New regulations to enforce statutes that require insurers to maintain a special investigation unit
See the full video at https://youtu.be/gy_3jDhDaNI Px19659003] I have completed a resource for everyone involved in the California insurance industry to enable them to comply with the recently revised California SIU regulations, as the audits add a lot to the obligations of insurance companies doing business in California.
The following is from the table of contents which explains what is in the book:
the SIU regulations; Fraud Division; California SIU Regulations; The SIU investigator; Full text and comments on special regulations for survey units; Identify insurance fraud; Insurance Fraud Prevention Act ̵1; Full text; Overview for training of integrated staff against fraud; Real Estate Insurance Fraud Red Flags; Red flags of fraud at the time of acquisition; Red flags of fraud associated with the insured; Red flags of fraud – Fraud against personal injury; Red flags of fraud – premiums; Red Flags of Fraud – Vehicles; Red Flags of Fraud – Profession; Red flags of fraud – personal conduct; Red flags of fraud – time of visit; Red flags of fraud; How to make a false assessment; Plan for document recording and archiving of insurance companies; And Forms.
The book is designed to help California's insurance claims personnel, claims personnel, independent insurance adjusters, special fraud investigators, private investigators working for the insurance industry, management, lawyers serving the industry, and any integrated California anti-fraud company that meets the requirements of California. Regulations rewritten and entered into force on October 1, 2020.
The state of California, by law, requires that all accepted insurance companies have a special investigation unit (a "SIU"). SIU must meet the requirements of the Special Investigative Unit Regulations ("SIU Regulations") and train all integrated anti-fraud staff to recognize insurance fraud indicators.
It is therefore necessary for insurance personnel who work in any way to present, process or negotiate insurance claims in California to be aware of the SIU regulations. The state has imposed all liability obligations to deal with insurance fraud if the insurers do business in the state. California Licensed Insurance Companies are liable under California Insurance Code Sections 1875.20-24 and California Code of Regulations, Section 10, Sections 2698.30 -.41 for establishing and maintaining special investigative units that identify and refer suspected insurance fraud to the California Department of Insurance (CDI) and directly to the local California County District Attorney & # 39 ;s Office for employee compensation only.
The rules also require each insurer to submit an SIU annual report to the CDI that provides important information about the insurer's SIU fraud prevention, procedures, and training materials. SIU's review program evaluates the report's accuracy, completeness and timeliness. The reports are used to carry out a risk assessment to determine which insurers are selected for review of SIU compliance. Risk criteria include, but are not limited to:
- Previous audit results for SIU compliance, as well as follow-up of recommendations and plans for corrective action.
- Deviations and / or non-compliance problems identified by analyzing SIU annual report;
- Quantity and / or quality of suspected insurance fraud references to CDI, known as eFD-1, FD-1 or SFC and references to California County District Attorneys' Offices for Employee Compensation Only;
- insurance lines that are relatively risky and susceptible to fraud;
- The nature and / or number of complaints against a particular insurer;
- The insurer's market share;
- Late or no response to written information requires letters from CDI or other authorized state authorities (eg district attorneys); and
- CDOI Executive Directive.
By following the training recommendations in the book, insurers can inoculate themselves against the possibility of paying huge fines to the CDOI for failure to fully comply with the amended SIU regulations.
The appendices include outlines to be used by an employee of the insurance company SIU, its trainers, teachers or lawyers to present a training class for all insurance companies' "integrated anti-fraud staff" as defined in the SIU regulations. Insurers must understand that each claims employee must be trained in accordance with the requirements of the SIU regulations no later than 30 days after the person is employed and thereafter annually. 2020 camera provides the training needed at no extra cost for one or two people.
California SIU Regulations 2020, and its annexes will provide the insurer and its personnel with the information needed to comply with the SIU Regulations and will provide the training required for what the SIU Regulations describe as one of the insurer's 'integrated anti-fraud staff.'
The book is available as a Kindle book and as a paperback book on amazon.com.
© 2020 – Barry Zalma. He also acts as an arbitrator or mediator for insurance-related disputes. He practiced law in California for more than 44 years as an insurance coverage and claims lawyer and more than 52 years in the insurance industry. He is available at http://www.zalma.com and firstname.lastname@example.org.
Mr. Zalma is the first recipient of the first annual Claims Magazine / ACE Legend Award.
For the past 52 years, Barry Zalma has devoted his life to insurance, insurance claims and the need to defeat insurance fraud. He has created the following library of books and other materials to enable insurers and their claims staff to become insurance claims staff.
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