N.C.P.I.—Crim. 228.30A

NOTE WELL: Use this instruction when the defendant presents a

false statement and the insurance claimant is the one injured.

NOTE WELL: For situations involving an alleged fraudulent

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

The defendant has been charged with presenting a false statement

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

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] [coverage] existed between (name

[insured] [insurance claimant]) and (name insurer).

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

[written] [oral] statement1 in opposition to a claim for [payment] [a benefit]

pursuant to the insurance [policy] [coverage].

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 insurance claimant).

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] [coverage] existed between

(name [insured] [insurance claimant]) and (name insurer), that the defendant

[presented] [caused to be presented] a [written] [oral] statement in

opposition to a claim for [payment] [a benefit] pursuant to the insurance

[policy] [coverage], 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, that the defendant acted with the intent to

[injure] [defraud] [deceive] (name insurance claimant), 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 to deny

benefit of insurance policy 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 to deny

benefit of insurance policy with a claim of $100,000 or more, but must

determine whether the defendant is guilty of presenting a false statement to

deny benefit of insurance policy.

Presenting a false statement to deny benefit of insurance policy differs

from of presenting a false statement to deny benefit of insurance policy 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] [coverage] existed between

(name [insured] [insurance claimant]) and (name insurer), and that the

defendant [presented] [caused to be presented] a [written] [oral] statement

in opposition to a claim for [payment] [a benefit] pursuant to the insurance

[policy] [coverage], 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, that the defendant acted with the intent to

[injure] [defraud] [deceive] (name insurance claimant), it would be your duty

to return a verdict of guilty of presenting a false statement to deny benefit of

insurance policy. 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.