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CA Department of Insurance

Resources, Publications, and Links

The Fraud Division has established a method for insurers, Third Party Administrators (TPA's), and self insureds to report suspected insurance fraud.  It is important to know that notification of insurance fraud may be made anonymously.

Suspected Fraudulent Claims

Electronic Suspected Fraudulent Claim (eFD-1) Home Page to submit and amend Electronic Suspected Fraudulent Claims (eFD-1's).

Printable Suspected Fraudulent Claim (SFC) Referral Form (FD-1)

Instructions - Reporting Suspected Fraudulent Insurance Claims Revised:  January 2008)

FD-1 Referral Form - (Revised:  January 2008)

Completed FD-1 forms and any attachments are to be mailed to the following address:

California Department of Insurance
Enforcement Branch Headquarters
Intake Unit
9342 Tech Center Drive, Ste. 100
Sacramento, CA 95826

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.

Consumer Insurance Fraud Reporting Form

Completed Consumer Insurance Fraud Forms are to be mailed to the following address:

California Department of Insurance
Enforcement Branch Headquarters Intake Unit
9342 Tech Center Drive, Ste. 100
Sacramento, CA 95826

It is important to know that notification of insurance fraud may be made anonymously.  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, in good faith, concerning a suspected fraudulent claim to law enforcement, including the California Department of Insurance Fraud Division.

You may also contact any of the Fraud Division Regional Offices directly responsible for your county.

For General Inquiries

For general questions or inquiries only, please use the our Contact Us Form. The Contact Us Form should not be used by agents or brokers.

Or

Call our Consumer Hotline:
800-927-4357 (HELP) or 213-897-8921
800-482-4TDD telecommunication device for the deaf
Telephone lines are open from 8:00 am to 5:00 pm, Monday through Friday, excluding holidays

Or

Write:
California Department of Insurance
300 South Spring Street, South Tower
Los Angeles, CA 90013

Or

Visit in person at 300 South Spring Street, South Tower, 9th floor
Los Angeles, CA 90013
Office Hours:  Monday through Friday, 8:00 am to 5:00 pm, excluding holidays

Or

Call your local Investigation Division Regional Office.
Address and phone numbers can be found on the Regional Office page

Program Regulations

Program for Investigation and Prosecution of Workers' Compensation Insurance
Fraud Regulations

Program for Investigation and Prosecution of Automobile Insurance Fraud Regulations

Organized Automobile Insurance Fraud Interdiction Program Regulations

Disability Insurance Fraud Assessment Grant Program Regulation

Special Investigative Unit (SIU) Compliance Review Program
9342 Tech Center Drive, Suite 100
Sacramento, CA 95826
Phone: 916-854-5760
siu-compliancereport@insurance.ca.gov
Fax: 916-255-3202

Special Investigative Unit Regulations
Effective October 07, 2005

Special Investigative Unit Compliance Requirements
A 43 slide presentation.  It may take a minute or two to load.

Electronic Special Investigative Unit (SIU) Annual Report
One requirement of insurance companies doing business in California is that they must submit an annual SIU Compliance Report.  Beginning in 2012, companies can now complete and submit this report online.

Local Assistance - District Attorney Program Report
Under the direction of the Insurance Commissioner of the State of California, the California Department of Insurance (CDI) administers the grant programs and the distribution of funds for enhanced investigation and prosecution of insurance fraud by local district attorneys.

The District Attorney Program Report allows district attorneys to complete the online District Attorney Program Reports (DAR), also known as Form 7.  The online reporting is available for the following insurance fraud programs:

  • Automobile Insurance Fraud
  • Disability and Health Care
  • Organized Automobile Fraud Activity Interdiction (Urban)
  • Workers' Compensation

Additionally, this site also provides access to the Request-For-Application (RFA) and its attachments, Frequently Asked Questions, Contact Information, and a variety of other helpful information.

The Department periodically releases statements and other information to the media.  The following link catalogs, by year or subject, what has been released. Press Releases

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.

In Fiscal Year 2007-08, the Department contracted with the Regents of the University of California through the University of California at Berkeley to conduct an extension of research that was previously funded by the California Commission on Health and Safety and Workers' Compensation. The research titled "The Fraud in Workers' Compensation Payroll Reporting Study" analyzed the degree to which employers under-report or misreport payroll for workers' compensation insurance purposes. This research study was presented to the Fraud Assessment Commission in January 2009.

The report concluded that in the year 2005 alone, under-reported insurance premiums ranged from $2.09 billion to $2.87 billion. Furthermore, the report indicates that several high-risk employers have fraudulently misreported their workers in high-risk/high-premium classes as earning wages in lower-risk occupations, accounting as much as 40 to 60 percent of payroll.

A research study, commissioned by the Fraud Assessment Commission, to determine the extent of medical overpayments and underpayments, was completed in June 2008. The results of this study, the first to measure medical payment accuracy in California, quantify what the experts in workers' compensation fraud detection have known for some time: medical provider fraud is one of the primary cost drivers that inflate the cost of claims and insurance premiums. That is why this area of workers' compensation insurance fraud has been given one of the highest priorities in Fraud Division investigations.

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