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CA Department of Insurance

SIU Compliance Office

SIU Compliance Review Program

The primary responsibility of the California Department of Insurance (CDI) Special Investigative Unit (SIU) Compliance Review Program is to audit insurers and to evaluate regulatory and statutory compliance regarding the establishment, maintenance and operation of the insurer's SIU program. The Compliance Review Program also distributes, monitors, and evaluates the SIU Annual Reports filed by approximately 1,100 insurers each year. For more information, please use the links below.


California licensed insurers are required by California Insurance Code Sections 1875.20-24 and California Code of Regulations, Title 10, Sections 2698.30 -.43 to establish and maintain Special Investigative Units that identify and refer suspected insurance fraud to CDI (and the 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);
  • CDI executive directive.

For questions regarding California SIU compliance requirements, please contact:

SIU Compliance Review Program
California Department of Insurance, Fraud Division
9342 Tech Center Drive, Suite 100
Sacramento, CA 95826
Phone: (916) 854-5760


Workers' Compensation Insurance Special Investigative Unit Guidelines and
Protocols

The Fraud Division of the California Department of Insurance, Enforcement Branch is pleased to offer insurers and employers the latest version of Workers' Compensation Insurance Special Investigations Unit Guidelines
and Protocols
.  The manual is intended to provide general guidelines for employees assigned with anti-fraud responsibility.  It is not intended to change any current reporting requirements.  Use of the material is strictly voluntary.  The California Department of Insurance offers these Guidelines and Protocols as an educational and training tool. 

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