how to request excess medical benefits - Chubb Group of Insurance ...

IMPORTANT NOTICENotice to Minnesota Claimants: A person whosubmits an application or files a claim with intent todefraud or helps commits a fraud against an insureris guilty of a crime.Notice to New Hampshire Claimants: Any personwho, with a purpose to injure, defraud or deceiveany insurance company, files a statement of claimcontaining any false, incomplete or misleadinginformation is subject to prosecution andpunishment for insurance fraud, as provided in RSA638:20.Notice to New Jersey Claimants: Any person whoknowingly files a statement of claim containing anyfalse or misleading information is subject tocriminal and civil penalties.Notice to New Mexico Claimants: Any personwho knowingly presents a false or fraudulent claimfor payment of a loss or benefit or knowinglypresents false information in an application forinsurance is guilty of a crime and may be subject tocivil fines and criminal penalties.Notice to New York Claimants: Any person whoknowingly and with intent to defraud any insurancecompany or other person files an application forinsurance or statement of claim containing anymaterially false information, or conceals for thepurpose of misleading, information concerning anyfact material thereto, commits a fraudulent insuranceact, which is a crime and shall also be subject to acivil penalty not to exceed five thousand dollars andthe stated value of the claim for each such violation.Notice to Oregon Claimants: Any person who,knowingly and with intent to defraud an insurancecompany or other person, submits an application orfiles a claim for insurance that contains anymaterially false information relating to an insurancecompany’s acceptance of risk, or conceals for thepurpose of misleading, information concerning anyfact material to an insurance company’s acceptanceof risk, may be guilty of a fraudulent act, which is acrime.Notice to Pennsylvania Claimants: Any personwho knowingly and with intent to defraud anyinsurance company or other person files anapplication for insurance or statement of claimcontaining any materially false information orconceals for the purpose of misleading, informationconcerning any fact material thereto commits afraudulent insurance act, which is a crime andsubjects such person to criminal and civil penalties.Notice to Virginia Claimants: It is a crime toknowingly provide false, incomplete or misleadinginformation to an insurance company for thepurpose of defrauding the company. Penaltiesinclude imprisonment, fines and denial of insurancebenefits.Notice to Claimants in all other states: Anyperson who knowingly and with intent to defraud ordeceive any insurance company files a claimcontaining any materially false, incomplete ormisleading information may be subject toprosecution for insurance fraud.Notice to Ohio Claimants: Any person who, withthe intent to defraud or knowing that he isfacilitating a fraud against an insurer, submits anapplication or files a claim containing a false ordeceptive statement is guilty of insurance fraud.Notice to Oklahoma Claimants: WARNING: Anyperson who knowingly, and with intent to injure,defraud or deceive any insurer, makes any claim forthe proceeds of an insurance policy containing anyfalse, incomplete or misleading information is guiltyof a felony.