Fraud Claims and Forms
Suspected Fraudulent Claims (SFCs)
The Fraud Division has established a method for insurers to report suspected insurance fraud. It is important to know that notification of insurance fraud may be made anonymously. You may contact any of the Fraud Division Regional Offices directly responsible for your county. Other types of complaints may be directed to the Department's Consumer Services Division. For further information about the Fraud Division and its programs, visit the Fraud Division's home page.
The Insurance Code states that no insurer, or the employees or agents of any insurer, shall be subject to civil liability for libel, slander or any other relevant cause of action by virtue of providing information concerning a Suspected Fraudulent Claim (SFC) to law enforcement, including the California Department of Insurance, Fraud Division.
There have been some minor upgrades to our intake process that will allow us to email the initial status letters to a referring Special Investigative Unit (SIU). The Fraud Division receives on average 27,000 referrals each year across all fraud programs. Until recently, the process required the Fraud Division to print and mail the initial status letters to the referring SIU. The letter will now be sent to the email address that is provided on the FD-1 or eFD1. If no email address is provided, the letter will be mailed.
Suspected Fraudulent Claim Form (electronic eFD-1)
To register or access the Electronic eFD-1s on a Continual Basis (i.e. Insurers, TPAs, Self-Insureds)
As of October 1, 2018, the Fraud Division released a new eFD-1 company portal.
Key information regarding the transition to the new company portal follows:
- On or after October 1, 2018, current eFD-1 company portal users will need to login with their current User ID and password. Once in, the system will ask you to reset your password. Please check your profile and set your security questions.
- After accessing the new portal, please verify/review your company information and report any discrepancy by emailing ElectronicSubmissionFDfirstname.lastname@example.org.
- Please verify/review the authorized companies that are authorized to submit referrals on your behalf in the new company portal.
- Unregistered companies must register at this time for the new company portal. All referrals must be submitted electronically.
- Referrals by mail will no longer be accepted.
Instructions -Reporting Suspected Fraudulent Insurance Claims (Revised: August 2018)
Consumer Insurance Fraud Reporting Form
The California Department of Insurance has developed a method for members of the general public to report cases of suspected insurance fraud. As noted in California Insurance Code section 1879.5, no person shall be subject to civil liability for filing a good faith report of suspected insurance fraud to the Department of Insurance. You may report online by clicking the link below.