reglab/statecodes huggingface dataset:
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 9 - Insurance Fraud › Article 2 - Special Investigative Unit › Section 2698.44 - Oversight of Special Investigative Unit Maintenance and Operations. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 5-3-94; operative 6-2-94 (Register 94, No. 18).
2.
					 Repealer filed 9-4-2003 as an emergency; operative 9-4-2003 (Register 2003, No.
					 36). A Certificate of Compliance must be transmitted to OAL by 1-2-2004 or
					 emergency language will be repealed by operation of law on the following
					 day.
3. Repealer refiled 1-2-2004 as an emergency; operative
					 1-3-2004. (Register 2004, No. 1). A Certificate of Compliance must be
					 transmitted to OAL by 5-3-2004 or emergency language will be repealed by
					 operation of law on the following day.
4. Repealer refiled 5-4-2004
					 as an emergency; operative 5-4-2004 (Register 2004, No. 19). A Certificate of
					 Compliance must be transmitted to OAL by 9-1-2004 or emergency language will be
					 repealed by operation of law on the following day.
5. Editorial
					 correction of HISTORY 4 (Register 2004, No. 36).
6. Repealer refiled
					 9-1-2004 as an emergency; operative 9-1-2004 (Register 2004, No. 36). A
					 Certificate of Compliance must be transmitted to OAL by 12-30-2004 or emergency
					 language will be repealed by operation of law on the following
					 day.
7. Repealer refiled 12-28-2004 as an emergency; operative
					 12-30-2004 (Register 2004, No. 53). A Certificate of Compliance must be
					 transmitted to OAL by 4-29-2005 or emergency language will be repealed by
					 operation of law on the following day.
8. Repealer refiled 4-29-2005
					 as an emergency; operative 4-29-2005 (Register 2005, No. 17). A Certificate of
					 Compliance must be transmitted to OAL by 8-29-2005 or emergency language will
					 be repealed by operation of law on the following day.
9. Certificate
					 of Compliance as 4-29-2005 order transmitted to OAL 8-26-2005 and filed
					 10-7-2005 (Register 2005, No. 40).
Note: Authority cited: Sections
						1872,
						1875.20,
						1875.21,
						1875.22 and
						1875.23,
						Insurance Code; Calfarm Ins. Co. v. Deukmejian (1989) 48 Cal.3d. 805, 824, 258
						Cal. Rptr. 161, 771 P.2d 1247; Credit Ins. Gen. Agents Assn. v. Payne (1976) 16
						Cal.3d 651, 656, 128 Cal. Rptr. 881, 547 P.2d 1247; Garris v. Carpenter (1939)
						33 Cal. App. 2d 649, 653, 92 P.2d 688. Reference: Sections
						1875.20,
						1875.21,
						1875.22 and
						1875.23,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 9 - Insurance Fraud › Article 2 - Special Investigative Unit › Section 2698.45 - Penalties. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 5-3-94; operative 6-2-94 (Register 94, No. 18).
2.
					 Change without regulatory effect amending subsection (c), filed 3-19-96
					 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 96, No. 12).
3. Repealer filed 9-4-2003 as an
					 emergency; operative 9-4-2003 (Register 2003, No. 36). A Certificate of
					 Compliance must be transmitted to OAL by 1-2-2004 or emergency language will be
					 repealed by operation of law on the following day.
4. Repealer
					 refiled 1-2-2004 as an emergency; operative 1-3-2004. (Register 2004, No. 1). A
					 Certificate of Compliance must be transmitted to OAL by 5-3-2004 or emergency
					 language will be repealed by operation of law on the following
					 day.
5. Repealer refiled 5-4-2004 as an emergency; operative
					 5-4-2004 (Register 2004, No. 19). A Certificate of Compliance must be
					 transmitted to OAL by 9-1-2004 or emergency language will be repealed by
					 operation of law on the following day.
6. Editorial correction of
					 HISTORY 5 (Register 2004, No. 36).
7. Repealer refiled 9-1-2004 as
					 an emergency; operative 9-1-2004 (Register 2004, No. 36). A Certificate of
					 Compliance must be transmitted to OAL by 12-30-2004 or emergency language will
					 be repealed by operation of law on the following day.
8. Repealer
					 refiled 12-28-2004 as an emergency; operative 12-30-2004 (Register 2004, No.
					 53). A Certificate of Compliance must be transmitted to OAL by 4-29-2005 or
					 emergency language will be repealed by operation of law on the following
					 day.
9. Repealer refiled 4-29-2005 as an emergency; operative
					 4-29-2005 (Register 2005, No. 17). A Certificate of Compliance must be
					 transmitted to OAL by 8-29-2005 or emergency language will be repealed by
					 operation of law on the following day.
10. Certificate of Compliance
					 as 4-29-2005 order transmitted to OAL 8-26-2005 and filed 10-7-2005 (Register
					 2005, No. 40).
Note: Authority cited: Sections
						700,
						704,
						704.7,
						1872,
						1875.20,
						1875.21,
						and
						1875.22,
						Insurance Code; Calfarm Ins. Co. v. Deukmejian (1989) 48 Cal.3d. 805, 824, 258
						Cal. Rptr. 161, 771 P.2d 1247; Credit Ins. Gen. Agents Assn. v. Payne (1976) 16
						Cal.3d 651, 656, 128 Cal. Rptr. 881, 547 P.2d 993; Garris v. Carpenter (1939)
						33 Cal. App. 2d. 649, 653, 92 P.2d 688. Reference: Sections
						1875.20,
						1875.21,
						1875.22 and
						1875.23,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 9 - Insurance Fraud › Article 3 - Program for Investigation and Prosecution of Workers' Compensation Insurance Fraud › Section 2698.50 - Authority and Purpose

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
These regulations are promulgated pursuant to authority
					 granted to the Insurance Commissioner under the provisions of Section
					 1872.83 of
					 the California Insurance Code. The purpose of these regulations is to set forth
					 the criteria for distribution of funds to district attorneys for enhanced
					 investigation and prosecution of workers' compensation insurance fraud cases,
					 including an application process and subsequent reporting
					 requirements.
1. New
					 article 3 and section filed 10-8-93; operative 11-8-93 (Register 93, No.
					 41).
Note: Authority cited: Section
						1872.83,
						Insurance Code; CalFarm Insurance Company, et al. v. Deukmejian, et al. (1989)
						48 Cal.3d 805, 824. Reference: Sections
						1872.83 and
						1872.9,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 9 - Insurance Fraud › Article 3 - Program for Investigation and Prosecution of Workers' Compensation Insurance Fraud › Section 2698.53 - Funding Procedure

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				  Funding shall be in the form of a Grant Award Agreement and shall require an
				  enabling resolution approving and authorizing execution of the agreement by the
				  county Board of Supervisors.
(b)
				  Funding shall be distributed on an annual basis in July and funding shall be
				  contingent upon the adoption of each annual State Budget Act and the collection
				  of assessments.
(c) Any portion of
				  distributed funds not used for local program purposes at the termination of
				  each program period as specified in the Request for Application shall be
				  returned to the Workers' Compensation Fraud Account in the Insurance Fund to be
				  reprogrammed for use in the subsequent program year for local program purposes.
				  Counties shall provide the Department with an estimate of unused funds within
				  sixty (60) days after the termination of the program period and shall complete
				  the transfer of funds to the Insurance Fund within thirty (30) days after the
				  completion of the final audit.
(d)
				  A district attorney who has undertaken investigations and prosecutions which
				  will continue into a subsequent year may carry over into the subsequent year
				  distributed but unused funds not exceeding twenty-five percent (25%) of the
				  total annual finding, provided that the district attorney specifies and
				  justifies in writing to the Commissioner how those funds will be used (1) at
				  the end of the program period and (2) at the time of the subsequent
				  application. In the event that distributed, but unused, funds exceed
				  twenty-five (25%) of the previous total annual funding, due to extenuating
				  circumstances, the Commissioner shall consider and approve requests for
				  carry-over to the extent that the district attorney provides
				  justification.
1. New
					 section filed 10-8-93; operative 11-8-93 (Register 93, No. 41).
2.
					 Amendment of subsection (b) filed 3-30-2006 as an emergency; operative
					 3-30-2006 (Register 2006, No. 13). A Certificate of Compliance must be
					 transmitted to OAL by 7-28-2006 or emergency language will be repealed by
					 operation of law on the following day.
3. Amendment of subsection
					 (b) refiled 7-28-2006 as an emergency; operative 7-28-2006 (Register 2006, No.
					 30). A Certificate of Compliance must be transmitted to OAL by 11-27-2006 or
					 emergency language will be repealed by operation of law on the following
					 day.
4. Certificate of Compliance as to 7-28-2006 order transmitted
					 to OAL 11-22-2006 and filed 1-8-2007 (Register 2007, No.
					 2).
Note: Authority cited: Section
						1872.83,
						Insurance Code; CalFarm Insurance Company, et al. v. Deukmejian, et al. (1989)
						48 Cal.3d 805, 824. Reference: Section
						1872.83,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 9 - Insurance Fraud › Article 3 - Program for Investigation and Prosecution of Workers' Compensation Insurance Fraud › Section 2698.54 - Criteria for Distribution of Funds to the District Attorneys

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Each district attorney's allocation shall consist of two
					 parts: a base allocation and a program award, both made as a result of the
					 evaluation of the county plans. The base allocation shall be made from fifty
					 percent (50%) of the total funds and allocated according to the following
					 "caseload estimate", an estimate of the district attorney's proportional share
					 of the state's workers' compensation fraud investigation and prosecution
					 caseload:
(a) The county's proportion
				  of the state's annual average number of workers engaged in wage and salary
				  employment for the most recent year of report shall receive the greatest weight
				  and shall account for sixty-six percent (66%) of the base allocation funding.
				  The employment data source is the Employment Development Department Annual
				  Planning Information.
(b) The
				  county's proportion of the state's workers' compensation suspected fraudulent
				  claims as reported to the California Department of Insurance over the previous
				  three years shall account for thirty-four percent (34%) of the base allocation
				  funding. The source for data on the number of suspected fraudulent claims
				  reported to the Division is the California Department of Insurance.
1. New
					 section filed 10-8-93; operative 11-8-93 (Register 93, No. 41).
2.
					 Change without regulatory effect amending section heading filed 12-13-93
					 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 93, No. 51).
Note: Authority cited: Section
						1872.83,
						Insurance Code; CalFarm Insurance Company, et al. v. Deukmejian, et al. (1989)
						48 Cal.3d 805, 824. Reference: Section
						1872.83,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 9 - Insurance Fraud › Article 3 - Program for Investigation and Prosecution of Workers' Compensation Insurance Fraud › Section 2698.55 - County Plan

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Each district attorney's program award shall be based on
					 the evaluation of the County Plan. The County Plan shall be evaluated by a
					 Review Panel to be comprised of two members of the Fraud Assessment Commission,
					 the Chief of the Fraud Division or the Chief of the Fraud Division's designee,
					 the Director of the Department of Industrial Relations or the Director of the
					 Department of Industrial Relations' designee, and an expert in consumer crime
					 investigation and prosecution to be designated by the Commissioner.
The County Plan shall include but need not be limited to
					 the following elements detailing the county's qualifications and the manner in
					 which the district attorney will use the funds to investigate and prosecute
					 workers' compensation insurance fraud:
(a) Qualifications.
(1) A description of the district attorney's
				  experience in investigating and prosecuting workers' compensation insurance
				  fraud. Relationships with other public or private entities which may be useful
				  to the program should also be included.. Specific activity during the past two
				  years should be detailed as follows:
(A)
				  Number of investigations initiated, specifying number of identified suspects
				  per investigation;
(B) Number of
				  warrants or indictments issued, specifying number of suspects and/or
				  defendants;
(C) Number of arrests
				  made;
(D) Number of convictions
				  obtained, specifying number of defendants, number obtained by trial verdict and
				  number obtained by plea or settlement;
(E) Amount of fines and penalty assessments
				  ordered and collected, specifying number of defendants; and
(F) Amount of restitution ordered and
				  collected, specifying number of defendants and victims.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 9 - Insurance Fraud › Article 3 - Program for Investigation and Prosecution of Workers' Compensation Insurance Fraud › Section 2698.56 - Budget Proposal

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The proposed budget forms the basis for program management
					 and audit and must be presented in line-item detail and cover the period from
					 July 1 through June 30. The budget may include a line item for an independent
					 audit to be completed at the end of the program period. The district attorney's
					 budget shall include, but need not be limited to, the following:
(a) Those salaries and benefits which are
				  computed at the county salary and benefit schedule.
(b) Operation support costs.
(1) Estimated costs shall be listed by line
				  item.
(2) Itemized costs shall
				  conform to county policy regarding appropriateness of expenditures.
(3) Allowable costs are those costs incurred
				  in district support of local program activities, including program related
				  travel, equipment costs proportional to their program-related use, facilities
				  cost, expert witness fees, audits.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 9 - Insurance Fraud › Article 3 - Program for Investigation and Prosecution of Workers' Compensation Insurance Fraud › Section 2698.57 - Funding Recommendations

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Based on the Review Panel's evaluation of each County Plan,
					 the Panel will forward funding recommendations to the Commissioner. If the
					 County Plan fails to respond adequately to the required items as specified in
					 Sections 2698.55 and
					 2698.56, the Panel may recommend
					 funding at the district attorney's base allocation level; however, the Panel
					 shall consider the importance of establishing a program presence in a county to
					 increase community awareness and deter workers' compensation fraud. However,
					 Applications which fail to meet the specified criteria may be recommended for
					 no funding.
1. New
					 section filed 10-8-93; operative 11-8-93 (Register 93, No. 41).
2.
					 Change without regulatory effect amending section filed 5-29-2019 pursuant to
					 section 100, title 1, California Code of
					 Regulations (Register 2019, No. 22).
Note: Authority cited: Section
						1872.83,
						Insurance Code; CalFarm Insurance Company, et al. v. Deukmejian, et al. (1989)
						48 Cal.3d 805, 824. Reference: Section
						1872.83,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 9 - Insurance Fraud › Article 3 - Program for Investigation and Prosecution of Workers' Compensation Insurance Fraud › Section 2698.59 - District Attorney Reporting

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Each district attorney receiving regular annual funds
					 and/or augmentation funds pursuant to Section
					 1872.83
					 shall submit an annual report at the close of the regular annual funding
					 program period, within the deadlines specified in subsection (d), below, to the
					 Commissioner on the local program and its accomplishments. Failure to submit
					 the annual report shall be considered in subsequent funding decisions. At a
					 minimum the report shall include the following items:
(a) An Expenditure Report, which shall
				  include the following:
(1) Personnel:
				  salaries and benefits.
(2)
				  Operations cost breakdown.
(3)
				  Explanation of any significant variances from the district attorney's plan as
				  approved.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 9 - Insurance Fraud › Article 4 - Program for Investigation and Prosecution of Automobile Insurance Fraud › Section 2698.60 - Authority and Purpose

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
These regulations are promulgated pursuant to authority
					 granted to the Insurance Commissioner under the provisions of Section
					 1872.8 of
					 the California Insurance Code. The purpose of these regulations is to establish
					 the level of annual assessment per insured vehicle in the state and to set
					 forth the intended and allowable use of funds to be distributed to district
					 attorneys for purposes of investigation and prosecution of automobile insurance
					 fraud, including an application process and subsequent reporting
					 requirements.
1. New
					 subchapter 9, article 4 and section filed 10-8-93; operative 11-7-93 (Register
					 93, No. 41).
Note: Authority cited: Section
						1872.8,
						Insurance Code; CalFarm Insurance Company et al. v. Deukmejian, et al. (1989)
						48 Cal.3d 805, 824. Reference: Section
						1872.8,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 9 - Insurance Fraud › Article 4 - Program for Investigation and Prosecution of Automobile Insurance Fraud › Section 2698.62 - Setting of the Annual Fee

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				  Each insurer will be assessed and will pay a fee of twenty-five ($.25) cents
				  per vehicle for each quarter of a calendar year or any part thereof that it
				  insures under a policy of insurance issued in this state. The assessment shall
				  be made as provided in paragraph (b) of this section.
(b) The Commissioner will invoice for the
				  assessment specified in subsection (a) quarterly. The assessment shall be due
				  on each vehicle, identified by its vehicle identification number for each
				  quarter that a policy is in force on such vehicle and when a vehicle is added
				  to or replaces one under an existing policy. Each quarterly assessment payment
				  shall be submitted with a certification by an Officer of the insurer, under
				  penalty of perjury under the laws of the State of California, that the number
				  of vehicles reported therein is accurate and has been calculated in conformity
				  with these regulations. The insurer shall, on request by the Commissioner,
				  provide verification of the number of vehicles insured under a policy of
				  insurance.
(c) Subject to the prior
				  written approval of the department, an insurer may use a method to identify the
				  vehicles subject to this assessment other than provided in subsection (b) if,
				  prior to using such methodology, the insurer:
(1) demonstrates that it can not identify the
				  vehicles it insures in this state by their individual vehicle identification
				  number;
(2) submits a detailed
				  description of proposed method,
(3)
				  demonstrates the proposed alternative method is as accurate a method as that
				  described in subsection (b) of this section, and
(4) agrees to use any method approved under
				  this subsection until another method may otherwise be approved in writing by
				  the department.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 9 - Insurance Fraud › Article 4 - Program for Investigation and Prosecution of Automobile Insurance Fraud › Section 2698.63 - Application Procedure

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				  A Request for Application (RFA) shall be distributed annually to each county
				  district attorney in the state.
(b)
				  The RFA shall specify a deadline for submission which shall be 30 days after
				  distribution.
(c) Any district
				  attorney who fails to submit an application, or whose application is not
				  received by the Commissioner at the address specified in the RFA, by the close
				  of business on the deadline date set forth in the RFA, may be subject to delay
				  in receiving any funding award. Any district attorney from whom an application
				  is not received within the ninety day period following the deadline set forth
				  in the RFA shall not be considered for funding.
(d) Applications for funding submitted by the
				  district attorneys shall list the County Plan and budget elements as outlined
				  in Section
				  2698.65 and shall include a Table
				  of Contents to facilitate plan review.
(e) Two or more counties may coordinate
				  planning and submit plans addressing a multi-county area so long as each
				  individual county plan identifies that county's proportion of the
				  budget.
1. New
					 section filed 10-8-93; operative 11-7-93 (Register 93, No.
					 41).
Note: Authority cited: Section
						1872.8,
						Insurance Code; CalFarm Insurance Company et al. v. Deukmejian, et al. (1989)
						48 Cal.3d 805, 824. Reference: Section
						1872.8,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 9 - Insurance Fraud › Article 4 - Program for Investigation and Prosecution of Automobile Insurance Fraud › Section 2698.64 - Funding Procedure

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				  Funding shall be in the form of a Grant Award Agreement and shall require an
				  enabling resolution by the county Board of Supervisors approving and
				  authorizing execution of the agreement.
(b) Subsequent to the initial grant award,
				  funding shall be distributed on a semi-annual basis, in July and January unless
				  otherwise specified and justified in the Request for Application by the
				  district attorney and contingent upon the adoption of each annual State Budget
				  Act and the collection of assessments.
(c) Any portion of distributed funds not used
				  for local program purposes at the termination of each annual funding cycle
				  shall be returned to the Insurance Fund to be reprogrammed for use in the
				  subsequent program year for local program purposes. Counties shall provide the
				  Department with an estimate of unused funds within sixty (60) days after the
				  termination of the program period and shall complete the transfer of funds back
				  to the Insurance Fund within thirty (30) days after the completion of the final
				  audit.
(d) A district attorney who
				  has undertaken investigations and prosecutions which will carryover into a
				  subsequent program year may carryover into the subsequent year distributed but
				  unused funds not exceeding twenty-five percent (25%) of the total annual
				  funding, provided that the district attorney files a written plan which
				  specifies and justifies to the Commissioner how those funds will be used at the
				  end of the program period and at the time of the subsequent application. In the
				  event that, due to extenuating circumstances, distributed funds exceeding
				  twenty-five percent (25%) of the previous total annual funding are unused, the
				  Commissioner shall consider and approve requests for carry-over of the unused
				  funds to the extent that the district attorney provides
				  justification.
1. New
					 section filed 10-8-93; operative 11-7-93 (Register 93, No.
					 41).
Note: Authority cited: Section
						1872.8,
						Insurance Code; CalFarm Insurance Company et al. v. Deukmejian, et al. (1989)
						48 Cal.3d 805, 824. Reference: Section
						1872.8,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 9 - Insurance Fraud › Article 4 - Program for Investigation and Prosecution of Automobile Insurance Fraud › Section 2698.65 - County Plan and Criteria for Distribution of Funds to the District Attorney Grantee

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
In order to be considered for funding, the local district
					 attorney must submit a plan outlining the projected and prior use of funds for
					 the purposes of the program. Funds assessed after January 1, 1993 shall be
					 distributed among these district attorneys who have submitted a plan. Seventy
					 percent (70%) of available funds will be distributed based on the applicant's
					 proportionate share of the state's population, twenty percent (20%) will be
					 distributed based on the applicant's proportionate share of the automobile
					 insurance suspected fraudulent claims submitted to the Fraud Division during
					 the prior three years and ten percent (10%) will be based on the Commissioner's
					 analysis of the County Plan. The plan must be submitted within the statutory
					 time-frame and must include the following elements:
(a) Problem Statement. A description of the
				  problem in the county, including how it arose, why it is important, its unique
				  aspects, if any, and what is needed to resolve the problem, including
				  supporting data, evidence, or indicators of fraudulent activity related to
				  automobile insurance.
(b)
				  Qualifications. A description of the applicant's experience in operating the
				  auto insurance fraud program using funds authorized under Section
				  1872.8 of
				  the Insurance Code since 1989 including:
(1)
				  The total amount of funds received by the local district attorney since
				  1989.
(2) The total amount expended
				  to support the district attorney's investigation and prosecution of auto
				  insurance fraud, including details of the following items:
(A) Personnel costs including salaries and
				  benefits.
(B) Operations expenses,
				  including space, equipment, travel and other expenses in support of the
				  program.
(3) The results
				  obtained through implementation of the program, including:
(A) The number of investigations initiated or
				  coordinated with other law enforcement agencies.
(B) The number of arrests and
				  convictions.
(C) The number of
				  indictments or complaints.
(D) A
				  comparison of the amounts originally claimed in cases determined to be
				  fraudulent compared to payments actually made.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 9 - Insurance Fraud › Article 4 - Program for Investigation and Prosecution of Automobile Insurance Fraud › Section 2698.66 - Budget Proposal

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The proposed budget forms the basis for program management
					 and audit and must be presented in line-item detail and cover a one year
					 program period from July through June. Annual budget levels shall be included
					 in the RFA. The budget may include a line item for an independent audit to be
					 completed at the end of each annual program period or as specified in the RFA.
					 The district attorney's budget shall include the following:
(a) Salaries and benefits computed at the
				  county salary and benefit schedule.
(b) Operation support costs.
(1) Estimated costs shall be listed by line
				  item.
(2) Itemized costs shall
				  conform to county policy regarding appropriateness of expenses.
(3) Allowable costs are those costs incurred
				  in direct support of local program activities, including program related
				  travel, equipment costs proportional to program-related use of the equipment,
				  facilities cost, expert witness fees and audits.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 9 - Insurance Fraud › Article 4 - Program for Investigation and Prosecution of Automobile Insurance Fraud › Section 2698.67 - District Attorney Reporting and Commissioner's Audit

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Each district attorney receiving funds pursuant to Section
					 1872.8
					 shall submit an annual report to the Commissioner regarding the local program
					 and its accomplishments. Failure to submit the annual report shall affect
					 subsequent funding decisions. The report shall include the following
					 items:
(a) An expenditure Report,
				  which shall include information for the following:
(1) Personnel: salaries and
				  benefits.
(2) Operations cost
				  breakdown.
(3) Explanation of any
				  significant variances from the county's plan as approved.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 9 - Insurance Fraud › Article 4 - Program for Investigation and Prosecution of Automobile Insurance Fraud › Section 2698.68 - Assessment of Annual Fee

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The fee imposed pursuant to California Insurance Code
					 Section
					 1872.81
					 shall be calculated and assessed in the same manner as set forth in Section
					 2698.62 of this Title and will be
					 paid in annualized increments of seven and one half cents ($.075) for each
					 calendar year quarter or any part thereof.
1. New
					 section filed 6-24-2002; operative 7-24-2002 (Register 2002, No.
					 26).
Note: Authority cited: Section
						1872.81,
						Insurance Code; CalFarm Insurance Company et al. v. Deukmejian, et al. (1989)
						48 Cal.2d 805, 824. Reference: Section
						1872.81,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 9 - Insurance Fraud › Article 5 - Organized Automobile Insurance Fraud Interdiction Program › Section 2698.71 - Annual Fee

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Each
				  insurer shall pay an annual fee of fifty cents ($.50) for each vehicle it
				  insures under a policy of insurance issued in this state. This annual fifty
				  cent fee shall be paid in increments of twelve and one-half cents ($.125) for
				  each quarter of a calendar year or any part thereof. The assessment shall be
				  made on a quarterly basis. The fee imposed pursuant to California Insurance
				  Code Section
				  1874.8
				  shall be calculated and assessed in the same manner as set forth in title 10
				  California Code of Regulations section
				  2698.62.
1. New
					 section filed 7-7-2000 as an emergency; operative 7-7-2000 (Register 2000, No.
					 27). A Certificate of Compliance must be transmitted to OAL by 11-6-2000 or
					 emergency language will be repealed by operation of law on the following
					 day.
2. Certificate of Compliance as to 7-7-2000 order, including
					 amendment of section, transmitted to OAL 10-12-2000 and filed 11-21-2000
					 (Register 2000, No. 47).
3. Amendment filed 12-26-2001 as an
					 emergency; operative 12-26-2001 (Register 2001, No. 52). A Certificate of
					 Compliance must be transmitted to OAL by 4-25-2002 or emergency language will
					 be repealed by operation of law on the following day.
4.
					 Reinstatement of section as it existed prior to 12-26-2001 emergency amendment
					 by operation of Government Code section
					 11346.1(f)
					 (Register 2002, No. 23).
5. Amendment filed 6-6-2002; operative
					 6-6-2002 pursuant to Government Code section
					 11343.4
					 (Register 2002, No. 23).
6. Amendment of subsection (a) and repealer
					 of subsections (b)-(e) filed 6-3-2005; operative 7-3-2005 (Register 2005, No.
					 22).
Note: Authority cited: Sections
						1874.8 and
						1874.81,
						Insurance Code. Reference: Section
						26500,
						Government Code; Sections
						1874.8,
						1874.81 and
						12995,
						Insurance Code; and Section
						670, Vehicle
						Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 9 - Insurance Fraud › Article 5 - Organized Automobile Insurance Fraud Interdiction Program › Section 2698.72 - Application Procedure and Contents

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The Commissioner shall designate a date
				  for the submission of an application requesting grant funding under this
				  program. Notice of the date for submission shall be mailed to each district
				  attorney at least 60 days before the date set for submission of an application.
				  Applications received after the date set for submission will not be considered
				  for funding.
(b) An application
				  shall include:
(1) a "strategic plan" as more
				  specifically described in section
				  2698.74.
(2) a "budget proposal" as more specifically
				  described in section
				  2698.75.
(3) a list of program contacts for the
				  applicant that shall include the name, position, business address, telephone
				  and fax number for each individual.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 9 - Insurance Fraud › Article 5 - Organized Automobile Insurance Fraud Interdiction Program › Section 2698.73 - Funding Procedure

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				  Funding of a grant shall be in the form of a grant award agreement. Each
				  applicant whose application has been approved for grant funding shall submit an
				  enabling resolution by the county Board of Supervisors approving and
				  authorizing execution of a grant award agreement.
(b) Distribution of grant award funds shall
				  be on a quarterly basis. Funding and dates of distribution shall be contingent
				  upon the adoption of an annual State Budget Act and the collection of
				  assessments. Funds to be distributed for the California Highway Patrol shall be
				  deposited in the motor vehicle account.
(c) Within 60 days after the end of each
				  funding cycle, a grantee shall provide the Department with an estimate of any
				  unexpended and/or unencumbered funds.
(d) A grantee who has undertaken
				  investigations and prosecutions which will carry-over into a subsequent funding
				  cycle may carry-over into the subsequent funding cycle distributed but unused
				  funds not exceeding twenty-five percent (25%) of the total funding cycle,
				  provided that the grantee files a written plan, at the end of the funding
				  cycle, which specifies and justifies to the Commissioner how those funds will
				  be used. In the event that, due to extenuating circumstances, distributed funds
				  exceeding twenty-five percent (25%) of the previous total funding cycle are
				  unused, the Commissioner may consider and approve requests for carry-over of
				  the unused funds to the extent that the grantee provides
				  justification.
1. New
					 section filed 7-7-2000 as an emergency; operative 7-7-2000 (Register 2000, No.
					 27). A Certificate of Compliance must be transmitted to OAL by 11-6-2000 or
					 emergency language will be repealed by operation of law on the following
					 day.
2. Certificate of Compliance as to 7-7-2000 order transmitted
					 to OAL 10-12-2000 and filed 11-21-2000 (Register 2000, No. 47).
3.
					 Repealer and new subsection (d) filed 4-16-2002 as an emergency; operative
					 4-16-2002 (Register 2002, No. 16). A Certificate of Compliance must be
					 transmitted to OAL by 8-14-2002 or emergency language will be repealed by
					 operation of law on the following day.
4. Certificate of Compliance
					 as to 4-16-2002 order transmitted to OAL 7-24-2002 and filed 8-28-2002
					 (Register 2002, No. 35).
Note: Authority cited: Sections
						1874.8 and
						1874.81,
						Insurance Code. Reference: Sections
						1872.8(b)(1),
						1874.8 and
						1874.81,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 9 - Insurance Fraud › Article 5 - Organized Automobile Insurance Fraud Interdiction Program › Section 2698.74 - Strategic Plan

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
A strategic plan shall include the following
					 elements:
(a) Table of
				  Contents.
(b) Problem Statement:
				  Each application shall include for the applicable county:
(1) A narrative description of the organized
				  automobile insurance fraud activity in the county, including any supporting
				  data, evidence, or indicators of fraudulent related activity.
(2) A description of the general criminal
				  activity, based upon the most recent California Crime Index Annual Report by
				  the California Attorney General.
(3) Population density, based upon the most
				  recent annual report compiled by the California Department of Finance,
				  Demographic Research Unit.
(4)
				  Automobile insurance claims frequency.
(5) Number of automobile fraud suspected
				  fraudulent claims reported to the Division during a 36-month period immediately
				  preceding the submission of the application.
(6) Evidence of prior and current organized
				  automobile insurance fraud activity.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 9 - Insurance Fraud › Article 5 - Organized Automobile Insurance Fraud Interdiction Program › Section 2698.75 - Budget Proposal

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) A
				  proposed budget shall be presented in line-item detail and cover each funding
				  cycle. The applicant's proposed budget shall include the following estimates:
(1) Salaries and benefits computed at the
				  county salary and benefit schedule. A current copy of the pertinent schedule
				  shall be submitted with the proposed budget.
(2) Support costs.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 9 - Insurance Fraud › Article 5 - Organized Automobile Insurance Fraud Interdiction Program › Section 2698.76 - Determination and Criteria for Awarding of Grants

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) In determining to award a grant under
				  this program, the Commissioner shall consider the information provided in an
				  application and may consider the recommendations and advice of the Fraud
				  Division and the Commissioner of the Highway Patrol.
(b) Priority shall be given to those grant
				  applications which, in the determination of the Commissioner, have the
				  potential to have the greatest impact on organized automobile insurance fraud
				  activity.
1. New
					 section filed 7-7-2000 as an emergency; operative 7-7-2000 (Register 2000, No.
					 27). A Certificate of Compliance must be transmitted to OAL by 11-6-2000 or
					 emergency language will be repealed by operation of law on the following
					 day.
2. Certificate of Compliance as to 7-7-2000 order transmitted
					 to OAL 10-12-2000 and filed 11-21-2000 (Register 2000, No.
					 47).
Note: Authority cited: Sections
						1874.8 and
						1874.81,
						Insurance Code. Reference: Sections
						1872.8(b)(1),
						1874.8(b) and
						(c) and
						1874.81(a),
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 9 - Insurance Fraud › Article 5 - Organized Automobile Insurance Fraud Interdiction Program › Section 2698.77 - Grant Reporting and Audit

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Each grantee shall submit annual reports
				  to the Commissioner covering the preceding funding cycle. The reports shall
				  consist of:
(1) An expenditure report, which
				  shall include:
(A) All operation
				  costs.
(B) Personnel: salaries and
				  benefits.
(C) Explanation of any
				  material variances from the proposed budget and strategic plan submitted with
				  the grant application.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 9 - Insurance Fraud › Article 6 - Law Enforcement Access to Insurance Claims Information › Section 2698.80 - Definitions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) "Claims
				  Analysis Bureau" (CAB) means a licensed, non-profit corporation, organized for
				  the purpose of fraud prevention or is a corporation that has made the filings
				  required by Section
				  1855.2 that receives, compiles and
				  transmits insurance claims information pursuant to California Insurance Code
				  (CIC) Sections
				  1875. 14.
(b) "Commissioner" means the Commissioner of
				  the Department of Insurance of the State of California.
(c) "Department" means the Department of
				  Insurance of the State of California.
(d) "Fraud Division" means the Department of
				  Insurance of the State of California Fraud Division, formerly known as the
				  Bureau of Fraudulent Claims.
(e)
				  "Insurance claims information" means any bodily injury, medical payment or
				  uninsured motorist claim made under a policy of automobile insurance.
(f) "Insurer" shall have the same meaning as
				  is given by CIC Section
				  1874.1.
(g) "Law Enforcement" shall have the same
				  meaning as is given by Penal Code Section
				  830.1,
				  830.32,
				  830.3,
				  830.8,
				  830.37 and
				  830.39 and
				  shall also include investigators for the Department of Consumer Affairs Bureau
				  of Automotive Repair.
(h) "Match
				  Report" or "Matched Claims Data Format" means the manner in which data is
				  provided to insurers by the Claims Analysis Bureau as a result of a match
				  between insurance claims information submitted by one insurer and information
				  previously submitted by another insurer.
(i) "Supplemental Information" means any
				  insurance claims information provided to the insurer after the initial
				  insurance claims information is filed.
1. New
					 article 6 (sections
					 2698.80-2698.86) and section filed
					 5-19-97; operative 6-18-97 (Register 97, No. 21).
2. Repealer of
					 article 6 (sections
					 2698.80-2698.86) and section and
					 new article 6 (sections
					 2698.80-2698.89.1) and section
					 filed 12-26-2006; operative 1-25-2006 (Register 2006, No.
					 52).
Note: Authority cited: Section
						1875.18(d)(2),
						Insurance Code. Reference: Section
						1875.18,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 9 - Insurance Fraud › Article 6 - Law Enforcement Access to Insurance Claims Information › Section 2698.81 - Prior Approval of Plan of Operation for Claims Analysis Bureau

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Every CAB shall
				  obtain the prior approval of a plan of operation as a CAB from the Insurance
				  Commissioner before it may perform any of the functions described in California
				  Insurance Code Section
				  1875.11.
(b) Every plan of operation as a CAB
				  submitted to the Insurance Commissioner for approval pursuant to Section
				  2698.81 shall:
(1) set forth written procedures and physical
				  controls to: prevent the unauthorized access to its system of records, to
				  prevent unauthorized disclosure of records and to prevent physical damage to or
				  destruction of records. At a minimum the administrative policies and procedures
				  and physical controls shall fully comply with the requirements set forth at
				  Section 2698.87(a)
				  (1)-(5);
(2) set forth written procedures regarding
				  the use of subcontractors to perform any function described in CIC 1875.11 (b).
				  At a minimum, such administrative policies and procedures and physical controls
				  shall fully comply with the requirements set forth at Section
				  2698.87(c)
				  (1)-(2).
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 9 - Insurance Fraud › Article 6 - Law Enforcement Access to Insurance Claims Information › Section 2698.82 - Deposit of Information to Claims Analysis Bureaus

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Insurers shall deposit insurance claims
				  information to a licensed insurance CAB within sixty (60) calendar days of
				  receipt of that insurance claims information.
(b) Any supplemental insurance claims
				  information provided to the insurer during the life of the claim shall be
				  reported within sixty (60) calendar days of receipt of that supplemental
				  insurance claims information.
(c)
				  No Claims Analysis Bureau shall charge any fee to any insurer for depositing
				  the information required by this section including supplemental insurance claim
				  information.
(d) The Commissioner
				  reserves the right to perform such audits as the Commissioner may deem
				  necessary to determine that appropriate insurance claims information is
				  deposited within the time frames specified in these regulations.
1. New
					 section filed 5-19-97; operative 6-18-97 (Register 97, No. 21).
2.
					 Repealer and new section filed 12-26-2006; operative 1-25-2006 (Register 2006,
					 No. 52).
3. Amendment of subsection (b) and NOTE filed 12-19-2007;
					 operative 1-18-2008 (Register 2007, No. 51).
4. Change without
					 regulatory effect amending subsection (d) filed 7-14-2021 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2021, No. 29). Filing deadline specified in Government
					 Code section
					 11349.3(a)
					 extended 60 calendar days pursuant to Executive Order
					 N-40-20.
Note: Authority cited: Section
						1875.18(d)(2),
						Insurance Code. Reference: Section
						1875.18,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 9 - Insurance Fraud › Article 6 - Law Enforcement Access to Insurance Claims Information › Section 2698.83 - Law Enforcement Access to Claims Analysis Bureau Insurance Claims Information

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				  Access to insurance claims information shall be made available to law
				  enforcement solely for the purpose of detection and investigation of insurance
				  fraud.
(b) No claims analysis
				  bureau shall charge any fee to any law enforcement agency for access to any
				  insurance claims information as defined in these regulations.
(c) A claims analysis bureau shall provide
				  insurance claims information in the form match report to law enforcement
				  entities within 10 calendar days of receipt of a complete and properly executed
				  written request for information.
(d) A written request by law enforcement
				  entities for insurance claims information shall contain the following
				  information:
(1) the specific insurance
				  claims information requested; and
(2) the identity of the requesting party
				  including contact information.