You Must Know how to Comply with the California SIU Regulations that are Effective October 1, 2020
New Regulations to Enforce Statutes Requiring Insurers To Maintain A Special Investigative Unit
I have completed a resource for everyone involved in the insurance industry in the state of California to enable them to comply with the newly revised California SIU Regulations since the revisions add much to the obligations of insurers doing business in California.
The new book: California SIU Regulations 2020 a book explaining the revised SIU Regulations is now available from Amazon.com here.
The following is from the table of contents explaining what is contained in the book:
The SIU Regulations; Fraud Division; California SIU Regulations; The SIU Investigator; Full Text And Commentary On Special Investigative Unit Regulations; Identifying Insurance Fraud; The Insurance Frauds Prevention Act — Full Text; Outline For Training Of Integral Anti-Fraud Personnel; Property Insurance Fraud Red Flags; Red Flags Of Fraud At Time Policy Is Acquired; Red Flags Of Fraud Associated With The Insured; Red Flags Of Fraud — Personal Injury Fraud; Red Flags Of Fraud — Premiums; Red Flags Of Fraud — Vehicle; Red Flags Of Fraud — Occupation; Red Flags Of Fraud — Personal Demeanor; Red Flags Of Fraud — Timing Of Visit; Red Flags Of Fraud; How To Make A Fake Appraisal; Plan For Document Recording & File Retention Insurance Company; And Forms.
The book is designed to assist California insurance claims personnel, claims professionals, independent insurance adjusters, special fraud investigators, private investigators who work for the insurance industry, the management in the industry, the attorneys who serve the industry, and all integral anti-fraud personnel working with California admitted insurers who must comply with the requirements of the California SIU Claims Regulations that were rewritten and made operative October 1, 2020.
The state of California, by statute, requires all admitted insurers to maintain a Special Investigative Unit (an “SIU”). The SIU must comply with the requirements set forth in the Special Investigative Unit Regulations (the “SIU Regulations”) and train all integral anti-fraud personnel to recognize indicators of insurance fraud.
It is necessary, therefore, that insurance personnel who are engaged in any way in the presentation, processing, or negotiation of insurance claims in California to be familiar with the SIU Regulations. The state has imposed on all claims personnel duties to deal with insurance fraud if the insurers are doing business in the state. California licensed insurers are required by California Insurance Code Sections 1875.20-24 and California Code of Regulations, Title 10, Sections 2698.30 -.41 to establish and maintain Special Investigative Units that identify and refer suspected insurance fraud to the California Department of Insurance (CDI) and directly to the local California County District Attorney’s Office for workers’ compensation only.
The regulations also require each insurer to submit an SIU Annual Report to CDI which provides important information regarding the insurer’s SIU anti-fraud operations, procedures, and training material. The SIU Compliance Review Program evaluates the accuracy, completeness, and timeliness of the report. The reports are used to conduct a risk assessment to help determine which insurers are selected for SIU compliance review. Risk criteria includes, but is not limited to:
- Prior SIU compliance review finding(s), as well as follow up on recommendations and corrective action compliance plans;
- Discrepancies and/or non-compliance issues identified by analyzing the SIU Annual Report;
- Quantity and/or quality of suspected insurance fraud referrals to CDI, known as eFD-1s, FD-1s, or SFCs and referrals to California County District Attorneys’ Offices for workers’ compensation only;
- lines of insurance that are relatively risky and susceptible to fraud;
- Nature and/or quantity of complaints received against a particular insurer;
- Market share of the insurer;
- Late or no response to written information demand letters from CDI or other authorized governmental agencies (e.g., district attorneys); and
- CDOI executive directive.
By following the training recommendations in the book insurers can inoculate themselves against the potential for paying enormous fines to the CDOI for failure to fully comply with the amended SIU Regulations.
The Appendices include outlines to be used by a staff member of the insurance company SIU, its trainers, educators, or lawyers to present a training class for all of the “integral anti-fraud personnel” of the insurers as defined by the SIU Regulations.
Insurers must understand that every claims employee must be trained in accordance with the requirements of the SIU Regulations no later than 30 days after the person is hired and annually thereafter.
As it is not economically reasonable to train one new employee California SIU Regulations 2020 cam provide the needed training without the additional expense of a training class for one or two persons.
California SIU Regulations 2020, and its appendices, will provide the insurer and its staff with the information needed to comply with the SIU Regulations and will provide the training required for what the SIU Regulations describe as one of the insurer’s “integral anti-fraud personnel.”
The book is available as a Kindle book and as a paperback at amazon.com.
© 2020 – Barry Zalma
Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He also serves as an arbitrator or mediator for insurance related disputes. He practiced law in California for more than 44 years as an insurance coverage and claims handling lawyer and more than 52 years in the insurance business. He is available at http://www.zalma.com and email@example.com.
Mr. Zalma is the first recipient of the first annual Claims Magazine/ACE Legend Award.
Over the last 52 years Barry Zalma has dedicated his life to insurance, insurance claims and the need to defeat insurance fraud. He has created the following library of books and other materials to make it possible for insurers and their claims staff to become insurance claims professionals.
Read posts from Barry Zalma at https://parler.com/profile/Zalma/posts