DIF On-Line Fraud Reporting

I have included information from the Florida Department of Financial Services, Division of Insurance Fraud, regarding their requirements for reporting a suspected fraud claim and the new rule governing the development and plans for Special Investigative Units. The new rule (69D-2.001, Florida Administrative Code) was implemented to establish guidelines and reporting requirements for insurer anti-fraud investigative units and anti-fraud plans. This rule coincides with Section 626.9891 of the Florida Statutes. The enclosed document entitled “Informational Memorandum” is the best source in understanding the new rule and its purpose.

The Division of Insurance Fraud now has on-line capability for reporting fraudulent insurance claims and for submitting the SIU Descriptions, Anti-Fraud Plan Filing Reports and the Insurance Fraud Plan Reporting (IFPR) forms. I have printed out the web-site and relevant documents from the IFPR section. There are different forms to be used when filing, for those carriers with more than $10 million in annual direct written premium in Florida and those who write less than $10 million in Florida. Insurance companies who have several subsidiaries are only required to file one SIU Description and Anti-Fraud Plan.

A key to reporting the Fraud plan is “acknowledging the component requirements.”  They are not looking for plan detail.  That will be DFS/OIR Market Conduct’s role in the audit/examination reviews.  The filing should acknowledge the rule component requirement in a declaratory statement. It will be the carrier’s responsibility to be certain that they will, in fact, implement and document the criteria, procedures, reporting, training, etc within their organization.

To report suspected insurance fraud activity you merely fill out the form under the tab “Insurance Company Tips”. It is extremely important when filling out this form that you indicate the correct county so that the referral gets to the correct office for handling. All the above information can be found on their website at www.fldfs.com/fraud.

Ms. Denise Prather, Senior Management Analyst, is an excellent contact at the Division of Insurance Fraud. She has granted me permission to provide you with her number if you have any questions when attempting to file a suspected fraudulent claim or reporting the IFPR. She can be contacted at 850-413-4036.

In addition, I have included a document that was prepared for the 2006 Florida Arson Seminar. The document is a combination of information developed by Mr. Burnette and other resources. I taught this segment at the conference to provide investigators with an understanding of what to do after they receive the documents under the Florida Arson Immunity Reporting Act. This allows the investigators to understanding what to look for in conducting their analysis of the records received from the insurance company. I hope this helps in understanding why the statute was originally developed and its importance to both public and private sectors.

We hope this information is helpful to you and your staff. Please feel fee to call me if you have any questions.