Workers compensation only. Disclosure of information to the fraud prevention unit — Any insurer, or agent authorized by the insurer to act on its behalf, having reason to believe that an insurance transaction may be fraudulent, shall send to the fraud prevention unit a report of the transaction and any additional information requested by the unit. The unit shall review the reports submitted and undertake further investigation in appropriate cases, as determined by the unit. § 27-49-5.1 — Insurer disclosure – Qualified immunity. (a) An insurer and an agent authorized to act on its behalf, upon written request, may provide to another insurer or insurance industry related organization whose purpose it is to investigate or assist in the prosecution of motor vehicle insurance fraud any and all relevant factually accurate information which the insurer may possess as to any motor vehicle claim or other information which may relate to whether a motor vehicle theft or motor vehicle insurance fraud has occurred. (b) No insurer, organization or agent authorized to act under subsection (a) of this section shall be subjected to any civil or criminal liability in any cause of action of any kind for releasing or receiving any relevant factually accurate information pursuant to subsection (a) of this section if it acts in good faith and with due care solely for the purpose of facilitating the discovery and prosecution of the theft or fraud.
Section 38-55-570 (A) “Any person, insurer, or authorized agency having reason to believe that another has made a false statement or misrepresentation or has knowledge of a suspected false statement or misrepresentation shall, for purposes of reporting and investigation, notify the Insurance Fraud Division of the Office of the Attorney General of the knowledge or belief and provide any additional information within his possession relative thereto.”
58-33-76. Notification of suspected fraud. An insurer, or any person authorized to act on its behalf, which reasonably believes that a false or fraudulent claim, statement, or representation has occurred, may notify an authorized agency and provide it with all relevant information in its possession. 58-33-77. Accessibility of information relevant to suspected fraud–Types of information. Upon request by an insurer to an authorized agency or by an authorized agency to an insurer, each may provide to the other, directly or through any person authorized to act on its behalf, all information relevant to any suspected false or fraudulent claim, statement, or representation, including the following information: (1) Insurance policy information relevant to an investigation, including any application for such a policy; (2) Available policy premium payment records; (3) History of previous claims made by an insured; and (4) Information relating to the investigation of any suspected insurance fraud, including statements of any person, proofs of loss and notice of loss. 58-33-79. Liability of supplier of information. Any insurer, authorized agency, or person authorized to act on their behalf, acting without bad faith or malice, who provides or receives information pursuant to §§ 58-33-76 and 58-33-77 is not subject to criminal prosecution, civil penalty, or civil liability therefor, except in cases of perjury or insurance fraud. Source: SL 1993, ch 368, § 5.
(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.
Section 731.592 (1) Notwithstanding ORS 746.665 (Limitations and conditions on disclosure of certain information), an insurer shall cooperate with any law enforcement agency or other state or federal agency that is investigating or prosecuting suspected criminal conduct involving insurance. The insurer shall provide any information requested by the agency unless the information is subject to a legal privilege that would prohibit disclosure. (2) If an insurer has reason to believe that criminal conduct involving insurance has been, is being or is about to be committed, the insurer shall notify the appropriate agency of that fact. The insurer is not required to notify the agency if the information or any part of the information upon which the belief is based is protected from disclosure by legal privilege. (3) An insurer providing information under this section may request information relating to the investigation that is in the possession or control of the agency. The agency may not provide an insurer with information that is privileged or confidential. Otherwise, the agency shall disclose requested information unless disclosure would jeopardize an ongoing investigation or prosecution. The agency may require that the insurer not disclose the information to any other person. (4) A person who has reason to believe criminal conduct involving insurance has been, is being or is about to be committed, or who collects, reviews or analyzes information concerning suspected criminal conduct involving insurance, may furnish any unprivileged information in the person’s possession concerning the suspected criminal conduct to an insurer who requests the information for the purpose of detecting, prosecuting or preventing criminal conduct involving insurance. (5) If an insurer or agency does not provide information as required by this section and the suspected criminal conduct results in a conviction, the insurer or agency is not eligible for any compensation to which the insurer or agency might otherwise be entitled from any award under ORS 137.106 (Restitution to victims).
59A-16C-6. Notice and cooperation required; tolling period. A. Every insurer or licensed insurance professional that has a reasonable belief that an act of insurance fraud will be, is being or has been committed shall furnish and disclose knowledge and information about it to the superintendent and shall cooperate fully with any investigation conducted by the superintendent. Failure to comply with this subsection shall constitute grounds for the superintendent to impose an administrative penalty pursuant to Section 59A-1-18 NMSA 1978 in addition to any applicable suspension, revocation or denial of a license or certificate of authority. B. A person who has a reasonable belief that an act of insurance fraud will be, is being or has been committed, or any person who collects, reviews or analyzes information concerning insurance fraud, may furnish and disclose any information in his possession concerning the insurance fraud to the superintendent or to an authorized representative of an insurer that requests the information for the purpose of detecting, prosecuting or preventing insurance fraud. C. If an insurer has a reasonable belief or probable cause to believe that an insurance fraud has been committed and has properly notified the superintendent of its suspicion, that notification shall toll any applicable time period in any unfair claims proceeding based on the alleged fraud until thirty days after determination by the superintendent and notice to the insurer that the superintendent will not recommend action on the claim. The determination by the superintendent shall not be admissible in any subsequent civil proceeding. D. The superintendent, in cooperation with insurers or others, may establish a voluntary fund to reward persons not connected with the insurance industry who provide information or furnish evidence leading to the arrest and conviction of persons responsible for insurance fraud.
Regulation. Section 86.5 – Reports of fraudulent acts. Any person licensed pursuant to the provisions of the Insurance Law who determines that an insurance transaction or purported insurance transaction appears to be fraudulent or suspect shall submit a report thereon to the Insurance Frauds Bureau. Reports shall be submitted on the prescribed reporting form issued by the Insurance Frauds Bureau or upon any other form approved by order of the superintendent. Reporting may also be done by means of any electronic medium or system approved by order of the superintendent.
Regulation. Any person licensed pursuant to the provisions of the Insurance Law who determines that an insurance transaction or purported insurance transaction appears to be fraudulent or suspect shall submit a report thereon to the Insurance Frauds Bureau. Reports shall be submitted on the prescribed reporting form issued by the Insurance Frauds Bureau or upon any other form approved by order of the superintendent. Reporting may also be done by means of any electronic medium or system approved by order of the superintendent.
State Insurance Code Section 405 (a) Any person licensed or registered pursuant to the provisions of this chapter, and any person engaged in the business of insurance or life settlement in this state who is exempted from compliance with the licensing requirements of this chapter, including the state insurance fund of this state, who has reason to believe that an insurance transaction or life settlement act may be fraudulent, or has knowledge that a fraudulent insurance transaction or fraudulent life settlement act is about to take place, or has taken place shall, within thirty days after determination by such person that the transaction appears to be fraudulent, send to the superintendent on a form prescribed by the superintendent, the information requested by the form and such additional information relative to the factual circumstances of the transaction and the parties involved as the superintendent may require. The superintendent shall accept reports of suspected fraudulent insurance transactions or fraudulent life settlement acts from any self insurer, including but not limited to self insurers providing health insurance coverage or those defined in section fifty of the workers’ compensation law, and shall treat such reports as any other received pursuant to this section. (b) The superintendent shall review each report and undertake such further investigation as the superintendent deems necessary and proper to determine the validity of the allegations. State Insurance Code Section 409 (Fraud prevention plans and special investigations units)* Every insurer writing insurance in the state except for insurers that write less than 3,000 policies shall file with the superintendent “a plan for the detection, investigation and prevention of fraudulent insurance activities ….” Section 409(b)(1) provides for provisions for full-time special investigation units that are separate from the underwriting or claims functions. Section 409 (b)(2) allows for the contracting of fraud investigators in lieu of an insurer providing its own special investigation unit.
State Insurance Code Section 405 “Any person licensed … who has reason to believe that an insurance transaction may be fraudulent, or has knowledge that a fraudulent insurance transaction is about to take place, or has taken place shall, within thirty days after determination by such person that the transaction appears to be fraudulent, send to the insurance frauds bureau on a form prescribed by the superintendent, the information requested by the form and such additional information relative to the factual circumstances of the transaction and the parties involved as the superintendent may require.” State Insurance Code Section 409 (Fraud prevention plans and special investigations units)* Every insurer writing insurance in the state except for insurers that write less than 3,000 policies shall file with the superintendent “a plan for the detection, investigation and prevention of fraudulent insurance activities ….” Section 409(b)(1) provides for provisions for full-time special investigation units that are separate from the underwriting or claims functions. Section 409 (b)(2) allows for the contracting of fraud investigators in lieu of an insurer providing its own special investigation unit.