N.C.P.I.—Crim. 228.30

NOTE WELL: Use this instruction when the defendant presents a

false statement and the insurer is the one defrauded.

NOTE WELL: For situations involving an alleged fraudulent denial

of insurance benefits use N.C.P.I—Crim. 228.30A.

The defendant has been charged with presenting a false statement

under an insurance policy with the intent to defraud the insurance company

with a claim of $100,000 or more.

For you to find the defendant guilty of this offense the State must prove

six things beyond a reasonable doubt:

First, that an insurance policy existed between (name insured) and

(name insurer).

Second, that the defendant [presented] [caused to be presented] a

[written] [oral] statement1 [as part of] [in support of] a claim for [payment]

[a benefit] pursuant to the insurance policy.

Third, that the statement contained false or misleading information

concerning a fact or a matter material to the claim.

Fourth, that the defendant knew the statement contained false or

misleading information concerning a fact or matter material to the claim.

Fifth, that the defendant acted with the intent2 to [injure] [defraud]

[deceive] (name insurer).

And Sixth, the amount of the claim for payment or other benefit was

$100,000 or more.

If you find from the evidence beyond a reasonable doubt that on or

about the alleged date an insurance policy existed between (name insured)

and (name insurer), and that the defendant [presented] [caused to be

presented] a [written] [oral] statement [as part of] [in support of] a claim for

[payment] [a benefit] pursuant to the insurance policy, the statement

contained false or misleading information concerning a fact or a matter

material to the claim, the defendant knew the statement contained false or

misleading information concerning a fact or matter material to the claim, the

defendant acted with the intent to [injure] [defraud] [deceive] the (name

insurer), and the amount of the claim for payment or other benefit was

$100,000 or more, it would be your duty to return a verdict of guilty of

presenting a false statement under an insurance policy with the intent to

defraud the insurance company with a claim of $100,000 or more. However,

if you do not so find or have a reasonable doubt as to one or more of these

things, you will not return a verdict of guilty of presenting a false statement

under an insurance policy with the intent to defraud the insurance company

with a claim of $100,000 or more, but must determine whether the defendant

is guilty of presenting a false statement under an insurance policy with the

intent to defraud the insurance company.

Presenting a false statement under an insurance policy with the intent

to defraud the insurance company differs from presenting a false statement

under an insurance policy with the intent to defraud the insurance company

with a claim of $100,000 or more in that the amount of the claim for payment

or other benefit need not be $100,000 or more.

If you find from the evidence beyond a reasonable doubt that on or

about the alleged date an insurance policy existed between (name insured)

and (name insurer), and that the defendant [presented] [caused to be

presented] a [written] [oral] statement [as part of] [in support of] a claim for

[payment] [a benefit] pursuant to the insurance policy, the statement

contained false or misleading information concerning a fact or a matter

material to the claim, the defendant knew the statement contained false or

misleading information concerning a fact or matter material to the claim, and

the defendant acted with the intent to [injure] [defraud] [deceive] the (name

insurer), it would be your duty to return a verdict of guilty of presenting a

false statement under an insurance policy with the intent to defraud the

insurance company. However, if you do not so find, or have a reasonable

doubt as to one or more of these things, it would be your duty to return a

verdict of not guilty.