Arson and Insurance Fraud Reporting; Notice 2016-04 [46 Pa.B. 2251]
[Saturday, April 30, 2016]This notice is issued to advise and remind insurers of their obligations under Commonwealth law in the reporting of suspected arson and insurance fraud, as well as to advise licensees that they are permitted to file reports of suspected arson or insurance fraud electronically with the National Insurance Crime Bureau.
Arson and insurance fraud are recognized in this Commonwealth as serious crimes. Commonwealth law explicitly requires insurer reporting of suspected arson (section 3(b)(1) of the Arson Reporting Immunity Act (40 P.S. § 1610.3(b)(1))) and suspected insurance fraud (75 Pa.C.S. § 1817 and 18 Pa.C.S. § 4117 (relating to reporting of insurance fraud; and insurance fraud)) to a law enforcement agency for consideration of criminal investigation and prosecution. Commonwealth law provides immunity to encourage and protect persons in that reporting. Accordingly, the Insurance Department (Department) releases the following guidance to insurers seeking to meet their statutory obligation for reporting of suspected arson and insurance fraud:
1. Each insurer has the burden of determining through investigation when the probable cause of a fire loss is arson or when a reasonable basis exists to believe that insurance fraud has occurred, is occurring or is to occur.
2. Upon reaching a determination, insurers will, within 30 days, make a written report of the suspected arson or insurance fraud to a Federal, State or local criminal law enforcement agency. Intead of making a written report, insurers are authorized to file reports electronically directly to the National Insurance Crime Bureau to satisfy their obligations under the law.
3. An insurer's entry of the suspected arson or suspected insurance fraud matter to a claims database or other information system serving the insurance industry will not in and of itself be viewed by the Department as satisfying that insurer's statutory obligation to report suspected arson or insurance fraud to a criminal law enforcement agency.
4. Examination of insurer fraud control programs will include a review of insurer determination of suspected arson and insurance fraud, and a confirmation of the insurer's written reporting to a criminal law enforcement agency.
Questions regarding this notice may be addressed to the Chief, Anti-fraud Compliance Division, Bureau of Enforcement, Insurance Department, 12th Floor, Straw- berry Square, Harrisburg, PA 17120, ra-in-fraud@state.pa.us.
This notice supersedes the notice published at 37 Pa.B. 6364 (December 1, 2007).
TERESA D. MILLER,
Insurance Commissioner[Pa.B. Doc. No. 16-761. Filed for public inspection April 29, 2016, 9:00 a.m.]
