KRS 304.47-050: Reports of possible fraudulent insurance acts -- Investigation --

Notification of prosecutor -- Immunity from civil liability.

(1) Any person, other than those specified in subsection (2) of this section, having

knowledge or believing that a fraudulent insurance act or any other act or practice

which, upon conviction, constitutes a felony or misdemeanor under the subtitle is

being or has been committed may send to the division a report of information

pertinent to this knowledge of or belief a nd any additional relevant information the

commissioner may request.

(2) The following persons, having knowledge or believing that a fraudulent insurance

act or any other act or practice which may constitute a felony or misdemeanor under

this subtitle is b eing or has been committed, shall send to the division a report or

information pertinent to the knowledge or belief and additional relevant information

that the commissioner or the commissioner's employees or agents may require:

(a) Any professional practi tioner licensed or regulated by the Commonwealth,

except as provided by law;

(b) Any private medical review committee;

(c) Any insurer, agent, or other person licensed under this chapter;

(d) The following Kentucky boards:

1. Board of Medical Licensure;

2. Board of Chiropractic Examiners;

3. Board of Nursing;

4. Board of Physical Therapy;

5. Board of Licensure for Occupational Therapy; and

6. Board of Licensure for Massage Therapy; and

(e) Any employee of the persons named in paragraphs (a) to (d) of this

subsection.

(3) The division or its employees or agents shall review this information or these

reports and select the information or reports that, in the judgment of the division,

may require further investigation. The division shall then cause an investigation of

the facts surrounding the information or report to be made to determine the extent,

if any, to which a fraudulent insurance act or any other act or practice which, upon

conviction, constitutes a felony or misdemeanor under this subtitle is being

committed.

(4) The following shall provide the division access to all relevant information the

commissioner may request:

(a) The Department of Workers' Claims; and

(b) The boards named in subsection (2)(d) of this section.

(5) The division shall report any alleged violations of law which the investigations

disclose to the appropriate licensing agency and the Commonwealth's attorney,

Attorney General, or other prosecuting agency having jurisdi ction with respect to a

violation. If prosecution by the Commonwealth's attorney, Attorney General, or

other prosecuting agency is not begun within sixty (60) days of the report, the

prosecuting attorney shall inform the division of the reasons for the lac k of

prosecution. In addition to filing a report with the appropriate prosecuting agency,

the commissioner may, through the Attorney General, prosecute violations of this

subtitle in the Circuit Court of the county in which the alleged wrongdoer resides or

has his or her principal place of business, in the Circuit Court of the county in

which the fraudulent insurance act has been committed, or, with consent of the

parties, in the Franklin Circuit Court.

(6) Notwithstanding the provisions of subsections (1) to (5) of this section, any person

having knowledge or believing that a fraudulent insurance act or any other act that

may be prohibited under this subtitle is being or has been committed, may notify

any law enforcement agency of his or her knowledge or be lief and provide

information relevant to the act, as may be requested by that agency, including, but

not limited to, insurance policy information including the application for insurance,

policy premium payment records, history of previous claims made by th e insured,

and other information relating to the investigation of the claim, including statements

of any person, proofs of loss, and notice of loss. Reporting to any other agency does

not relieve those listed in subsection (2) of this section of their mand atory duty to

report to the division.

(7) If the information referred to in this section is specifically requested by the division,

any other law enforcement agency, or a prosecuting attorney, the insurer shall

provide certified copies of the requested inf ormation within ten (10) business days

of the request or as soon thereafter as reasonable.

(8) In the absence of malice, fraud, or gross negligence, the following shall not be

subject to any civil liability for libel, slander, or related cause of action by virtue of

filing reports or for releasing or receiving any information pursuant to this

subsection:

(a) An insurer;

(b) An agent authorized by an insurer to act on its behalf;

(c) A law enforcement agency;

(d) The Department of Workers' Claims;

(e) The boards named in subsection (2)(d) of this section;

(f) Employees of the persons named in paragraphs (d) and (e) of this subsection;

or

(g) An insured.