Fraud Statement

Warning: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claims containing any materially false information or conceals, for the purposes of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and may subject such person to criminal and substantial civil penalties.

No provision states: AL, CT, GA, IL, IA, KS, MA, MI, MS, MO, MT, NE, NV, NC, ND, SC, SD, UT, VT, WI and WY.

AK residents only: "A person who knowingly and with intent to injure, defraud, or deceive an insurance company files a claim containing false, incomplete, or misleading information may be prosecuted under state law."

AZ residents only: "For your protection Arizona law requires the following statement to appear on this form. Any person who knowingly presents a false or fraudulent claim for payment of a loss is subject to criminal and civil penalties."

CA residents only: "For your protection California law requires the following to appear on this form: Any person who knowingly presents false or fraudulent claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison."

DE residents only: "Any person who knowingly, and with intent to injure, defraud or deceive any insurer, files a statement of claim containing any false, incomplete or misleading information is guilty of a felony."

DC residents only: "Warning: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and/or fines. In addition, an insurer may deny insurance benefits if false information materially related to a claim was provided by the applicant."

FL residents only: "Any person who knowingly and with intent to injure, defraud, or deceive any insurance company files a statement of claim containing any false, incomplete, or misleading information is guilty of a felony of the third degree."

IN residents only: "A person who knowingly and with intent to defraud an insurer files a statement of claim containing any false, incomplete, or misleading information commits a felony."

KY residents only: "Any person who knowingly and with intent to defraud any insurance company or other person files a statement of claim containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime."

MD residents only: "Any person who knowingly and willfully presents a false or fraudulent claim for payment of a loss or benefit or who knowingly and willfully presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison."

MN residents only: "A person who files claim with intent to defraud or helps commit a fraud against an insurer is guilty of a crime."

NH residents only: "Any person who, with a purpose to injure, defraud or deceive any insurance company, files a statement of claim containing any false, incomplete or misleading information is subject to prosecution and punishment for insurance fraud as provided in section 638:20."

NJ residents only: "Any person who knowingly files a statement of claim containing any false or misleading information is subject to criminal and civil penalties."

OK residents only: "WARNING: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony."

PA residents only: "Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties."

RI residents only: "Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison."

TX residents only: "Any person who knowingly presents a false or fraudulent claim for the payment of a loss is guilty of a crime and may be subject to fines an confinement in state prison."

WA residents only: "It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines and denial of insurance benefits."

WV residents only: "Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison."

The parties to this agreement (the “Agreement ”) are the primary insured person, insured person, and/or claimant ( “You”) and American Bankers Insurance Company of Florida, including its applicable affiliates (collectively, “Assurant”, “we” or “us”), who agree as follows:

1. By electing to initiate your insurance claim (Notice of Loss) online via the <Chase><Card Benefits Insurance> Claims Center, You understand that the information submitted will begin the claim process, however additional information will be required to complete your claim submission.
2. You agree to be contacted by email and/or telephone to obtain additional information needed to complete the Notice of Loss process.
3. You further agree to have us electronically deliver to you any information, correspondence, notices or other documentation related to the Notice of Loss you file (the "Claims Documents"). You acknowledge and understand that you may receive these electronic Claims Documents instead of paper documents in the US Mail. You also acknowledge that your assigned insurance adjuster may communicate with you electronically regarding your claim.
4. At any time while this Agreement is effective, you may obtain a paper copy of a particular Claims Document at no charge by contacting us and requesting a copy through any of the following methods: calling us at <1-800-000-0000>, emailing us at <[email protected]>, or writing to us at Assurant, Attn: <Chase><Card Benefits Insurance> Claims Center, PO Box <XXXXXX>, Miami, FL 33157.
5. Since email correspondence may be the primary method of communication between you and us while this Agreement is in effect, you agree that you will promptly notify us of a change in your email address.
6. To access and view the Claims Documents, you will need an Internet connection, an active, valid email account, and Adobe Acrobat Reader. You will need the hardware capabilities to electronically store or save your Claims Documents, and you will also need a functional printer to print out your Claims Documents.

   To obtain a free copy of Acrobat Reader, please click here.

7. You are responsible for accessing, opening and reading your Claims Documents. Electronic Claims Documents have the same legal effect as printed ones. If you cannot access, open or read any Claims Documents, you must contact us. You agree that your email account is configured to properly receive incoming emails from assurant.com.
8. We may amend the terms of this Agreement at any time by providing notice to you of the amendment(s). If you do not agree with the term(s) of the amendment(s), you can terminate this Agreement as described above in Section 3.
9. We do not warrant that the delivery of electronic Claims Documents will be uninterrupted or free of error. We are not liable for any loss or damage arising from problems or issues with your equipment or your telecommunications provider, for your failure to meet your responsibilities as outlined in this Agreement or on our website, for your failure to access, open and read your Claims Documents after they are sent to you, or for any equipment problems or other occurrences beyond our reasonable control.
10. By accepting this Agreement below, you acknowledge that you have read, understand and agree to the terms and conditions of this Agreement. This Agreement is effective when we receive your acceptance.