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Criminal Jury Instructions

Criminal Jury Instructions Home

10.6-3  Insurance Fraud -- § 53a-215

Revised to December 1, 2007

The defendant is charged [in count __] with insurance fraud.  The statute defining this offense reads in pertinent part as follows: 

a person is guilty of insurance fraud when the person, with the intent to (injure / defraud / deceive) any insurance company, <insert appropriate subsection:>

  • § 53a-215 (1):  (presents / causes to be presented) to any insurance company, any written or oral statement including computer-generated documents as part of, or in support of,

  • § 53a-215 (2):  (assists / abets / solicits / conspires with) another to prepare or make any written or oral statement that is intended to be presented to any insurance company in connection with, or in support of,

(any application for any policy of insurance / any claim for payment or other benefit pursuant to such policy of insurance), knowing that such statement contains any false, incomplete, or misleading information concerning any fact or thing material to such application or claim for the purposes of defrauding such insurance company.

For you to find the defendant guilty of this charge, the state must prove the following elements beyond a reasonable doubt:

Element 1 - Claim or application to insurance company
The first element is that the defendant <insert as appropriate:>

  • (presented / caused to be presented) to any insurance company, any written or oral statement including computer-generated documents as part of, or in support of,

  • (assisted / abetted / solicited / conspired with) another to prepare or make any written or oral statement that is intended to be presented to any insurance company in connection with, or in support of,

any (application for any insurance policy / any claim for payment or other benefit pursuant to an insurance policy).

"Insurance company" includes any person or combination of persons doing any kind or form of insurance business other than a fraternal benefit society, and shall include a receiver of any insurer when the context reasonably permits.1

"Statement" includes, but is not limited to, any notice, statement, invoice, account, estimate of property damages, bill for services, test result, or other evidence of loss, injury, or expense.2

"Insurance" means any agreement to pay a sum of money, provide services or any other thing of value on the happening of a particular event or contingency or to provide indemnity for loss in respect to a specified subject by specified perils in return for a consideration.  In any contract of insurance, an insured shall have an interest which is subject to a risk of loss through destruction or impairment of that interest, which risk is assumed by the insurer and such assumption shall be part of a general scheme to distribute losses among a large group of persons bearing similar risks in return for a ratable contribution or other consideration.3

"Policy" means any document, including attached endorsements and riders, purporting to be an enforceable contract, which memorializes in writing some or all of the terms of an insurance contract.4

Element 2 - Knowledge of falsity
The second element is that the defendant knew that such statement contained false, incomplete, or misleading information concerning any fact or thing material to such (application / claim).  A person acts "knowingly" with respect to conduct or circumstances when (he/she) is aware that (his/her) conduct is of such nature or that such circumstances exist.  <See Knowledge, Instruction 2.3-3.>

Element 3 - Intent
The third element is that the defendant intended to (injure / defraud / deceive) the insurance company.

<See Intent: Specific, Instruction 2.3-1, and Intent to Defraud, Instruction 2.3-6.>

Conclusion

In summary, the state must prove beyond a reasonable doubt that the defendant 1) <insert specific allegations regarding the presentation of the application or claim>, 2) (he/she) knew that the (application / claim) contained false statements, and 3) (he/she) intended to deceive or defraud the insurance company.

If you unanimously find that the state has proved beyond a reasonable doubt each of the elements of the crime of insurance fraud, then you shall find the defendant guilty.  On the other hand, if you unanimously find that the state has failed to prove beyond a reasonable doubt any of the elements, you shall then find the defendant not guilty.
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1 General Statutes § 38a-1 (11).

2 General Statutes § 53a-215 (b).

3 General Statutes § 38a-1 (15).

4 General Statutes § 38a-1 (10).
 


 

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