DC CY
YEAR
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Annual Anti−Fraud Statistical Report
Company Name:
*
NAIC Number:
*
NAIC Group Number:
*
If none enter "0"
Group reporting
− If you need additional space, please submit a separate sheet in Word format to:
betty.bates@dc.gov
NAIC Underwriting Company Names And NAIC Numbers:
*
#
Auto
P/C
Life
Health
Worker's
Comp
Totals
1
Number of claims received
2
Number of suspected cases accepted by SIU (Totals)
2a
Number of application fraud cases referred to SIU
2b
Number of claim fraud cases referred to SIU
2c
Number of premium avoidance cases referred to SIU
3
Number denied, dropped or mitigated w/ SIU Invest
4
Number cases referred to DISB Fraud Bureau
5
Number referred to nonprofit agency (NICB, NHCAA)
6
Number referred to law enforcement (DCMPD, FBI, etc.)
7
Number of arrests
8
Number of convictions
9
Dollar amount of restitution/fines by SIU/Company
10
Number of Civil/Criminal Prosecutions (Totals)
10a
Claimant/Insured
*
10b
Provider (Medical, Legal, Other)
*
10c
Internal (Agent/Broker)
*
11
Amount of money not paid because of SIU activities
Notations/Explanations (Optional as determined by insurer):
SURVEY COMPLETED BY:
Name:
*
Position:
*
Phone:
*
Email:
*
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