State Regulators, Insurers Streamline Fraud Reporting Process

Insurance regulators and the insurance industry have joined together to help streamline the reporting process for suspicious insurance claims. Participants say the new process will eliminate duplicate filing when reporting possible fraud in a filed insurance claim

Under the new reporting process, insurers can now file a single report directly to multiple state insurance departments and the National Insurance Crime Bureau (NICB)/ ISO (Insurance Services Office). Reports filed with the NICB/ISO Fraud Bureau Reporting Program will now also be filed with the National Association of Insurance Commissioners’ (NAIC) Online Fraud Reporting System (OFRS).

Most state insurance regulators mandate that insurance companies directly report suspected fraudulent or suspicious activities in a filed insurance claim. Beginning today, 47 states will accept reports either through the NAIC OFRS or via a direct system connection from NICB/ISO. ISO ClaimSearch provides the reporting system used by NICB and its member companies.

“Addressing insurance fraud is an important step in reducing costs and protecting both consumers and insurers,” said Jane L. Cline, NAIC president and West Virginia insurance commissioner. “The more data state insurance departments receive, the further we can go in eliminating insurance fraud.”

“This agreement saves insurance companies and fraud investigators time and improves investigative resources for state fraud bureaus,” said Sandy Praeger, chair of the NAIC Antifraud Task Force and Kansas insurance commissioner. “We are already receiving twice as many fraud referrals from property and casualty insurers now that NICB/ISO members are providing reports to the NAIC OFRS system.”

The NICB and ISO expect to provide the NAIC OFRS with approximately 80,000 reports of suspected fraud per year.

“This expansion of NICB’s Fraud Bureau Reporting Program, in cooperation with the NAIC and state fraud bureaus, brings us closer to offering a single system where the insurance industry can report suspected fraud and get the data in the hands of people that can make a difference,” said Joe Wehrle, NICB president and CEO.

There is no cost to the state insurance departments when suspected fraud is reported through the NAIC OFRS system.

Consumers are encouraged to report any suspicions of insurance fraud to their state insurance regulators by visiting https://eapps.naic.org/ofrs/.

Sources: ISO, NAIC, NICB