The Fraud Unit is unable to adjust claims and will not act as a mediator in claims disputes. All referrals to the fraud unit will be handled as criminal investigations. The Fraud Unit will commence no investigation until a final decision has been made regarding payment or non-payment of the claim. Finally, a company should not threaten to refer a claim to the Fraud Unit solely to obtain an advantage in settlement negotiations or a civil matter.
Submit a Suspected Fraudulent Claim Report online today. Companies will need to supply any documents or evidence which support their beliefs that the act may be fraudulent.
Companies are required to be able to provide copies of documents showing that the claim was submitted and, if applicable, that payments were made to the claimant (i.e., claim form, settlement draft-front and back, etc.);
Supply copies of documents which support beliefs that the claim or act may be fraudulent. Highlight any specific details that should be brought to the Division's attention (i.e., false statements, altered figures, inconsistencies, etc.).
Please be certain to indicate whether a final determination has been made regarding payment or non-payment of the claim.
All original documents, along with the postmarked envelopes in which they were received, should be retained in the company's file. In some cases, it may be necessary for an investigator of the Fraud Division to have access to the entire claim file. In these instances, an official request either in writing or by telephone will be made by the Division to the appropriate company representative for the entire file.