# Title 26.1 — Insurance

## Chapter 26.1-02.1 — Insurance Fraud

### § 26.1-02.1-01. Definitions.

As used in this chapter:
1. "Breach of trust" means any criminal act or an element of a criminal act by a person,
including an act that constitutes or involves misuse, misapplication, or
misappropriation of the following:
a. Anything of value held as a fiduciary, in which "fiduciary" includes a trustee,
administrator, executor, conservator, receiver, guardian, agent, employee,
partner, officer, director, or public service; or
b. Anything of value of any public, private, or charitable organization.
2. "Business of insurance" means the writing of insurance or the reinsuring of risks by an
insurer, including acts necessary or incidental to writing insurance or reinsuring risks
and the activities of persons who act as or who are officers, directors, agents,
producers, or employees of insurers, or who are other persons authorized to act on
their behalf. The term does not include the activities of the North Dakota life and health
insurance guaranty association or the North Dakota insurance guaranty association.
3. "Dishonesty" means a criminal act, including an offense constituting or involving
perjury, bribery, arson, knowingly receiving or possession of stolen property, forgery or
falsification of documents, counterfeiting, knowingly issuing a bad check, false or
misleading oral or written statements, false pretenses, deception, fraud, schemes or
artifices to deceive or defraud, material misrepresentations, or the failure to disclose
material facts.
4. "Financial loss" includes loss of earnings, out-of-pocket and other expenses, repair
and replacement costs, and claims payments.
5. "Fraudulent insurance act" includes the following acts or omissions committed by a
person knowingly and with intent to defraud:
a. Presenting, causing to be presented, or preparing with knowledge or belief that it
will be presented to or by an insurer, reinsurer, insurance producer, or any agent
thereof, false or misleading information as part of, in support of, or concerning a
fact material to one or more of the following:
(1) An application for the issuance or renewal of an insurance policy or
reinsurance contract;
(2) The rating of an insurance policy or reinsurance contract;
(3) A claim for payment or benefit pursuant to an insurance policy or
reinsurance contract;
(4) Premiums paid on an insurance policy or reinsurance contract;
(5) Payments made in accordance with the terms of an insurance policy or
reinsurance contract;
(6) A document filed with the commissioner or the chief insurance regulatory
official of another jurisdiction;
(7) The financial condition of an insurer or reinsurer;
(8) The formation, acquisition, merger, reconsolidation, dissolution, or
withdrawal from one or more lines of insurance or reinsurance in all or part
of this state by an insurer or reinsurer;
(9) The issuance of written evidence of insurance;
(10) The reinstatement of an insurance policy; or
(11) The formation of an agency, brokerage, or insurance producer contract.
b. Solicitation or acceptance of new or renewal insurance risks on behalf of an
insurer, reinsurer, or other person engaged in the business of insurance by a
person who knows or should know that the insurer or other person responsible for
the risk is insolvent at the time of the transaction.
c. Removal, concealment, alteration, or destruction of the assets or records of an
insurer, reinsurer, or other person engaged in the business of insurance.

d. Theft by deception or otherwise, or embezzlement, abstracting, purloining, or
conversion of moneys, funds, premiums, credits, or other property of an insurer,
reinsurer, or person engaged in the business of insurance.
e. Attempting to commit, aiding or abetting in the commission of, or conspiring to
commit the acts or omissions specified in this section.
6. "Insurance" means a contract or arrangement in which one undertakes to pay or
indemnify another as to loss from certain contingencies called "risks", including
through reinsurance; pay or grant a specified amount or determinable benefit to
another in connection with ascertainable risk contingencies; pay an annuity to another;
or act as surety. The term does not include a debt cancellation contract between a
bank and debtor, between a credit union and debtor, or between a savings association
and debtor and does not include a debt suspension contract between a bank and
debtor, between a credit union and debtor, or between a savings association and
debtor.
7. "Insurer" means a person entering into arrangements or contracts of insurance or
reinsurance and who agrees to perform any of the acts set forth in subsection 4,
whether the person has or is required to have a certificate of authority or denies being
an insurer. The term does not include the North Dakota life and health insurance
guaranty association, the risk management fund, a bank, credit union, or savings
association as a party to a debt cancellation contract or debt suspension contract, or
the North Dakota insurance guaranty association.
8. "Person" means an individual, corporation, partnership, association, joint stock
company, trust, unincorporated organization, or any similar entity or any combination
of the foregoing.
9. "Policy" means an individual or group policy, group certificate, contract, or
arrangement of insurance or reinsurance affecting the rights of a resident of this state
or bearing a reasonable relation to this state, regardless of whether delivered or issued
for delivery in this state.
10. "Practitioner" means a licensee of this state authorized to practice medicine and
surgery, psychology, chiropractic, or law or any other licensee of the state whose
services are compensated, directly or indirectly, by insurance proceeds, or a licensee
similarly licensed in other states and nations or the practitioner of any nonmedical
treatment rendered in accordance with a recognized religious method of healing.
11. "Reinsurance" means a contract, binder of coverage including placement slip, or
arrangement under which an insurer procures insurance for itself in another insurer as
to all or part of an insurance risk of the originating insurer.
### § 26.1-02.1-02. Insurance fraud.

Repealed by S.L. 2003, ch. 235, § 11.
### § 26.1-02.1-02.1. Fraudulent insurance acts, interference, participation, and licensure of

convicted felons prohibited.
1. A person may not commit a fraudulent insurance act.
2. A person may not knowingly or intentionally interfere with the enforcement of the
provisions of this chapter or investigations of suspected or actual violations of this
chapter.
3. a. A person convicted of a felony involving dishonesty or breach of trust may not
participate in the business of insurance. The commissioner shall deny an
application for license under chapter 26.1-26, or shall revoke or shall refuse to
renew a license issued under chapter 26.1-26, if the commissioner finds the
applicant or licensee has been convicted of a felony involving dishonesty or
breach of trust.
b. A person in the business of insurance may not knowingly or intentionally permit a
person convicted of a felony involving dishonesty or breach of trust to participate
in the business of insurance.

### § 26.1-02.1-02.2. Venue for filing criminal charges.

If a person commits a fraudulent insurance act or any crime associated with a fraudulent
insurance act, the venue for charging the crime may be any county in which the offense, any
element of the offense, or payment related to the offense was perpetrated, received, produced,
prepared, instigated, procured, promoted, or aided. If a person commits a fraudulent insurance
act and commits additional crimes in the commission of a fraudulent insurance act or as part of
a scheme associated with a fraudulent insurance act, venue need only be established for one
offense. All offenses associated with a fraudulent insurance act may be charged in the same
venue as established in one of the counts.
### § 26.1-02.1-03. Disclosure of information.

Repealed by S.L. 2003, ch. 235, § 11.
### § 26.1-02.1-04. Immunity.

1. A person when acting without malice is not subject to liability by virtue of filing reports,
or furnishing orally or in writing other information concerning any suspected,
anticipated, or completed fraudulent insurance act, when the reports or information are
provided to or received from the commissioner; federal, state, or local law enforcement
or regulatory officials; the national association of insurance commissioners; or any
other not-for-profit organization established to detect and prevent insurance fraud and
any employee or agent of any of these entities.
2. Except in prosecution for perjury or insurance fraud, and in the absence of malice, an
insurer, or any officer, employee, or agent thereof, or any licensed insurance producer
or private person who cooperates with, furnishes evidence, or provides or receives
information regarding any suspected fraudulent insurance act to or from the
commissioner; federal, state, or local law enforcement or regulatory officials; the
national association of insurance commissioners; or any not-for-profit organization
established to detect and prevent fraudulent insurance acts and any employee or
agent of any of these entities who complies with an order issued by a court of
competent jurisdiction acting in response to a request by any of these entities to
provide evidence or testimony is not subject to a criminal proceeding or to a civil
penalty with respect to any act concerning which the person testifies to or produces
relevant matter.
3. In the absence of malice, an insurer, or any officer, employee, or agent thereof, or any
licensed insurance producer or private person who cooperates with, furnishes
evidence, or provides information regarding any suspected fraudulent insurance act to
the commissioner; federal, state, or local law enforcement or regulatory officials; the
national association of insurance commissioners; or any not-for-profit organization
established to detect and prevent fraudulent insurance acts and any employee or
agent of any of these entities who complies with an order issued by a court of
competent jurisdiction acting in response to a request by any of these entities to
furnish evidence or provide testimony, is not subject to civil liability for libel, slander, or
any other relevant tort, and no civil cause of action of any nature exists against the
person, for filing reports, providing information, or otherwise cooperating with an
investigation or examination of any of these entities.
4. The commissioner; federal, state, or local law enforcement or regulatory officials; the
national association of insurance commissioners; or any not-for-profit organization
established to detect and prevent fraudulent insurance acts and any employee or
agent of any of these entities, when acting without malice is not subject to civil liability
for libel, slander, or any other relevant tort, and no civil cause of action of any nature
will lie against the person by virtue of the execution of official activities or duties of the
entity by virtue of the publication of any report or bulletin related to the official activities
or duties of the entity.
5. This section does not abrogate or modify in any way common law or statutory privilege
or immunity heretofore enjoyed by any person or entity.

### § 26.1-02.1-05. Penalties - Restitution.

1. a. A violation of section 26.1-02.1-02.1 is:
(1) A class A felony if the value of any property or services retained exceeds
fifty thousand dollars;
(2) A class B felony if the value of the act associated with the fraud or directly
related to the fraud exceeds fifty thousand dollars;
(3) A class B felony if the value of any property or services retained exceeds ten
thousand dollars but does not exceed fifty thousand dollars;
(4) A class C felony if the value of the act associated with the fraud or directly
related to the fraud exceeds ten thousand dollars but does not exceed fifty
thousand dollars;
(5) A class C felony if the value of any property or services retained exceeds
one thousand dollars but does not exceed ten thousand dollars; and
(6) A class A misdemeanor in all other cases.
b. For purposes of this section, the value of any property and services must be
determined in accordance with section 12.1-23-05.
2. If a practitioner is adjudicated guilty of a violation of section 26.1-02.1-02.1, the court
shall notify the appropriate licensing authority of this state of the adjudication. The
appropriate licensing authority shall hold an administrative hearing to consider the
imposition of administrative sanctions as provided by law against the practitioner.
3. In addition to any other punishment, a person that violates section 26.1-02.1-02.1 must
be ordered to make restitution to the insurer or to any other person for any financial
loss sustained as a result of the violation of section 26.1-02.1-02.1. The court shall
determine the extent and method of restitution.
4. A prosecution for any felony offense under chapter 26.1-02.1 must be commenced
within three years after the date of discovery of the fraud.
5. A prosecution for any misdemeanor or infraction offense under chapter 26.1-02.1 must
be commenced within two years after the date of discovery of the fraud.
### § 26.1-02.1-05.1. Administrative penalty and enforcement.

1. Upon a showing by a preponderance of evidence that a violation of this chapter
occurred, and with the consent of the county state's attorney, the commissioner may
impose an administrative penalty not to exceed ten thousand dollars for each
fraudulent insurance act. Assessment of the administrative penalty must be
determined by the nature, circumstances, extent, and gravity of the fraudulent
insurance act or acts, any prior history of such act or acts, the degree of culpability,
and such other matters as justice may require. The commissioner shall determine the
administrative penalty, such as fines, restitution, or both.
2. In the event of nonpayment of the administrative penalty after all rights of appeal have
been waived or exhausted, the commissioner may bring a civil action in district court
for the collection of the administrative penalty and any other expenses incurred,
including interest, attorney's fees, and costs, in the following manner:
a. A summons and complaint must be filed in the district court of Burleigh County
setting forth that administrative action was taken against the defendant in
accordance with this chapter, that the defendant either voluntarily entered a
consent order that called for the payment of a specified monetary penalty, or in
the alternative, that after proper notice and hearing, the defendant was
determined to be in violation of this chapter and that by order of the commissioner
a specified monetary penalty had been assessed against the defendant, that all
rights of appeal have been waived or exhausted, and that payment in full has not
been made in accordance with the terms of the consent order or other order of
the commissioner. The insurance department shall attach to the complaint a
certified copy of that consent order or other order of the commissioner.
b. The court shall enter judgment in favor of the department for the amount specified
in the complaint if the department establishes:

(1) The defendant is the same person against which the consent order or other
order of the commissioner applies; and
(2) Payment in full has not been made by or on behalf of the defendant
according to the terms of the consent or other order of the commissioner.
c. Except as otherwise provided in this section the North Dakota Rules of Civil
Procedure govern the civil proceedings.
3. A person that is found to have committed a fraudulent insurance act and assessed an
administrative penalty or a person that violated an order of the commissioner pursuant
to a hearing or consent order in relation to an administrative penalty associated with a
fraudulent insurance act, may be liable for expenses incurred by the insurance
department at the discretion of the commissioner. The assessment for costs may not
exceed fifteen percent of each penalty assessed under this section.
4. The commissioner may order restitution to the insurer or self-insured employer of any
insurance proceeds paid pursuant to a fraudulent insurance act. Restitution ordered
must be paid by the owing party to the insurance regulatory trust fund under section
5. The expenses or administrative penalties collected by the commissioner under this
chapter are appropriated to the insurance department in accordance with this section
and section 26.1-01-07.1. All such moneys that are deposited in the insurance
regulatory trust fund under this chapter may be appropriated for use in the education
and enforcement of insurance fraud, except funds ordered as restitution to a victim.
Restitution funds must be reallocated to the victim. In the discretion of the department,
the department may pay a reward drawn from the assessed administrative penalty to
an individual who reports to the insurance department an incident of fraudulent
insurance act that results in either an admission or finding of fraud. The reward may
not exceed the lesser of the assessed administrative penalty or twenty-five thousand
dollars. In order to be eligible to receive a reward under this subsection, a reporting
individual shall sign a written complaint that subjects the person to the sanctions of
section 26.1-02.1. Persons required to report fraudulent insurance acts under
subsection 1 of section 26.1-02.1-06 are not eligible to receive a reward pursuant to
this subsection.
6. The insurance department may collect moneys for use by the department for fraud
education and enforcement purposes.
a. The following amounts must be deposited in the insurance regulatory trust fund
for use by the department for fraud education and enforcement purposes, all
sums received from:
(1) Fines assessed in accordance with this chapter; and
(2) Assessment of department costs under subsection 3.
b. The moneys received under this subsection are reserved for the use by the
insurance department to defray the expenses of the department in the
performance of the various functions and duties associated with fraud
enforcement, fund specialized training of department personnel tasked with
working within fraud enforcement, and provide the funding for specialized
equipment, specialized technology, and insurance fraud public service and
prevention campaigns and rewards.
c. The moneys deposited for this purpose are subject to the provisions of section
26.1-01-07.1.
### § 26.1-02.1-05.2. Consent orders.

A person may enter a consent order by which such person, without admitting the conduct
alleged, consents to the imposition of an administrative penalty and when so requested agrees
to cease and desist the acts or omissions alleged in the complaint.
### § 26.1-02.1-05.3. Criminal prosecution.

The imposition of a fine or other sanction under this chapter does not preclude prosecution
for a violation of a criminal law of the state.

### § 26.1-02.1-06. Mandatory reporting of fraudulent insurance acts.

1. A person engaged in the business of insurance having knowledge or a reasonable
belief that a fraudulent insurance act is being, will be, or has been committed shall
provide to the commissioner the information required by, and in a manner prescribed
by, the commissioner.
2. Any other person having knowledge or a reasonable belief that a fraudulent insurance
act is being, will be, or has been committed may provide to the commissioner the
information required by, and in a manner prescribed by, the commissioner.
3. A person who provides nonpublic personal information to the commissioner pursuant
to this section does not violate the insurance privacy law under section 26.1-02-27.
### § 26.1-02.1-07. Confidentiality.

1. Any documents, materials, or other information in the possession or control of the
commissioner which are provided pursuant to section 26.1-02.1-06 or obtained by the
commissioner in an investigation of suspected or actual fraudulent insurance acts are
confidential by law and privileged, not subject to subpoena, and not subject to
discovery or admissible in evidence in any private civil action. However, the
commissioner is authorized to use the documents, materials, or other information in
the furtherance of any regulatory or legal action brought as a part of the
commissioner's official duties.
2. Neither the commissioner nor any person who received documents, materials, or other
information while acting under the authority of the commissioner may be permitted or
required to testify in any private civil action concerning any confidential documents,
materials, or information subject to subsection 1.
3. In order to assist in the performance of the commissioner's duties, the commissioner
may:
a. Share documents, materials, or other information, including the confidential and
privileged documents, materials, or information subject to subsection 1 with other
state, federal, and international regulatory agencies, with the national association
of insurance commissioners and its affiliates and subsidiaries, and with local,
state, federal, and international law enforcement authorities, provided that the
recipient agrees to maintain the confidentiality and privileged status of the
document, material, or other information;
b. Receive documents, materials, or information, including otherwise confidential
and privileged documents, materials, or information from the national association
of insurance commissioners and its affiliates and subsidiaries and from regulatory
and law enforcement officials of other foreign or domestic jurisdictions, and shall
maintain as confidential or privileged any document, material, or information
received with notice or the understanding that it is confidential or privileged under
the laws of the jurisdiction that is the source of the document, material, or
information; and
c. Enter into agreements governing sharing and use of information consistent with
this subsection.
4. A privilege or claim of confidentiality in the documents, materials, or information is not
waived as a result of disclosure to the commissioner under this section or as a result
of sharing as authorized in subsection 3.
5. Any investigative information gathered under section 26.1-02.1-06 or 26.1-02.1-08 is
criminal investigative information and may not be disclosed except as provided under
section 44-04-18.7.
### § 26.1-02.1-08. Creation and purpose of the insurance fraud unit.

1. The North Dakota insurance fraud unit is established within the insurance department.
The commissioner may appoint the full-time supervisory and investigative personnel of
the insurance fraud unit, who must be qualified by training and experience to perform
the duties of their positions. The commissioner may also appoint clerical and other

staff necessary for the insurance fraud unit to carry out its duties and responsibilities
under this chapter.
2. The insurance fraud unit shall:
a. Initiate independent inquiries and conduct independent investigations when the
insurance fraud unit has cause to believe that a fraudulent insurance act may be,
is being, or has been committed;
b. Review reports or complaints of alleged fraudulent insurance activities from
federal, state, and local law enforcement and regulatory agencies, persons
engaged in the business of insurance, and the public to determine whether the
reports require further investigation and to conduct these investigations; and
c. Conduct independent examinations of alleged fraudulent insurance acts and
undertake independent studies to determine the extent of fraudulent insurance
acts.
3. The insurance fraud unit may:
a. Inspect, copy, or collect records and evidence;
b. Serve subpoenas;
c. Administer oaths and affirmations;
d. Share records and evidence with federal, state, or local law enforcement or
regulatory agencies;
e. Execute search warrants and arrest warrants for criminal violations of this
chapter;
f. Arrest upon probable cause without warrant a person found in the act of violating
or attempting to violate a provision of this chapter;
g. Make criminal referrals to prosecuting authorities; and
h. Conduct investigations outside of this state. If the information the insurance fraud
unit seeks to obtain is located outside this state, the person from whom the
information is sought may make the information available to the insurance fraud
unit to examine at the place where the information is located. The insurance fraud
unit may designate a representative, including an official of the state in which the
matter is located, to inspect the information on behalf of the insurance fraud unit,
and the insurance fraud unit may respond to a similar request from an official of
another state.
### § 26.1-02.1-09. Peace officer status.

A fraud unit investigator has all the powers conferred by law upon any peace officer of this
state when making arrests for criminal violations established as a result of an investigation
pursuant to this chapter. The general laws applicable to arrests by a peace officer of the state
also apply to a fraud unit investigator. A fraud unit investigator may execute an arrest warrant
and search warrant for the same criminal violation; serve subpoenas issued for the examination,
investigation, and trial of all offenses identified through an investigation; and arrest upon
probable cause without warrant a person found in the act of committing a violation of the
provisions of this chapter.
### § 26.1-02.1-10. Other law enforcement or regulatory authority.

This chapter does not:
1. Preempt the authority or relieve the duty of other law enforcement or regulatory
agencies to investigate, examine, and prosecute suspected violations of law;
2. Prevent or prohibit a person from disclosing voluntarily information concerning
insurance fraud to a law enforcement or regulatory agency other than the insurance
fraud unit; or
3. Limit the powers granted elsewhere by the laws of this state to the commissioner or
the insurance fraud unit to investigate and examine possible violations of law and to
take appropriate action against wrongdoers.

### § 26.1-02.1-11. Rules.

The commissioner may adopt rules determined necessary by the commissioner for the
administration of this chapter.
