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Reporting Suspected Fraud in PA

The Pennsylvania Insurance Department recently issued a bulletin regarding fraud reporting.  Entitled “Arson and Insurance Fraud Reporting; Notice 2016-04,” the DOI notice sought to “advise and remind” insurers regarding the reporting of suspected arson and insurance fraud.

Reporting FraudPennsylvania law expressly mandates that insurers report suspected arson and suspected insurance fraud to a law enforcement agency.  Meanwhile, insurers enjoy immunity for their good faith fraud reporting.

Some additional, important points, include:

  • Insurers are to make a written report to law enforcement agency (federal, state or local).  Insurers may also report electronically to the NICB.
  • An insurer’s entry of the suspected fraud into a claims database does not satisfy the statutory obligation to report to law enforcement.
  • Examination of fraud control programs will include review of arson and fraud determinations and confirmation of the insurer’s written reporting to a law enforcement.

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