Nevada Fraud Reporting

Definition of “Insurance Fraud”

NRS 686A.2815 defines “Insurance fraud”:

“Insurance fraud” means knowingly and willfully:

1. Presenting or causing to be presented any statement to an insurer, a reinsurer, a producer, a broker or any agent thereof, if the person who presents or causes the presentation of the statement knows that the statement conceals or omits facts, or contains false or misleading information concerning any fact material to an application for the issuance of a policy of insurance pursuant to this title.

2. Presenting or causing to be presented any statement as a part of, or in support of, a claim for payment or other benefits under a policy of insurance issued pursuant to this title, if the person who presents or causes the presentation of the statement knows that the statement conceals or omits facts, or contains false or misleading information concerning any fact material to that claim.

3. Assisting, abetting, soliciting or conspiring with another person to present or cause to be presented any statement to an insurer, a reinsurer, a producer, a broker or any agent thereof, if the person who assists, abets, solicits or conspires knows that the statement conceals or omits facts, or contains false or misleading information concerning any fact material to an application for the issuance of a policy of insurance pursuant to this title or a claim for payment or other benefits under such a policy.

4. Acting or failing to act with the intent of defrauding or deceiving an insurer, a reinsurer, a producer, a broker or any agent thereof, to obtain a policy of insurance pursuant to this title or any proceeds or other benefits under such a policy.

5. As a practitioner, an insurer or any agent thereof, acting to assist, conspire with or urge another person to commit any act or omission specified in this section through deceit, misrepresentation or other fraudulent means.

6. Accepting any proceeds or other benefits under a policy of insurance issued pursuant to this title, if the person who accepts the proceeds or other benefits knows that the proceeds or other benefits are derived from any act or omission specified in this section.

7. Employing a person to procure clients, patients or other persons who obtain services or benefits under a policy of insurance issued pursuant to this title for the purpose of engaging in any act or omission specified in this section, except that such insurance fraud does not include contact or communication by an insurer or an agent or representative of the insurer with a client, patient or other person if the contact or communication is made for a lawful purpose, including, without limitation, communication by an insurer with a holder of a policy of insurance issued by the insurer or with a claimant concerning the settlement of any claims against the policy.

8. Participating in, aiding, abetting, conspiring to commit, soliciting another person to commit, or permitting an employee or agent to commit any act or omission specified in this section.

(Added to NRS by 2001, 1095)

Mandatory Fraud Reporting Statute(s)

Nev. Rev. Stat. 686A.283(1) establishes the mandatory reporting requirement:

Any person, governmental entity, insurer or authorized representative of an insurer shall report any information concerning insurance fraud to the Commissioner and Attorney General on a form prescribed by the Commissioner and Attorney General.

NRS 686A.285 requires a report by the insurer of its suspicion that loss to the insured was caused by other than an accidental or natural occurrence:

1. If an insurer has a reasonable suspicion that a loss to an insured may have been caused by other than an accidental or a natural occurrence, the insurer shall notify the Commissioner and Attorney General in writing of the insurer’s reasons for the suspicion.

2. Any insurer making such a report shall provide the Commissioner and Attorney General with any information the insurer obtained during its investigation of the claim.

3. If the loss referred to in subsection 1 is believed to be caused by fire, the insurer shall also so notify an investigative or law enforcement agency.

(Added to NRS by 1983, 1387; A 2001, 1097)

How to Report Fraud

Nevada Attorney General Insurance Fraud Unit: www.AG.NV.gov

Report suspected insurance fraud by either calling one of the main offices

  • Carson City Office, ph 775-684-1100
  • Las Vegas Office, ph 702-486-3420
  • Reno Office, ph 775-688-1818
  • or by printing, filling out and mailing the reporting form for insurance companies