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HomeMy WebLinkAboutINSURANCE CLAIM the Hanover Insurance Croup' PO Box 15145 Worcester MA 01615-0145 Telephone: 617-306-8001 Ext: Fax Number: 508-926-5660 March 22, 2023 YARMOUTH TOWN HALL RECEIVE ® BUILDING DEPARTMENT 1146 MA-28 SOUTH YARMOUTH MA MAR 2 7 2023 BUILDING DEPARTMENT Re: Our Insured: Jeffrey King By' — Policy Number: HPN D340193 Claim Number: 85-00343597 001 Date of Loss: 03/21/2023 Property Address: 248 CAMP ST APTJ1 WEST YARMOUTH MA To whom it may concern: Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass. General Laws, Ch. 143, Sec. 6 to be applicable. If any notice under Mass. General Laws, Ch. 139, Sec. 3B is appropriate, please direct it to the attention of the undersigned and include a reference to the captioned insured, location, policy number, date of loss, and claim number. On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. Sincerely, chka. cinuriak Matthew Murphy Sr. Field Property Adjuster The Citizens Insurance Company of America 617.306.8001/mamurphy@hanover.com Page 1 of 1 271-5657(2/22) Fraud Warning Statement for all States(except as individually listed below): Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance 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 that person to criminal and civil penalties (In Oregon, the aforementioned actions may constitute a fraudulent insurance act which may be a crime and may subject the person to penalties). (In New York,the civil penalty is not to exceed five thousand dollars($5,000)and the stated value of the claim for each such violation). (Not applicable in AL,AR,AZ, CA, CO, DC, FL, KS, LA, ME, MD, MN, NM, OK, PR, RI, TN,VA,VT,WA and WV). APPLICABLE IN AL, AR, DC, LA, MD, NM, RI, TX (Workers' Compensation Only), and WV: Any person who knowingly (or willfully in MD) presents a false or fraudulent claim for payment of a loss or benefit or who knowingly(or willfully in MD) presents false information in an application for insurance is guilty of a crime and may be sub- ject to fines or confinement in prison. APPLICABLE IN ARIZONA: For your protection Arizona law requires the following statement to appear an this form. Any person who knowingly presents a false or fraudulent claim for payment of a loss is subject to criminal and civil penalties. APPLICABLE IN CALIFORNIA: For your protection California law requires the following to appear on this form.Any person who know- ingly presents false or fraudulent information to obtain or amend insurance coverage or to make a claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison. APPLICABLE IN COLORADO: It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete, or misleading facts or information to a policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado Division of Insurance within the department of regulatory agencies. APPLICABLE IN DELAWARE,FLORIDA and OKLAHOMA:Any person who knowingly and with intent to injure,defraud,or deceive any insurer files a statement of claim or an application containing any false, incomplete,or misleading information is guilty of a felony(In FL, a person is guilty of a felony of the third degree). APPLICABLE IN KANSAS: Any 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, broker or any agent thereof, any written statement as part of, or in support of, an application for the issuance of, or the rating of an insurance policy for personal or commercial insurance, or a claim for payment or other benefit pursuant to an insurance policy for commercial or personal insurance which such person knows to contain materially false information concerning any fact material thereto; or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act. APPLICABLE IN MAINE, TENNESSEE, VIRGINIA, WASHINGTON AND NORTH CAROLINA: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties may include imprisonment,fines or a denial of insurance benefits. APPLICABLE IN INDIANA: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. APPLICABLE IN KENTUCKY: 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. APPLICABLE IN NEW HAMPSHIRE: Any person who with a purpose to injure, defraud or deceive any insurance company, files a statement of claim containing false, incomplete or misleading information is subject to prosecution and punishment for insurance fraud, as provided in RSA 638:20. APPLICABLE IN MINNESOTA: A person who files a claim with intent to defraud or helps commit a fraud against an insurer is guilty of a crime. MN Workers' Compensation Only: Any person who with intent to defraud, receives workers compensation benefits to which the person is not entitled by knowingly misrepresenting, misstating, or failing to disclose any material fact is guilty of theft and shall be sentenced pursuant to s 609.52, subdivision 3. PENNSYLVANIA Motor Vehicle Only: Any person who knowingly and with intent to injure or defraud any insurer files an application or claim containing any false, incomplete or misleading information shall, upon conviction, be subject to imprisonment for up to seven years and payment of a fine of up to$ 15,000.