The primary responsibility of the Special Investigative Unit (SIU) Compliance Review Office is to inspect insurance companies to ensure regulatory compliance with regard to the establishment, staffing and operation of the insurer's SIU. The Office also is responsible for updating, distributing, reviewing, monitoring and tracking the annual SIU compliance reports filed by over 1,100 insurance companies each year.
The majority of California licensed insurers are required by California Insurance Code Section 1875.20-24 and California Code of Regulations, Title 10, Section 2698.30-.43 to establish and maintain Special Investigative Units. Regulation also requires each insurance company to submit an annual compliance report to the Fraud Division, SIU Compliance Review Office. The SIU annual reports must provide adequate information and documentation regarding the insurer's anti-fraud operations, policies and procedures, and anti-fraud training. The SIU Compliance Review Office provides the format and instruction for submission of the reports and reviews, monitors and evaluates the completeness and timeliness of the reports filed annually. After completion of a review and evaluation of the insurers' reports filed annually, the SIU Compliance Review Office considers various risk-based criteria for proper selection of insurers for SIU review. The risk-based criteria include, but are not limited to:
- Prior SIU review history, including follow-up of audit findings and implemented recommendations;
- Possible deficiencies or areas of non-compliance identified during examination of annual SIU compliance reports;
- Quantity and quality of suspected insurance fraud (FD-1 and eFD-1) submissions;
- Insurance that is risky and susceptible to fraud, thus negatively impacting consumers, producers and insurers:
- Volume and nature of complaints received for a particular insurance company;
- Market share of the insurance carrier; and/or
- CDI executive directive.
During Fiscal Year 2010-11, the SIU Compliance Review Office audit staff conducted five on-site audits of primary insurance companies which included 20 subsidiary companies, for a total of 25 insurers. Of the 25 companies reviewed, five were authorized to write workers' compensation insurance in California. Two of the five primary companies reviewed were out of state and three were located in California.
You can contact the SIU Compliance Review Office at:
9342 Tech Center Drive, Suite 100
Sacramento, CA 95826
Phone: (916) 854-5760
Fax: (916) 255-3302