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Beware! California wants to add the SIU regulations



The California Department of Insurance (CDOI) has organized a discussion on proposed changes to the SIU Regulations that must be followed and followed by almost all insurers writing insurance in the State of California. In this way, CDOI ignores the fact that insurers are the only victim of a crime – insurance fraud – required by law and law to investigate the crime and provide the evidence necessary to prosecute the crime to the CDOI Fraud or a local prosecutor [19659002] The CDOI notes that the purpose of these discussions is to enable interested and interested persons to submit statements or comments regarding the proposed regulation's amendments.

Date: March 20, 201

9
Time: 1:30 pm to 3:30 pm, or as soon as after 1:30 pm
Location: California Insurance Department
Headquarters of Executive Offices
2400 Del Paso Road, Suite 190
Sacramento, California 95834

] Some of the proposed amendments

The proposed changes appear to add more rules , more busy work for the members of SIU.

If the insurer contracts with a third party to provide SIU services, the new regulation will provide, unless changed, that the contracted entity contains provisions of a contract that the contracted entity may include with any subcontractor to perform SIU or integrated fraud prevention services or functions of the contracted entity on behalf of the insurance undertaking.

Reporting to CDOI, if assumed, will include a full summary of all the facts on which the reasonable belief in the insurance fraud is based. Synopsis should contain the following information, if known: (A) When the reporting party was suspected.
(B) The facts that caused the reporting party to believe or to have been the subject of insurance fraud. (C) The suspected distortions and who it was who allegedly made them. (D) How the alleged distortions are essential and how they affect the claim or insurance transaction. (E) Identification of relevant witnesses to the alleged distortion. (F) What documentation is available on the alleged distortion.

In addition, the provisions will require, if adopted, ( 3) The SIU staff shall receive at least five (5) fraud prevention per calendar year. The proposed regulation specifies the type of training required.

In addition, CDOI requires the insurer to provide a description of the insurer's methods and copies of written procedures used by the insurer or its procured entities to detect, investigate, and report suspicious insurance fraud. In addition, the CDOI requires a description of and copies of the insurer's plan and plans for all procured entities that have SIU or integrated anti-fraud responsibility for first and ongoing fraud prevention and training for integrated fraud prevention under this article, including identification of the subjects covered, a description of the process used to ensure that the training is received and a proof that the training occurred .

It will also require every insurer to report how SIU is adequately staffed, including the total number of employees of the SIU employed by the insurer nationally and in California, Total number of hours worked on anti-fraud both nationally and in California and total hours of contracted SIU staff time. In addition, the insurer must report the number of claims processed by the depositor, the number referred to SIU and the number of referrals that resulted in SIU's initiating an investigation both nationally and in California. The insurer must also report the number of suspected fraud reported to the CDOI, the number of arrests that resulted from the referrals to CDOI and the number of judgments and the number and type of civil actions initiated in California, with details of each case.

Current rules, with my comment, can be purchased as a paperback or Kindle book here. Available as a Kindle Book and available as a paperback.

  California SIU Regulations: California State Supervision of Insurance Fraud Investigation California SIU Regulations are designed to help California Insurance Personnel, Professionals, Independent Insurance Adjusters, Special Anti-Fraud Officers, Private Investigators for the Insurance Industry, Industry Leadership, Lawyers Serves the Industry, and All Integral Anti-Fraud Employees Working With California Recognized Insurers to Fulfill the Requirements of California SIU Claims Re

According to law, California's state law requires all insurers to maintain a particular investigative unit ("SIU") that meets the requirements of the SIU Regulations ( SIU regulations) and educate all integrated anti-fraud agents to recognize insurance fraud indicators.

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About Barry Zalma

An insurance protection and responsibility management author, consultant and expert witness with more than 48 years of practical and court experience.


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