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RE: Legal/Ethical question about deductibles

 
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RE: Legal/Ethical question about deductibles - 8/1/2006 8:55:28 PM   
Big Bob

 

Posts: 185
Joined: 10/4/2005
Status: offline
racko,Cletus advised along time ago, actually it was his daddy: ..." Never pick a fight with the big dog... the pack may come after you."

"follow the money" deep throat.. Just how big do you think those E $ tranfers daily from the mortgage companies escrow dept. to the carriers are?



< Message edited by Big Bob -- 8/1/2006 8:59:23 PM >
This is a Forum Archive Post. Click here to visit the current forum. Post #: 61
RE: Legal/Ethical question about deductibles - 8/2/2006 2:14:25 AM   
racko

 

Posts: 228
Joined: 2/17/2006
Status: offline
Pick fights?  Uh Uh, not me...not even with small dogs.

What Swink said... on another thread.
This is a Forum Archive Post. Click here to visit the current forum. Post #: 62
RE: Legal/Ethical question about deductibles - 8/15/2006 8:27:39 PM   
Tejaus


Posts: 33
Joined: 11/7/2005
Status: offline
According to Texas Law it is illegal for a contractor to pay for the deductible or offer a rebate.  The state would also have to determine the culpability of the insured in order to prosecute them in addition the contractor. See 35.02 Insurance Fraud below.

Texas Stautes Title 3 Chapter 27 Fraud, Business and Commerce Code

§ 27.02. CERTAIN INSURANCE CLAIMS FOR EXCESSIVE
CHARGES.  (a) A person who sells goods or services commits an
offense if:
(1)  the person advertises or promises to provide the
good or service and to pay:
(A)  all or part of any applicable insurance
deductible;  or              
(B)  a rebate in an amount equal to all or part of
any applicable insurance deductible;
(2)  the good or service is paid for by the consumer
from proceeds of a property or casualty insurance policy;  and
(3)  the person knowingly charges an amount for the
good or service that exceeds the usual and customary charge by the
person for the good or service by an amount equal to or greater than
all or part of the applicable insurance deductible paid by the
person to an insurer on behalf of an insured or remitted to an
insured by the person as a rebate.
(b)  A person who is insured under a property or casualty
insurance policy commits an offense if the person:
(1)  submits a claim under the policy based on charges
that are in violation of Subsection (a) of this section;  or
(2)  knowingly allows a claim in violation of
Subsection (a) of this section to be submitted, unless the person
promptly notifies the insurer of the excessive charges.
(c)  An offense under this section is a Class A misdemeanor.                  

Added by Acts 1989, 71st Leg., ch. 898, § 1, eff. Sept. 1, 1989.      

§ 35.02. INSURANCE FRAUD.  (a) A person commits an
offense if, with intent to defraud or deceive an insurer, the
person, in support of a claim for payment under an insurance policy:
(1)  prepares or causes to be prepared a statement
that:                   
(A)  the person knows contains false or misleading
material information;  and
(B)  is presented to an insurer;  or                                        
(2)  presents or causes to be presented to an insurer a
statement that the person knows contains false or misleading
material information.
(a-1)  A person commits an offense if the person, with intent
to defraud or deceive an insurer and in support of an application
for an insurance policy:
(1)  prepares or causes to be prepared a statement
that:                   
(A)  the person knows contains false or misleading
material information;  and
(B)  is presented to an insurer;  or                                        
(2)  presents or causes to be presented to an insurer a
statement that the person knows contains false or misleading
material information.
(b)  A person commits an offense if, with intent to defraud
or deceive an insurer, the person solicits, offers, pays, or
receives a benefit in connection with the furnishing of goods or
services for which a claim for payment is submitted under an
insurance policy.
(c)  An offense under Subsection (a) or (b) is:                               
(1)  a Class C misdemeanor if the value of the claim is
less than $50;     
(2)  a Class B misdemeanor if the value of the claim is
$50 or more but less than $500;
(3)  a Class A misdemeanor if the value of the claim is
$500 or more but less than $1,500;
(4)  a state jail felony if the value of the claim is
$1,500 or more but less than $20,000;
(5)  a felony of the third degree if the value of the
claim is $20,000 or more but less than $100,000;
(6)  a felony of the second degree if the value of the
claim is $100,000 or more but less than $200,000;  or
(7)  a felony of the first degree if:                                        
(A)  the value of the claim is $200,000 or more; 
or                      
(B)  an act committed in connection with the
commission of the offense places a person at risk of death or
serious bodily injury.
(d)  An offense under Subsection (a-1) is a state jail
felony.              
(e)  The court shall order a defendant convicted of an
offense under this section to pay restitution, including court
costs and attorney's fees, to an affected insurer.
(f)  If conduct that constitutes an offense under this
section also constitutes an offense under any other law, the actor
may be prosecuted under this section, the other law, or both.
(g)  For purposes of this section, if the actor proves by a
preponderance of the evidence that a portion of the claim for
payment under an insurance policy resulted from a valid loss,
injury, expense, or service covered by the policy, the value of the
claim is equal to the difference between the total claim amount and
the amount of the valid portion of the claim.
(h)  If it is shown on the trial of an offense under this
section that the actor submitted a bill for goods or services in
support of a claim for payment under an insurance policy to the
insurer issuing the policy, a rebuttable presumption exists that
the actor caused the claim for payment to be prepared or presented.

Added by Acts 1995, 74th Leg., ch. 621, § 1, eff. Sept. 1, 1995. 
Amended by Acts 2003, 78th Leg., ch. 605, § 1, eff. Sept. 1,
2003;  Acts 2005, 79th Leg., ch. 1162, § 4, eff. Sept. 1, 2005.


   

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