California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 9 - Insurance Fraud › Article 8 - Disability Insurance Fraud Assessment Grant Program › Section 2698.95.12 - Definitions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
For the purposes of these regulations:
(a) "Application" means the written document
				  submitted to the Commissioner by which a local district attorney requests
				  program funding, including a plan setting forth the district attorney's
				  intended use of funds to enhance investigation and prosecution of disability
				  insurance fraud.
(b) "Assessment"
				  means the surcharge collected from insurers and self-insured employers to
				  support the program to enhance investigation and prosecution of disability
				  insurance fraud.
(c) "Case" means
				  the file set up by the California Department of Insurance Fraud Division
				  (formerly, the Bureau of Fraudulent Claims), and/or district attorney in the
				  course of and for the purpose of investigation, development of evidence and
				  prosecution of individual or consolidated activities of suspected disability
				  insurance fraud.
(d) "Claim" means
				  the request for payment of disability benefits which has been submitted to an
				  insurer.
(e) "Commissioner" means
				  the Insurance Commissioner of the state of California.
(f) "County Plan" means the plan submitted to
				  the Commissioner as part of the application process by the local district
				  attorney which details the projected use of the funds sought pursuant to these
				  regulations.
(g) "Department" means
				  the California Department of Insurance.
(h) "District Attorney" means the prosecuting
				  officer of a California county jurisdictional district.
(i) "Fraud Division" or "Division" means the
				  California Department of Insurance Fraud Division, formerly known as the Bureau
				  of Fraudulent Claims. The former Bureau was designated a Division subsequent to
				  the original enactment of section
				  1872.85 of
				  the Insurance Code.
(j) "Funding
				  cycle" means a period of one fiscal year.
(k) "Grantee" means a grant-funded
				  applicant.
(l) "Incidental
				  Expenses", as used in Insurance Code section
				  1872.85(a),
				  means those costs incurred by the California Department of Insurance to
				  administer the program and may include reasonable costs for collection of
				  assessments, administrative support of the Fraud Division program component,
				  and management of the distribution and oversight of monies allocated to the
				  district attorneys.
(m) "Program"
				  means those activities conducted by the Department, or any other agency, which
				  are directed toward the enhanced investigation and prosecution of disability
				  insurance fraud and which require funding or administration through assessments
				  and the distribution of funds to the Fraud Division and to district
				  attorneys.
(n) "Insurer" shall have
				  the same meaning as used in Insurance Code section
				  23.
(o) "Regulations" means these regulations,
				  California Code of Regulations Title 10, Chapter 5, Subchapter 9, Article
				  8.
(p) "Suspected Fraudulent Claim"
				  means a claim which has been referred to the Division because the insurer
				  reasonably believes that the claim involves a person who has committed a
				  fraudulent act related to disability insurance.
1. New
					 section filed 11-3-2005; operative 12-3-2005 (Register 2005, No.
					 44).
Note: Authority cited: Section
						1872.85,
						Insurance Code; CalFarm Insurance Company, et al. v. Deukmejian, et al. (1989)
						48 Cal.3d 805 and 824. Reference: Section
						1872.85,
						Insurance Code.