40 Pa. Stat. § 474.1

Current through Pa Acts 2024-53, 2024-56 through 2024-92

Section 474.1 - Immunity from liability

(a) In the absence of fraud or bad faith, no person or his employes or agents shall be subject to civil liability and no civil cause of action shall arise against any of them for any of the following:

(1) Information relating to suspected fraudulent insurance acts or persons suspected of engaging in such acts furnished by them to or received from Federal, State or local law enforcement officials, their agents and employes and designees.

(2) Information relating to suspected fraudulent insurance acts or persons suspected of engaging in such acts furnished by them to or received from other persons subject to the provisions of this act.

(3) Information furnished by them or received from a Federal, State or local agency, the National Association of Insurance Commissioners or another organization established to detect and prevent fraudulent insurance acts, their agents, employes or designees or a recognized comprehensive database system approved by the Insurance Department.

(a.1) In the absence of fraud or bad faith, the immunity granted in subsection (a) shall also apply to persons identified as designated employes of insurers, self-insurers or insurance licensees whose responsibilities include the investigation and disposition of claims relating to suspected fraudulent insurance acts when sharing information on such acts or persons suspected of engaging in such acts with other designated employes of the same or other insurers, self-insurers or insurance licensees whose responsibilities include the investigation or disposition of claims relating to suspected fraudulent insurance acts.

(b) State agencies and their employes and designees, in the absence of fraud or bad faith, shall not be subject to civil liability for sharing information identified in subsection (a). No civil cause of action shall arise against any of them by virtue of the publication of a report or bulletin related to the official activities of the State agency.

(c) Nothing in this section is intended to abrogate or modify a common law or statutory immunity heretofore enjoyed by any person.

(d) As used in this section the following words and phrases shall have the meanings given to them in this subsection:

"Absence of bad faith" means without serious doubt that the information furnished or received, or the report or bulletin published, is not true.

"Absence of fraud" means without knowledge that the information furnished or received, or the report or bulletin published, is not true.

"Fraudulent insurance act" means an act committed by a person who, knowingly and with intent to defraud, presents, causes to be presented or prepares with knowledge or belief that it will be presented to or by an insurer, purported insurer or broker, or an agent of an insurer, purported insurer or broker, information as part or in support of an application for the issuance or rating of an insurance policy for commercial or personal insurance, or a claim for payment or other benefit pursuant to an insurance policy for commercial or personal insurance which he knows to contain materially false information concerning a fact material to the statement or claim or to conceal, for the purpose of misleading, information concerning a fact material to the statement or claim.

"Insurer" means an insurance company, association, exchange, interinsurance exchange, health maintenance organization, preferred provider organization, professional health services plan corporation subject to 40 Pa.C.S. Ch. 63 (relating to professional health services plan corporations), a hospital plan corporation subject to 40 Pa.C.S. Ch. 61 (relating to hospital plan corporations), fraternal benefit society, beneficial association, Lloyd's insurer or health plan corporation.

40 P.S. § 474.1

1921, May 17, P.L. 682, No. 284, § 349.1, added 1986 , June 11, P.L. 226, No. 64, § 2, imd. effective. Amended 2010, Oct. 27, P.L. 952, No. 97, §1, effective in 60 days [ 12/27/2010].