts that is
furnished to or received from any of the following:
| (1) |
Any law enforcement official, or any
agent or employee of such official; |
| (2) |
Other persons subject to the provisions
of Title XXXIX [39] of the Revised Code; |
| (3) |
The superintendent and any designee of
the superintendent, any insurance frauds bureau, the national association of
insurance commissioners, or any organization established to detect and prevent
fraudulent insurance acts; |
| (4) |
Any
other person involved in the detection or prevention of fraudulent insurance
acts. |
|
| (C) |
The
superintendent and any designee of the superintendent, or any insurance frauds
bureau, in the absence of malice, fraud, or bad faith, is not subject to civil
liability for libel, slander, or other relevant tort and no civil cause of
action of any nature arises against such a person by virtue of the publication
of any report or bulletin related to the official activities of the
superintendent or of any insurance frauds bureau in relation to fraudulent
insurance acts. |
| (D) |
Nothing in
this section is intended to abrogate or modify in any way any common law or
statutory privilege or immunity enjoyed by any person. |
| (E) |
Nothing in this section shall be construed to
negate, supersede, or otherwise affect section
3911.06,
3911.07,
3915.05, or
3923.04 of the Revised Code.
|
| (F) |
This section may be cited as
the conference of insurance legislators/national association of insurance
commissioners model immunity act. |
Effective Date:
03-17-1998 .
| (A) |
As used in
this section:
| (1) |
"Certificate holder" means
any person whose employment or retirement status is the basis of eligibility
for coverage under a group policy of sickness and accident insurance or for
enrollment under a group contract of a health insuring corporation. |
| (2) |
"Health insurer" means any sickness and
accident insurer or health insuring corporation. |
|
| (B) |
Each person to whom a group policy or contract of
sickness and accident insurance or other health care coverage has been
delivered or issued for delivery in this state by a health insurer shall make a
reasonable effort to notify every certificate holder, or certificate holder's
designee, who is covered under that policy or contract whenever the person
fails to make a required premium payment or contribution on behalf of the
certificate holder and that failure results in the termination of coverage. The
person shall mail or present the notice to the certificate holder or
certificate holder's designee no later than five days after the date on which
the person receives the notice from the health insurer as required under
division (D) of this section. If a person other than the policyholder or
contract holder is obligated to make the required premium payment or
contribution on behalf of the certificate holder, that person shall mail or
present the notice as required by this section. |
| (C) |
The notice required by division (B) of this
section shall be in writing and shall clearly state that the person failed to
make the required premium payment or contribution, the reasons for the failure,
and the effect of the failure on the coverage of the certificate holder under
the policy or contract. |
| (D) |
If a
person described in division (B) of this section fails to make a required
premium payment or contribution on behalf of a certificate holder and that
failure results in the termination of the coverage, the health insurer
providing the coverage shall notify the person in writing of that person's
duties as described in divisions (B) and (C) of this section. If a person other
than the policyholder or contract holder is obligated to make the required
premium payment or contribution on behalf of the certificate holder, the
insurer shall notify the person in writing of that person's duties as described
in divisions (B) and (C) of this section. |
| (E) |
A certificate holder may designate any person to
receive on the certificate holder's behalf the notice required by division (B)
of this section. The certificate holder shall furnish the name and address of
the person so designated to the person to whom the group policy or contract has
been delivered or issued for delivery. |
| (F) |
No person shall knowingly fail to comply with
division (B) or (C) of this section. |
Effective Date:
06-04-1997 .
| (A) |
As used in
this section and sections
3999.37 and
3999.38 of the Revised Code:
| (1) |
"Insurer" means any person that is
authorized to engage in the business of insurance in this state under Title
XXXIX [39] of the Revised Code, any health insuring corporation, or any other
person engaging either directly or indirectly in this state in the business of
insurance or entering into contracts substantially amounting to insurance under
section 3905.42 of the Revised Code.
|
| (2) |
"Impaired" or "impairment"
means a financial situation in which the insurer's assets are less than the sum
of the insurer's minimum required capital, minimum required surplus, and all
liabilities, as determined in accordance with the requirements for the
preparation and filing of the insurer's annual financial statement. |
| (3) |
"Chief executive officer" means the
person, irrespective of the person's title, designated by the board of
directors or trustees of an insurer as the person charged with the
responsibility of administering and implementing the insurer's policies and
procedures. |
|
| (B) |
Whenever a chief executive officer of an insurer knows or has reason to know
that the insurer is impaired, the chief executive officer shall provide written
notice of the impairment to the superintendent of insurance and to each member
of the board of directors or trustees of the insurer. The chief executive
officer shall provide the notice as soon as reasonably possible, but no later
than thirty days after the chief executive officer knows or has reason to know
of the impairment. No chief executive officer shall fail to provide notice in
compliance with this division. |
| (C) |
The notice received by the superintendent under
division (B) of this section is confidential and is not a public record under
section 149.43 of the Revised Code.
|
| (D) |
Notwithstanding division (C)
of this section, the superintendent may do any of the following:
| (1) |
Disclose the notice upon obtaining prior
written consent from the insurer to which the notice pertains; |
| (2) |
Share the notice that is the subject of
this section with the chief deputy rehabilitator, the chief deputy liquidator,
other deputy rehabilitators and liquidators, and any other person employed by,
or acting on behalf of, the superintendent pursuant to Chapter 3901. or 3903.
of the Revised Code, with other local, state, federal, and international
regulatory and law enforcement agencies, with local, state, and federal
prosecutors, and with the national association of insurance commissioners and
its affiliates and subsidiaries, provided that the recipient agrees to maintain
the confidential status of the notice and has authority to do so; |
| (3) |
Disclose the notice in the furtherance of
any regulatory or legal action brought by or on behalf of the superintendent or
the state, resulting from the exercise of the superintendent's official duties.
|
|
| (E) |
Notwithstanding
divisions (C) and (D) of this section, the superintendent may authorize the
national association of insurance commissioners and its affiliates and
subsidiaries by agreement to share confidential notices received pursuant to
division (D)(2) of this section with local, state, federal, and international
regulatory and law enforcement agencies and with local, state, and federal
prosecutors, provided that the recipient agrees to maintain the confidential
status of the notice and has authority to do so. |
| (F) |
Notwithstanding divisions (C) and (D) of this
section, the chief deputy rehabilitator, the chief deputy liquidator and other
deputy rehabilitators and liquidators may disclose notices in the furtherance
of any regulatory or legal action brought by or on behalf of the
superintendent, the rehabilitator, the liquidator, or the state resulting from
the exercise of the superintendent's official duties in any capacity.
|
| (G) |
Nothing in this section shall
prohibit the superintendent from receiving notices in accordance with section
3901.045 of the Revised Code.
|
| (H) |
The superintendent may enter
into agreements governing the sharing and use of notices consistent with the
requirements of this section. |
| (I) |
| (1) |
No waiver of any applicable privilege or
claim of confidentiality in the notices that are the subject of this section
shall occur as a result of sharing or receiving notices as authorized in
divisions (D)(2), (E), and (G) of this section. |
| (2) |
The disclosure of a notice in connection with a
regulatory or legal action pursuant to divisions (D)(3) and (F) of this section
does not prohibit an insurer or any other person from taking steps to limit the
dissemination of the notice to persons not involved in or the subject of the
regulatory or legal action on the basis of any recognized privilege arising
under any other section of the Revised Code or the common law. |
|
Effective Date:
06-18-2002 .
No person shall do any of the following:
| (A) |
Conceal any property belonging to an insurer;
|
| (B) |
Transfer or conceal his own
property or property belonging to an insurer in contemplation of a proceeding
under Chapter 3903. of the Revised Code; |
| (C) |
Conceal, destroy, mutilate, alter, or make a false
entry in any document that affects or relates to the property of an insurer;
|
| (D) |
Withhold any document that
affects or relates to the property of an insurer from a receiver, trustee, or
other officer of a court entitled to its possession; |
| (E) |
Give, obtain, or receive anything of value for
acting or forbearing to act in any judicial proceeding, if the act results in
or contributes to the impairment or insolvency of any insurer. |
Effective Date:
08-08-1991 .
No insurer shall knowingly declare or pay any dividend whenever
the insurer is impaired. For purposes of this section, "insurer" also includes
any person doing the business of insurance in this state.
Effective Date:
08-08-1991 .
| (A) |
Except as
provided in division (D) of this section, every insurer, as defined in division
(A) of section
3999.36 of the Revised Code, shall
adopt an antifraud program and shall specify in a written plan the procedures
it will follow when instances of insurance fraud or suspected insurance fraud
are brought to its attention. The insurer shall identify in the written plan
the person or persons responsible for the insurer's antifraud program.
|
| (B) |
| (1) |
An insurer shall develop a written plan required
by division (A) of this section within ninety days after obtaining its license
to transact business within this state or within ninety days after beginning to
engage in the business of insurance within this state and shall thereafter
maintain such a written plan. |
| (2) |
An insurer engaged in the business of insurance within this state on the
effective date of this section shall develop a written plan required by
division (A) of this section within ninety days after the effective date of
this section and shall thereafter maintain such a written plan. |
|
| (C) |
If an insurer modifies the
procedures it follows for instances of insurance fraud or suspected insurance
fraud, or if there is a change in the person or persons responsible for the
insurer's antifraud program, the insurer shall modify the written plan it
maintains pursuant to this section. |
| (D) |
The requirements of this section are not
applicable to any insurer identified in division (A) of this section that is
not engaged in writing direct insurance in this state. |
Effective Date:
03-17-1998 .
| (A) |
If an
insurer, as defined in division (A) of section
3999.36 of the Revised Code, has a
reasonable belief that a person is perpetrating or facilitating an insurance
fraud, as established by section
2913.47 of the Revised Code, or
has done so, the insurer shall notify the department of insurance. |
| (B) |
The notification required by division
(A) of this section shall be made in accordance with rules adopted by the
department of insurance. |
| (C) |
Division (A) of this section does not require notification of the department of
insurance if the insurance fraud involves a claim of an amount less than one
thousand dollars. |
| (D) |
This
section applies to insurance fraud perpetrated or facilitated by any person,
including, but not limited to, any applicant, policyholder, subscriber, or
enrollee, or any officer, director, manager, employee, representative, or agent
of the insurer. |
Effective Date:
03-17-1998 .
| (A) |
Whoever
violates section
3999.02 of the Revised Code is
guilty of a misdemeanor of the second degree. |
| (D) |
Whoever violates section
3999.10 or
3999.11 of the Revised Code shall
be fined five hundred dollars for a first offense and shall be fined one
thousand dollars for each subsequent offense. |
| (E) |
Whoever violates section
3999.12 of the Revised Code shall
be fined not less than ten nor more than one thousand dollars. |
| (F) |
Whoever violates division (F) of section
3999.32, division (B) of section
3999.36, or section
3999.37 or
3999.38 of the Revised Code is
guilty of a felony of the fourth degree. |
| (G) |
Whoever violates division (A) of section
3999.18 of the Revised Code is
guilty of a felony of the fourth degree. |
| (H) |
Whoever violates division (B) of section
3999.18 of the Revised Code is
guilty of a misdemeanor of the first degree on a first offense and a felony of
the fifth degree on each subsequent offense. |
| (I) |
If a person is found guilty under this section,
the court may award restitution in accordance with section
2929.18 of the Revised Code.
|
Effective Date:
07-02-2004 .