California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 9 - Insurance Fraud › Article 2 - Special Investigative Unit › Section 2698.32 - SIU Staffing

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				  Adequacy. The adequacy of an insurer's SIU staffing shall be determined by its
				  demonstrated ability to establish, operate and maintain an SIU that is in
				  compliance with these regulations. Factors that may be considered in staffing
				  the SIU include, but not limited to, the number of policies written and
				  individuals insured in California, number of claims received with respect to
				  California insureds on an annual basis, volume of suspected fraudulent
				  California claims currently being detected and other factors relating to the
				  vulnerability of the insurer to insurance fraud.
(b) Knowledge. An SIU shall be composed of
				  employees who have knowledge and/or experience in general claims practices, the
				  analysis of claims for patterns of fraud, and current trends in insurance
				  fraud, education and training in specific red flags, red flag events, and other
				  criteria indicating possible fraud. They shall have the ability to conduct
				  effective investigations of suspected insurance fraud and be familiar with
				  insurance and related law and the use of available insurer related database
				  resources.
1. New
					 section 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					 emergency language will be repealed by operation of law on the following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.
2. New section 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					 transmitted to OAL by 5-3-2004 or emergency language will be repealed by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.
3. New section 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					 language will be repealed by operation of law on the following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.
4. Editorial correction of HISTORY 3 (Register 2004, No.
					 36).
5. New section 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.
6. New section 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.
7. New section 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.
8. Certificate of Compliance
					 as 4-29-2005 order, including repealer and new section, transmitted to OAL
					 8-26-2005 and filed 10-7-2005 (Register 2005, No.
					 40).
Note: Authority cited: Sections
						1875.24,
						1879.5 and
						1879.6,
						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; and Garris v. Carpenter
						(1939) 33 Cal. App. 2d. 649, 653, 92 P.2d 688. Reference: Sections
						1875.20,
						1875.21,
						1875.24,
						1879.5,
						12921(a)
						and
						12926,
						Insurance Code.