INSURANCE DEPARTMENT Arson and Insurance Fraud Reporting; Notice 2001-08 [31 Pa.B. 5508] This notice is issued to advise and remind insurers of their obligations under Pennsylvania law in the reporting of suspected arson and insurance fraud.
Arson and insurance fraud are recognized in Pennsylvania as serious crimes. Pennsylvania law explicitly requires insurer reporting of suspected arson (40 P. S. § 1610.3(b)(1)) and suspected insurance fraud (75 Pa.C.S. § 1817 and 18 Pa.C.S. § 4117) to a law enforcement agency for consideration of criminal investigation and prosecution. Pennsylvania 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 their 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 such 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.
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, Strawberry Square, Harrisburg PA 17120 by letter or via e-mail at ra-in-fraud@state.pa.us.
M. DIANE KOKEN,
Insurance Commissioner[Pa.B. Doc. No. 01-1787. Filed for public inspection September 28, 2001, 9:00 a.m.]
