Fraud Requirements for Insurance Companies

 

June 15, 2015

 

In order to control insurance fraud, states require certain actions by companies. This chart shows which states require carriers to have statements disclaiming fraud on claim submission forms, which states require the submission of formal fraud plans to the state, which states require the existence of fraud plans and which require an annual summary of actions and results of fraud plans.

 

 

Fraud statement

required on

claim form

Company must

submit fraud

plan to state

Company must

have fraud plan

in place

Annual summary

of action of

fraud plans

required

Alabama

Code of Ala. 27-12A-1 through 27-12A-42

x

 

 

 

Alaska

Alaska Stat. §§21.36.360 through 21.36.410

x

 

 

 

Arizona

A.R.S. §§20-466.01, 20-466, 20-452.04

 

 

 

 

Arkansas

A.C.A. §§23-66-501 through 23-66-513, 23-100-101

x- not reinsurance

x- if have plan, submit

x- or other initiative; hire investigators, etc.

 

California

doesn't apply to reins.

Cal Ins Code §§1872.8, 1879.1 through 1879.8

x

x

x

x

Colorado

doesn't apply to reins.

CRS 10-1-128,10-1-129, 10-4-1001 through 10-4-1009

x- apps, or pol or claim forms

 

x

x

Connecticut

Conn. Gen. Stat.

§§53-440 through 53-445

 

 

 

 

Delaware

18 Del. C. §§2401 through 2415

 

 

 

 

 

 

 

Fraud statement

required on

claim form

Company must

submit fraud

plan to state

Company must

have fraud plan

in place

Annual summary

of action of

fraud plans

required

District of Columbia Not to reinsurers D.C. Code §§22-3225.01 through 22-3225.13

x & app

x

x

x

Florida

Fla. Stat. §§626.989, 626.9891, 633.126, 817.234

 

x- less than 10 mil dwp, or can opt to set up unit

x

w/c only

Georgia

O.C.G.A. §§33-1-9, 33-1-16, 33-1-17

 

 

 

 

Hawaii

HRS §§431:2-401 through 431:2-410

 

 

 

 

Idaho

Idaho Code §§41-268, 41-290 through 41-298

 

 

 

 

Indiana

Ind. Code Ann. §§27-1-3-22; 27-2-19-7; 35-43-5-4.5

 

 

 

 

Iowa

Iowa Code §§507E.1 through 507E.8

 

 

 

 

Kansas

K.S.A. §§40-2,118a and 40-2,119

 

 

x

 

Kentucky

includes w/c

KRS §§304.47-010 through 304.47-080

x- & apps, does not apply to reins

 

x

 

Louisiana

La. R.S. 22:1921 through 22:1929; 40:1425

 

 

 

 

Maine

24-A M.R.S. §§2186 and 2187

x & app

 

x

x

 

 

 

This premium content is locked for FC&S Coverage Interpretation Subscribers

Enjoy unlimited access to the trusted solution for successful interpretation and analyses of complex insurance policies.

  • Quality content from industry experts with over 60 years insurance experience, combined
  • Customizable alerts of changes in relevant policies and trends
  • Search and navigate Q&As to find answers to your specific questions
  • Filter by article, discussion, analysis and more to find the exact information you’re looking for
  • Continually updated to bring you the latest reports, trending topics, and coverage analysis