Insurance crimes

AN ACT Relating to enhancing public safety and enforcement of 1
crimes that impact insurance; amending RCW 48.135.005, 48.135.010, 2
48.135.020, 48.135.040, 48.135.050, 48.135.060, and 48.135.070; 3
reenacting and amending RCW 9A.04.080; adding a new section to 4
chapter 48.135 RCW; and prescribing penalties. 5
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:6
NEW SECTION. Sec. 1. A new section is added to chapter 48.135 7
RCW to read as follows: 8
For purposes of this chapter, unless the context clearly requires 9
otherwise, "insurer" means an entity described in RCW 48.01.050 and 10
includes, but is not limited to, an insurance company authorized 11
under chapter 48.05 RCW, a disability insurer regulated under chapter 12
48.20 or 48.21 RCW, a health care service contractor registered under 13
chapter 48.44 RCW, and a health maintenance organization registered 14
under chapter 48.46 RCW. 15
Sec. 2. RCW 48.135.005 and 2006 c 284 s 1 are each amended to 16
read as follows: 17
The purpose of this chapter and sections 14 through 17, chapter 18
284, Laws of 2006 is to confront the problem of insurance fraud ((in 19
this state by making a concerted effort to detect insurance fraud, 20
Z-0573.1
SENATE BILL 6031
State of Washington 69th Legislature 2026 Regular Session
By Senators Lovick, Fortunato, Conway, Cortes, Frame, Liias,
Riccelli, Shewmake, Trudeau, Warnick, Wellman, C. Wilson, and J.
Wilson; by request of Insurance Commissioner
Prefiled 01/08/26. Read first time 01/12/26. Referred to Committee
on Business, Trade & Economic Development.
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reduce the occurrence of fraud through criminal enforcement and 1
deterrence, require restitution of fraudulently obtained insurance 2
benefits and expenses incurred by an insurer in investigating 3
fraudulent claims, )) and other crimes that impact the insurance 4
industry, or insurance consumers or beneficiaries in this state by 5
updating definitions to address recurring or technologically 6
sophisticated fraud schemes, and making a concerted effort to: Detect 7
such crimes, reduce their occurrence through criminal enforcement and 8
deterrence; require restitution of expenses incurred by an insurer in 9
investigating or paying fraudulent claims or resulting from other 10
crimes; require restitution to insurance consumers victimized by 11
insurance fraud and other insurance-related crimes; and reduce the 12
amount of premium dollars used to pay fraudulent claims. The primary 13
focus of the insurance fraud program is on organized ((fraudulent 14
activities committed against insurance companies )) or collusive 15
criminal schemes that fraudulent activities committed against impact 16
insurance companies or insurance consumers. 17
Sec. 3. RCW 48.135.010 and 2009 c 162 s 32 are each amended to 18
read as follows: 19
((The definitions in this section apply throughout this chapter 20
unless the context clearly requires otherwise.21
(1) "Insurance fraud" means an act or omission committed by a 22
person who,)) (1) A person is guilty of insurance fraud if the person 23
knowingly, and with intent to defraud, commits, or conceals any 24
material information concerning, one or more of the following:25
(a) Presenting, causing to be presented, or preparing with 26
knowledge or belief that it will be presented to or by an insurer, 27
insurance producer, or surplus line broker, false information as part 28
of, in support of, or concerning a fact material to one or more of 29
the following: 30
(i) An application for the issuance or renewal of an insurance 31
policy; 32
(ii) The rating of an insurance policy or contract;33
(iii) A claim for payment or benefit pursuant to an insurance 34
policy; 35
(iv) Premiums paid on an insurance policy; 36
(v) Payments made in accordance with the terms of an insurance 37
policy; or 38
(vi) The reinstatement of an insurance policy;39
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(b) ((Willful embezzlement)) Embezzling, abstracting, purloining, 1
or engaging or conspiring in conversion of moneys, funds, premiums, 2
credits, benefits, or other property of an insurer ((or)), person 3
engaged in the business of insurance((; or4
(c))), or insurance consumer or beneficiary;5
(c) Submitting of a bill or claim to an insurer or insurance 6
consumer:7
(i) For medical, vehicle, or property services not rendered, 8
vehicle or property repairs not made, or supplies not provided;9
(ii) Using a current procedural terminology (CPT) code or health 10
care common procedure coding system (HCPCS) code not reasonably 11
appropriate to the service provided or procedure performed; or12
(iii) Using the name, credentials, or national provider 13
identifier (NPI) of a health care provider who neither rendered nor 14
supervised the billed service;15
(d) Submitting a statement, estimate, invoice, bid, proposal, 16
proof of loss, or any other document that misrepresents the scope of 17
damages or costs of repairs associated with a property insurance 18
claim;19
(e) Falsifying diagnostic or treatment information in a patient's 20
medical file to bill for treatments or prescriptions that would not 21
otherwise have been covered by the insurer;22
(f) Misrepresenting the identity of, or impersonating, a person, 23
government representative, or business in connection with an 24
insurance policy application, premium payment, claim, or the 25
solicitation or performance of mitigation, restoration, or repair 26
services;27
(g) Procuring or handling funds intended for payment of premium 28
in any of the following ways:29
(i) Collecting or receiving funds intended for the payment of 30
premium from an individual or entity, or under a premium finance 31
agreement, but misappropriating or converting the funds, or failing 32
to remit the funds to the insurer in a prompt manner;33
(ii) Misrepresenting the amount of premium owed or the terms of a 34
premium finance agreement; or35
(iii) Submitting falsified or forged premium finance agreements 36
or insurance policy information to obtain premium finance loan 37
proceeds;38
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(h) When appraising or umpiring under the appraisal clause of an 1
insurance contract, failing to do so in an impartial manner, 2
including:3
(i) In a self-interested manner, such as on a contingency fee 4
basis, or to secure additional appraisal or umpiring opportunities; 5
or6
(ii) According to influence from an insurer, policyholder, 7
claimant, or other; or8
(i) Attempting to commit, aiding or abetting in the commission 9
of, or conspiracy to commit the acts or omissions specified in this 10
subsection (1). 11
((The definition of insurance fraud is for illustrative purposes 12
only under this chapter to describe the nature of the behavior to be 13
reported and investigated, and is not intended in any manner to 14
create or modify the definition of any existing criminal acts nor to 15
create or modify the burdens of proof in any criminal prosecution 16
brought as a result of an investigation under this chapter.17
(2) "Insurer" means an insurance company authorized under chapter 18
48.05 RCW, a health care service contractor registered under chapter 19
48.44 RCW, and a health care maintenance organization registered 20
under chapter 48.46 RCW.)) (2)(a) Insurance fraud is a class B 21
felony.22
(b) For purposes of this section, each instance of insurance 23
fraud constitutes a separate offense.24
(c) Insurance fraud may be charged and prosecuted in any county 25
where the crime occurred, the accused resides, an insurance consumer 26
or beneficiary victimized by the crime resides, or an impacted 27
insurer has its primary place of business within the state.28
(3)(a) For purposes of determining under subsection (1)(c)(ii) of 29
this section whether a current procedural terminology code was 30
reasonably appropriate for the service provided or procedure 31
performed, the trier of fact must consider any evidence presented, 32
and the applicable current procedural terminology code set published 33
by the American medical association.34
(b) For purposes of determining under subsection (1)(c)(ii) of 35
this section whether a health care common procedure coding system 36
code was reasonably appropriate for the service provided or the 37
procedure performed, the trier of fact must consider any evidence 38
presented, and the applicable current procedural terminology code set 39
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published by the department of health and human services, centers for 1
medicare and medicaid services. 2
Sec. 4. RCW 48.135.020 and 2006 c 284 s 3 are each amended to 3
read as follows: 4
(1) There is established an insurance fraud program within the 5
office of the insurance commissioner. The commissioner may employ 6
supervisory, legal, ((and)) investigative, and other personnel for 7
the program, who must be qualified by training and experience in the 8
areas of detection, investigation, or prosecution of fraud ((in which 9
the insurance industry is a victim )) and other crimes in which the 10
insurance industry or an insurance consumer or beneficiary is a 11
victim or is impacted . The chief of the fraud program is a full -time 12
position that is appointed by the commissioner. The chief serves at 13
the pleasure of the commissioner. The commissioner shall provide 14
office space, equipment, supplies, investigators, clerical staff, and 15
other staff that are necessary for the program to carry out its 16
duties and responsibilities under this chapter. 17
(2) The commissioner may fund one or more state patrol officers 18
to work with the insurance fraud program and the funding for the 19
officers must be paid out of the budget of the insurance fraud 20
program. 21
(3) The commissioner may fund one or more assistant attorneys 22
general and support staff to work with the insurance fraud program 23
and the funding for the assistant attorneys general and support staff 24
must be paid out of the budget of the insurance fraud program.25
(4) The commissioner may make grants to or reimburse local 26
prosecuting attorneys to assist in the prosecution of insurance 27
fraud. The grants must be paid out of the budget of the insurance 28
fraud program. The commissioner may investigate and seek prosecution 29
of crimes involving insurance fraud upon the request of or with the 30
concurrence of the county prosecuting attorney of the jurisdiction in 31
which the offense has occurred. Before such a prosecution, the 32
commissioner and the county in which the offense occurred shall reach 33
an agreement regarding the payment of all costs, including expert 34
witness fees, and defense attorneys' fees associated with any such 35
prosecution. 36
(((5) Staff levels for this program, until June 30, 2010, shall 37
not exceed 8.0 full-time equivalents.))38
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Sec. 5. RCW 48.135.040 and 2006 c 284 s 5 are each amended to 1
read as follows: 2
(1) The commissioner may: 3
(a) Employ and train personnel , and contract for goods and 4
services, to achieve the purposes of this chapter and to employ legal 5
counsel, investigators, auditors, financial or digital forensic 6
staff, and clerical support personnel and other personnel as the 7
commissioner determines necessary from time to time to accomplish the 8
purposes of this chapter; 9
(b) Initiate inquiries and conduct investigations when the 10
commissioner has cause to believe that insurance fraud or other 11
crimes that impact the insurance industry or insurance consumers or 12
beneficiaries, has been, is being, or is about to be committed;13
(c) Conduct independent ((examinations)) investigations of 14
alleged insurance fraud or other crimes that impact the insurance 15
industry or insurance consumers or beneficiaries; 16
(d) Review notices, reports, or complaints of suspected insurance 17
fraud ((activities)) or other crimes that impact the insurance 18
industry or insurance consumers or beneficiaries, from federal, 19
state, and local law enforcement and regulatory agencies, persons 20
engaged in the business of insurance, and any other person to 21
determine whether the reports require further investigation;22
(e) Share records and evidence with federal, state, or local law 23
enforcement ((or regulatory agencies, and enter into interagency )), 24
prosecutorial, or regulatory entities, and enter into interagency, 25
joint operation, or cross commission agreements; 26
(f) Conduct investigations outside this state. If the information 27
the commissioner seeks to obtain is located outside this state, the 28
person from whom the information is sought may make the information 29
available to the commissioner to examine at the place where the 30
information is located. The commissioner may designate 31
representatives, including officials of the state in which the matter 32
is located, to inspect the information on behalf of the commissioner, 33
and the commissioner may respond to similar requests from officials 34
of other states; 35
(g) Administer oaths and affirmations, subpoena witnesses, compel 36
their attendance, ((take)) obtain evidence, and require and compel 37
the production of any books, papers, correspondence, memoranda, 38
agreements, data, or other documents or records that the commissioner 39
deems relevant or material to an inquiry concerning insurance fraud 40
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or other crimes that impact the insurance industry or insurance 1
consumers or beneficiaries; 2
(h) Report incidents of alleged insurance fraud or other crimes 3
that impact the insurance industry or insurance consumers or 4
beneficiaries, disclosed by its investigations to the appropriate 5
prosecutorial authority ((,)) including, but not limited to , the 6
attorney general , a county or federal prosecuting authority, and to 7
any other appropriate law enforcement, administrative, regulatory, or 8
licensing agency; 9
(i) Assemble evidence, prepare charges, and work closely with any 10
prosecutorial authority having jurisdiction to pursue prosecution of 11
insurance fraud or other crimes that impact the insurance industry or 12
insurance consumers or beneficiaries; ((and))13
(j) Undertake independent studies to determine the extent of 14
((fraudulent insurance acts)) criminal acts that impact the insurance 15
industry or insurance consumers or beneficiaries; and16
(k) Acquire and use technology to accomplish the purposes of this 17
chapter including, but not limited to, detecting crime and collusive 18
schemes, and organizing and analyzing data, evidence, investigations, 19
and exhibits. 20
(2) The fraud program investigators who have obtained 21
certification as a peace officer under RCW 43.101.095 have the powers 22
and status of a limited authority Washington peace officer.23
Sec. 6. RCW 48.135.050 and 2006 c 284 s 6 are each amended to 24
read as follows: 25
(1) Any insurer or licensee of the commissioner that has 26
reasonable belief that an act of insurance fraud ((which is or may be 27
a crime under Washington law )) or other crimes that impact the 28
insurance industry or insurance consumers or beneficiaries, has been, 29
is being, or is about to be committed shall furnish and disclose the 30
knowledge and information to the commissioner or the national 31
insurance crime bureau, the national association of insurance 32
commissioners, or similar organization, who shall disclose the 33
information to the commissioner ((, and )). The insurer and any 34
licensee of the commissioner shall cooperate fully with any 35
investigation conducted by the commissioner. 36
(2) Any person that has a reasonable belief that an act of 37
insurance fraud ((which is or may be a crime under Washington law )) 38
or other crimes that impact the insurance industry or insurance 39
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consumers or beneficiaries, has been, is being, or is about to be 1
committed; or any person who collects, reviews, or analyzes 2
information concerning insurance fraud ((which is or may be a crime 3
under Washington law )) or other crimes that impact the insurance 4
industry or insurance consumers or beneficiaries, may furnish and 5
disclose any information in its possession concerning such an act to 6
the commissioner or to an authorized representative of an insurer 7
that requests the information for the purpose of detecting, 8
prosecuting, or preventing ((insurance fraud)) crime that impacts the 9
insurance industry, or insurance consumers or beneficiaries.10
(3) Any certified public accountant, state or local law 11
enforcement agency, public safety entity, or regulatory entity for 12
health care or financial service providers, that has reasonable 13
belief that an act of insurance fraud or other crime that impacts the 14
insurance industry or insurance consumers or beneficiaries, has been, 15
is being, or is about to be committed, shall furnish and disclose any 16
information in its possession concerning such an act to the 17
commissioner.18
(4) Any business entity registered to do business in this state 19
under chapter 23.95 RCW that executes an agreement to finance the 20
payment of a premium for an insurance policy shall send a copy of the 21
executed agreement and the associated insurance policy to the 22
commissioner within 30 calendar days of executing the agreement.23
Sec. 7. RCW 48.135.060 and 2006 c 284 s 7 are each amended to 24
read as follows: 25
(1) Documents, materials, or other information as described in 26
subsection (3), (4), or both of this section are exempt from public 27
inspection and copying under chapter ((s 42.17 and)) 42.56 RCW. The 28
commissioner is authorized to use such documents, materials, or other 29
information in the furtherance of any regulatory or legal action 30
brought as a part of the commissioner's official duties.31
(2) The commissioner: 32
(a) May share documents, materials, or other information, 33
including the documents, materials, or information subject to 34
subsection (1) of this section, with (i) the national association of 35
insurance commissioners and its affiliates and subsidiaries, (ii) 36
regulatory and law enforcement officials of other states and nations, 37
the federal government, and international authorities, (iii) the 38
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national insurance crime bureau, and (iv) an insurer with respect to 1
whom the suspected fraudulent claim may be perpetrated;2
(b) May receive documents, materials, or information from (((i) 3
the)) any source including, but not limited to: (i) The national 4
association of insurance commissioners and its affiliates and 5
subsidiaries, (ii) regulatory and law enforcement officials of other 6
states and nations, the federal government, and international 7
authorities, (iii) the national insurance crime bureau, and (iv) an 8
insurer with respect to whom the suspected fraudulent claim may be 9
perpetrated and any such documents, materials, or information as 10
described in subsection (3), (4), or both of this section are exempt 11
from public inspection and copying; and 12
(c) May enter into agreements governing the sharing and use of 13
information consistent with this subsection. 14
(3) Specific intelligence information and specific investigative 15
records compiled by investigative, law enforcement, and penology 16
agencies, the fraud program of the office of the insurance 17
commissioner, and state agencies vested with the responsibility to 18
discipline members of any profession, the nondisclosure of which is 19
essential to effective law enforcement or for the protection of any 20
person's right to privacy, are exempt under subsection (1) of this 21
section. 22
(4) Information revealing the identity of persons who are 23
witnesses to or victims of crime or who file complaints with 24
investigative, law enforcement, and penology agencies, or the fraud 25
program of the office of the insurance commissioner, if disclosure 26
would endanger any person's life, physical safety, or property, is 27
exempt under subsection (1) of this section. If at the time a 28
complaint is filed the complainant, victim, or witness indicates a 29
desire for disclosure or nondisclosure, such desire shall govern.30
(5) No waiver of an existing privilege or claim of 31
confidentiality in the documents, materials, or information may occur 32
as a result of disclosure to the commissioner under this section or 33
as a result of sharing documents, materials, or information as 34
authorized in subsection (2) of this section. 35
(6) Documents, materials, or other information that is in the 36
possession of persons other than the commissioner that would 37
otherwise not be confidential by law or privileged do not become 38
confidential by law or privileged by providing the documents, 39
materials, or other information to the commissioner.40
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Sec. 8. RCW 48.135.070 and 2006 c 284 s 8 are each amended to 1
read as follows: 2
In a criminal prosecution for any crime under Washington law in 3
which ((the insurance company is a victim, the insurance company )) an 4
insured person or an insurance company, consumer, or beneficiary is a 5
victim, the insured person, insurance company, consumer, or 6
beneficiary is entitled to be considered as a victim in any 7
restitution ordered by the court under RCW 9.94A.753 or 9.94A.750, as 8
part of the criminal penalty imposed against the defendant convicted 9
for such a violation. 10
Sec. 9. RCW 9A.04.080 and 2024 c 298 s 16 and 2024 c 297 s 11 11
are each reenacted and amended to read as follows:12
(1) Prosecutions for criminal offenses shall not be commenced 13
after the periods prescribed in this section. 14
(a) The following offenses may be prosecuted at any time after 15
their commission: 16
(i) Murder; 17
(ii) Homicide by abuse; 18
(iii) Arson if a death results; 19
(iv) Vehicular homicide; 20
(v) Vehicular assault if a death results; 21
(vi) Hit-and-run injury-accident if a death results (RCW 22
46.52.020(4)); 23
(vii) Rape in the first degree (RCW 9A.44.040) if the victim is 24
under the age of sixteen; 25
(viii) Rape in the second degree (RCW 9A.44.050) if the victim is 26
under the age of sixteen; 27
(ix) Rape of a child in the first degree (RCW 9A.44.073);28
(x) Rape of a child in the second degree (RCW 9A.44.076);29
(xi) Rape of a child in the third degree (RCW 9A.44.079);30
(xii) Sexual misconduct with a minor in the first degree (RCW 31
9A.44.093); 32
(xiii) Custodial sexual misconduct in the first degree (RCW 33
9A.44.160); 34
(xiv) Child molestation in the first degree (RCW 9A.44.083);35
(xv) Child molestation in the second degree (RCW 9A.44.086);36
(xvi) Child molestation in the third degree (RCW 9A.44.089);37
(xvii) Sexual exploitation of a minor (RCW 9.68A.040);38
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(xviii) Rape in the first degree (RCW 9A.44.040) if the 1
perpetrator is a first responder as defined in RCW 70.54.430 and if 2
the first responder used the first responder's position to facilitate 3
the commission of the offense; 4
(xix) Rape in the second degree (RCW 9A.44.050) if the 5
perpetrator is a first responder as defined in RCW 70.54.430 and if 6
the first responder used the first responder's position to facilitate 7
the commission of the offense; 8
(xx) Rape in the third degree (RCW 9A.44.060) if the perpetrator 9
is a first responder as defined in RCW 70.54.430 and if the first 10
responder used the first responder's position to facilitate the 11
commission of the offense; 12
(xxi) Trafficking (RCW 9A.40.100) if the victim is under the age 13
of 18; 14
(xxii) Commercial sexual abuse of a minor (RCW 9.68A.100);15
(xxiii) Promoting commercial sexual abuse of a minor (RCW 16
9.68A.101); 17
(xxiv) Promoting travel for commercial sexual abuse of a minor 18
(RCW 9.68A.102); and 19
(xxv) Permitting commercial sexual abuse of a minor (RCW 20
9.68A.103). 21
(b) Except as provided in (a) of this subsection, the following 22
offenses may not be prosecuted more than 20 years after its 23
commission: 24
(i) Rape in the first degree (RCW 9A.44.040); 25
(ii) Rape in the second degree (RCW 9A.44.050); or26
(iii) Indecent liberties (RCW 9A.44.100). 27
(c) The following offenses may not be prosecuted more than ten 28
years after its commission: 29
(i) Any felony committed by a public officer if the commission is 30
in connection with the duties of his or her office or constitutes a 31
breach of his or her public duty or a violation of the oath of 32
office; 33
(ii) Arson if no death results; 34
(iii) Rape in the third degree (RCW 9A.44.060);35
(iv) Attempted murder; or 36
(v) Trafficking under RCW 9A.40.100. 37
(d) A violation of this offense listed in this subsection (1)(d) 38
may be prosecuted up to 10 years after its commission or, if 39
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committed against a victim under the age of 18, up to the victim's 1
30th birthday, whichever is later: RCW 9A.64.020 (incest).2
(e) A violation of RCW 9A.36.170 may be prosecuted up to 10 years 3
after its commission, or if committed against a victim under the age 4
of 18, up to the victim's 28th birthday, whichever is later.5
(f) A violation of RCW 48.135.010 may not be prosecuted more than 6
10 years after its commission or discovery, whichever is later.7
(g) The following offenses may not be prosecuted more than six 8
years after its commission or discovery, whichever occurs later:9
(i) Violations of RCW 9A.82.060 or 9A.82.080; 10
(ii) Any felony violation of chapter 9A.83 RCW;11
(iii) Any felony violation of chapter 9.35 RCW;12
(iv) Theft in the first or second degree under chapter 9A.56 RCW 13
when accomplished by color or aid of deception; 14
(v) Theft from a vulnerable adult under RCW 9A.56.400;15
(vi) Trafficking in stolen property in the first or second degree 16
under chapter 9A.82 RCW in which the stolen property is a motor 17
vehicle or major component part of a motor vehicle as defined in RCW 18
46.80.010; or 19
(vii) Violations of RCW 82.32.290 (2)(a)(iii) or (4).20
(((g))) (h) The following offenses may not be prosecuted more 21
than five years after its commission: Any class C felony under 22
chapter 74.09, 82.36, or 82.38 RCW. 23
(((h))) (i) Bigamy may not be prosecuted more than three years 24
after the time specified in RCW 9A.64.010. 25
(((i))) (j) A violation of RCW 9A.56.030 may not be prosecuted 26
more than three years after the discovery of the offense when the 27
victim is a tax exempt corporation under 26 U.S.C. Sec. 501(c)(3).28
(((j))) (k) No other felony may be prosecuted more than three 29
years after its commission; except that in a prosecution under RCW 30
9A.44.115, if the person who was viewed, photographed, or filmed did 31
not realize at the time that he or she was being viewed, 32
photographed, or filmed, the prosecution must be commenced within two 33
years of the time the person who was viewed or in the photograph or 34
film first learns that he or she was viewed, photographed, or filmed.35
(((k))) (l) No gross misdemeanor, except as provided under (e) of 36
this subsection, may be prosecuted more than two years after its 37
commission. 38
(((l))) (m) No misdemeanor may be prosecuted more than one year 39
after its commission. 40
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(2) The periods of limitation prescribed in subsection (1) of 1
this section do not run during any time when the person charged is 2
not usually and publicly resident within this state.3
(3) In any prosecution for a sex offense as defined in RCW 4
9.94A.030, the periods of limitation prescribed in subsection (1) of 5
this section run from the date of commission or four years from the 6
date on which the identity of the suspect is conclusively established 7
by deoxyribonucleic acid testing or by photograph as defined in RCW 8
9.68A.011, whichever is later. 9
(4) If, before the end of a period of limitation prescribed in 10
subsection (1) of this section, an indictment has been found or a 11
complaint or an information has been filed, and the indictment, 12
complaint, or information is set aside, then the period of limitation 13
is extended by a period equal to the length of time from the finding 14
or filing to the setting aside. 15
NEW SECTION. Sec. 10. If any provision of this act or its 16
application to any person or circumstance is held invalid, the 17
remainder of the act or the application of the provision to other 18
persons or circumstances is not affected.19
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