Del. P.J.I. Crim. No. 11.913(a)(1)

INSURANCE FRAUD

In order to find Defendant guilty of Insurance Fraud, you must find the State has

proved the following four (4) elements beyond a reasonable doubt:

(1) Defendant presented, or caused to be presented, any oral or written

statement as part of a claim for payment or benefit under an insurance policy;

(2) Defendant knew the statement contained false, incomplete or misleading

information concerning any fact or material feature of the claim;

(3) Defendant meant to injure, defraud or deceive; and

(4) Defendant acted intentionally.

[if applicable]

[It is not a defense to the charge of Insurance Fraud that Defendant’s insurance

claim form did not include the required statement that: "Any person who knowingly,

and with intent to injure, defraud or deceive any insurer, files a statement of claim

containing any false, incomplete or misleading information is guilty of a felony."]

“Defraud” means to acquire a gain or advantage by fraud.

“Fraud” means an intentional perversion, misrepresentation or concealment of

truth.

“Intentionally” means it was Defendant's conscious objective or purpose to

cause monetary harm to the insurer or to defraud, injure or deceive another person or

entity.

“Knowingly” means Defendant was aware that statements were untrue,

incomplete or misleading.

“Statement” includes, but is not limited to, a police report, any notice, statement,

proof of loss, bill of lading, receipt for payment, invoice, account, estimate of property

damages, bill for services, diagnosis, prescription, hospital or doctor records, X rays,

test result or other evidence of loss, injury or expense.

"Insurer" shall include, but is not limited to, a health service corporation or

health maintenance organization.

"Insurance policy" shall include, but is not limited to, the subscriber and

members contracts of health service corporations and health maintenance

organizations. “Information material to a claim” means information a reasonable

person would consider important when processing an insurance claim.