Mandatory Reporting - InsuranceFraud.org

Title 24-A: MAINE INSURANCE CODE

Chapter 23: TRADE PRACTICES AND FRAUDS

§2186. Insurance fraud prevention

Reporting of fraudulent insurance acts. Fraudulent insurance acts must be reported in accordance with this subsection.

A. An insurer shall, annually on or before March 1st or within any reasonable extension of time granted by the superintendent, file with the superintendent a report relating to fraudulent insurance acts that the insurer knew or reasonably believed had been committed during the previous calendar year. The report must contain information required by the superintendent in the manner prescribed by the superintendent. The information must be reported on an aggregate basis and may not contain any information identifying any individuals or entities. The superintendent shall adopt by January 1, 1999 rules necessary to define the information that must be reported. Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter II‑A.

§33-41-5. Reporting of insurance fraud or criminal offenses otherwise related to the business of insurance. (a) A person engaged in the business of insurance having knowledge or a reasonable belief that fraud or another crime related to the business of insurance is being, will be or has been committed shall provide to the commissioner the information required by, and in a manner prescribed by, the commissioner. (b) The commissioner may prescribe a reporting form to facilitate reporting of possible fraud or other offenses related to the business of insurance for use by persons other than those persons referred to in subsection (a) of this section.

Workers compensation only. Sec. 102-125 – Fraudulent Claims Reporting “(1) If an insurer or self-insured employer has evidence that a claim is false or fraudulent in violation of Sec. 943.395 and if the insurer or self-insured employer is satisfied that reporting the claim to the department will not impede its ability to defend the claim, the insurer or self-insured employer shall report the claim to the department. The department may require an insurer or self-insured employer to investigate an alleged false or fraudulent claim and may provide the insurer or self-insured employer with any records of the department relating to that claim. An insurer or self-insured employer that investigates a claim under this subsection shall report on the results of that investigation to the department.”

Section 52-40(A) – of S. 421, Chapter 590, Laws 1998 A. If any insurer, any employee thereof, or any insurance professional has knowledge of, or has reason to believe that a violation of Section 18.2-178 will be, is being, or has been committed, that person shall furnish and disclose any information in his possession concerning the fraudulent act to the Department, (Department of State Police) subject to any legal privilege protecting such information.

RCW 48.135.050 Furnishing and disclosing insurance fraud knowledge and information. (1) Any insurer or licensee of the commissioner that has reasonable belief that an act of insurance fraud which is or may be a crime under Washington law has been, is being, or is about to be committed shall furnish and disclose the knowledge and information to the commissioner or the national insurance crime bureau, the national association of insurance commissioners, or similar organization, who shall disclose the information to the commissioner, and cooperate fully with any investigation conducted by the commissioner. (2) Any person that has a reasonable belief that an act of insurance fraud which is or may be a crime under Washington law has been, is being, or is about to be committed; or any person who collects, reviews, or analyzes information concerning insurance fraud which is or may be a crime under Washington law may furnish and disclose any information in its possession concerning such an act to the commissioner or to an authorized representative of an insurer that requests the information for the purpose of detecting, prosecuting, or preventing insurance fraud. 48.50.030 Release of information or evidence by insurer. (1) Any authorized agency may request, in writing, that an insurer release to the agency any or all relevant information or evidence which the insurer may have in its possession relating to criminal activity, if such information or evidence is deemed important by the agency in its discretion. (2) An insurer who has reason to believe that a person participated or is participating in criminal activity relating to a contract of insurance may report relevant information to an authorized agency. (3) The information provided to an authorized agency under this section may include, without limitation: (a) Pertinent insurance policy information relating to a claim under investigation and any application for such a policy; (b) Policy premium payment records which are available; (c) History of previous claims in which the person was involved; and (d) Material relating to the investigation of the loss, including statements of any person, proof of loss, and any other evidence found in the investigation. (4) The insurer receiving a request under subsection (1) of this section shall furnish all relevant information requested to the agency within a reasonable time, orally or in writing. 48.50.040. Notification by insurer. (1) When an insurer has reason to believe that a fire loss reported to the insurer may be of other than accidental cause, the insurer shall notify the chief of the Washington state patrol, through the director of fire protection, in the manner prescribed under RCW 48.05.320 concerning the circumstances of the fire loss, including any and all relevant material developed from the insurer’s inquiry into the fire loss. (2) Notification of the chief of the Washington state patrol, through the director of fire protection, under subsection (1) of this section does not relieve the insurer of the duty to respond to a request for information from any other authorized agency and does not bar an insurer from other reporting under RCW 48.50.030(2). 48.50.070. Immunity from liability for releasing information. Any licensed insurance producer, title insurance agent, or insurer or person acting in the insurer’s behalf, health maintenance organization or person acting in behalf of the health maintenance organization, health care service contractor or person acting in behalf of the health care service contractor, or any authorized agency which releases information, whether oral or written, to the commissioner, the national insurance crime bureau, the national association of insurance commissioners, other law enforcement agent or agency, or another insurer under RCW 48.50.030, 48.50.040, 48.50.050, 48.50.055, or 48.135.050 is immune from liability in any civil or criminal action, suit, or prosecution arising from the release of the information, unless actual malice on the part of the insurance producer, title insurance agent, insurer, health care maintenance organization, health care service contractor, or authorized agency against the insured is shown.

Workers compensation only. (b) Any insurer, insurance professional or other person that has reasonable belief that an act violating Section 56-47-103 or 56-47-104 will be, is being, or has been committed, shall furnish and disclose any information in its possession concerning such act to the appropriate law enforcement official or authority, Department of Commerce and Insurance or Department of Labor, subject to any legal privilege protecting such information.”

Section 56-53-109(b) Any insurer or insurance professional that has reasonable belief that an violating Section 56-53-102 or Section 56-53-103 will be, is being, or has been committed shall furnish and disclose any information in its possession concerning such act to the appropriate law enforcement official or authority, insurance department, state division of insurance fraud, or state or federal regulatory or licensing authority, subject to any legal privilege protecting such information. In no case shall the information be required by subpoena or otherwise to be given to the person alleged to have committed a violation, unless in possession of an insurer and that insurer used the information to deny a claim of the person, in whole or in part.

§ 701.051. DUTY TO REPORT. (a) Not later than the 30th day after the date the person makes the determination or reasonably suspects that a fraudulent insurance act has been or is about to be committed in this state, the person: (1) shall report the information in writing to the insurance fraud unit of the department, in the format prescribed by the fraud unit or by the National Association of Insurance Commissioners; and (2) may also report the information to another authorized governmental agency. (b) A report made to the insurance fraud unit constitutes notice to each other authorized governmental agency. (c) A person who is a member of an organization primarily dedicated to the detection, investigation, and prosecution of insurance fraud fully complies with the person’s obligations under Subsection (a) by authorizing the organization to report on the person’s behalf information required to be reported under Subsection (a). The person retains any liability resulting from the failure of the organization to report in a manner that complies with Subsection (a).

Utah Code Section 31A-31-110 (1)(a) A person shall report a fraudulent insurance act to the department if: (i) the person has a good faith belief on the basis of a preponderance of the evidence that a fraudulent insurance act is being, will be, or has been committed by a person other than the person making the report; and (ii) the person is: (A) an insurer; or (B) in relation to the business of title insurance, an auditor that is employed by a title insurer. (b) The report required by this Subsection (1) shall: (ii) provide information in detail relating to: (A) the fraudulent insurance act; and (B) the perpetrator of the fraud insurance act; and (iii)(A) state whether the person required to report under Subsection (1)(a) also reported the fraudulent insurance act to: (I) the attorney general; (II) a state law enforcement agency; (III) a criminal investigative department or agency of the United States; (IV) a district attorney; or (V) the prosecuting attorney of a municipality or county; and (B) if the person reported the fraudulent insurance act as provided in Subsection (1)(b)(iii)(A), state the agency to which the person reported the fraudulent insurance act. (c) A person required to submit a written report under Subsection (1) shall submit a written report to the department by no later than 90 days from the day on which the person required to report the fraudulent insurance act has a good faith belief on the basis of a preponderance of the evidence that the fraudulent insurance act is being, will be, or has been committed. (2) An action brought under Section 31A-2-201, 31A-2-308, or 31A-31-109, for failure to comply with Subsection (1) shall be commenced within four years from the date on which a person described in Subsection (1) (a) has a good faith belief on the basis of a preponderance of the evidence that a fraudulent insurance act is being, will be, or has been committed; and (b) willfully fails to report the fradulent insurance act. (3) The department may be rule made in accordance with Title 63, chapter 46a, Utah Administrative Rulemaking Act, provide a process by which a person described in Subsection (1)(a)(ii)(B) may comply with the requirements of Subsection (1) by reporting a fraudulent insurance act to the insurer with whom the person is employed, except that the rule shall provide that if the person reports the fraudulent insurance act to the insurer, the insurer is required to report the fraudulent insurance act to the department. (4) A person described in Subsection (1)(a)(ii) who in good faith makes a report under this section, in accordance with Section 21A-31-105, is immun from civil action, civl penalty, or damages for making the report.

(A) Any insurer who has reason to believe that a person or entity has engaged in or is engaging in an act or practice that violates any statute or administrative rule of this state related to insurance fraud shall immediately notify the Anti-Fraud Unit of the Insurance Department.

Maine-Title 24-Mandatory Reporting