CY2016 Anti-fraud Compliance Reporting
Effective March 27, 2003, Amendments to the DC Insurance Anti-fraud Law, DC Official Code § 22-3225.01 et seq.
A. Submission of a CY Annual Anti-fraud Statistical Activity Reporting Form
DC Official Code § 22-3225.12:
NOTE: NOT APPLICABLE, IF YOUR COMPANY WAS GRANTED AN EXEMPTION
(1) Current Filing Requirements: The 2003 amendment requires insurers to report annually to DISB’s Enforcement and Consumer Protection Division (ECPD) a summary of action taken under their anti-fraud plans to prevent and combat fraud for the District of Columbia Only.
(2) DC Form: The annual report should provide detailed information as prescribed on the reporting form.
(3) Captured Data: Annual reports under this section should cover anti-fraud activities for the previous calendar year (January 1 through December 31) for the District of Columbia Only.
(4) Filing Deadline: Reports are to be filed by March 31 of the upcoming year and cover the previous calendar year’s anti-fraud activities for the District of Columbia Only.
(5) Submit ONLY One Composite Report, Per NAIC Group: As the principal company, send one (1) report, which is a compilation of all your subsidiary companies within your same National Association of Insurance Commissioners (NAIC) group, by line of businesses as shown on the reporting form, if applicable. The reporting form should reflect only the total compilation of statistical numbers under the applicable header column for all Life, Health, P/C, WC, etc. for all your underwriting companies. That is, if underwriting company number one has two (2) cases, and underwriting company number two has four (4) cases, please enter the combined number of six (6) under the respective header column.
B. Submission of an Anti-fraud Plan, DC Official Code § 22-3225.09(a)
NOTE: NOT APPLICABLE, IF GRANTED AN EXEMPTION
This provision requires insurers to report an anti-fraud plan to ECPD only once, not annually, initially. For new insurers, please file, within six (6) months of the effective date of the issuance of the DC Certificate of Authority. However, if there are any significant changes made to your anti-fraud plan, please submit an updated anti-fraud plan to our office.
C. DC Point of Contact Person Form:
If there are changes made to your compliance or Special Investigation Unit (SIU) point of contact person(s) for the District of Columbia, please complete and submit an updated “DC Point of Contact Persons Form” only to our office. The form should contain your company’s compliance reporting representative and your SIU reporting representative responsible for the District of Columbia geographical area.
D. Reporting Forms of Suspected Insurance Fraud, DC Official Code § 22-3225.08(a)
This provision requires insurers to report action that constitutes the commission of insurance fraud to the ECPD. Please use the Uniform Suspected Insurance Fraud Reporting Form when reporting suspicious claims, or as part of your submission package for individual investigation cases. Please submit your referral form directly to [email protected]. For questions, call (202) 442-7109.
Please address all compliance inquiries or correspondence to the following:
Government of the District of Columbia
Department of Insurance, Securities and Banking
Enforcement and Consumer Protection Division
1050 First Street, NE, Suite 801
Washington, DC 20002
Office: (202) 727-8000
Email: [email protected]