California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 9 - Insurance Fraud › Article 2 - Special Investigative Unit › Section 2698.35 - Detecting Suspected Insurance Fraud

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) An insurer's integral anti-fraud
				  personnel are responsible for identifying suspected insurance fraud during the
				  handling of insurance transactions and referring it to the SIU as part of their
				  regular duties.
(b) The SIU shall
				  establish, maintain, distribute, and monitor written procedures to be used by
				  the integral anti-fraud personnel to detect, identify, document, and refer
				  suspected insurance fraud to the SIU. The written procedures shall include a
				  listing of the red flags to be used to detect suspected insurance fraud for the
				  insurer. The red flags listed pursuant to the immediately preceding sentence
				  shall be specific to each line of insurance, or each insurance product,
				  transacted in or issued by the insurer.
(c) The procedures for detecting suspected
				  insurance fraud shall provide for comparison of any insurance transaction
				  against red flags and other criteria that may indicate possible
				  fraud.
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					 emergency language will be repealed by operation of law on the following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					 transmitted to OAL by 5-3-2004 or emergency language will be repealed by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					 language will be repealed by operation of law on the following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					 transmitted to OAL by 12-30-2004 or emergency language will be repealed by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).
9. Amendment
					 of subsections (b) and (c) and repealer of subsections (c)(1)-(c)(5) filed
					 7-30-2020; operative 10-1-2020 (Register 2020, No.
					 31).
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.