§ 155.23 — Fraud reporting

Illinois § 155.23

• Jurisdiction: Illinois
• Topic: REGULATION
• Ch. 215: INSURANCE
• Act 215 ILCS 5/: Illinois Insurance Code.
• Art.: Article IX - Provisions Applicable To All Companies

Text

(1) The Director is authorized to promulgate reasonable rules requiring insurers, as defined in Section 155.24, doing business in the State of Illinois to report factual information in their possession that is pertinent to suspected fraudulent insurance claims, fraudulent insurance applications, or premium fraud after he has made a determination that the information is necessary to detect fraud or arson. Claim information may include: (a) Dates and description of accident or loss. (b) Any insurance policy relevant to the accident or loss. (c) Name of the insurance company claims adjustor and claims adjustor supervisor processing or reviewing any claim or claims made under any insurance policy relevant to the accident or loss. (d) Name of claimant's or insured's attorney. (e) Name of claimant's or insured's physician, or any person rendering or purporting to render medical treatment. (f) Description of alleged injuries, damage or loss. (g) History of previous claims made by the claimant or insured. (h) Places of medical treatment. (i) Policy premium payment record. (j) Material relating to the investigation of the accident or loss, including statements of any person, proof of loss, and any other relevant evidence. (k) any facts evidencing fraud or arson. The Director shall establish reporting requirements for application and premium fraud information reporting by rule. (2) The Director of Insurance may designate one or more data processing organizations or governmental agencies to assist him in gathering such information and making compilations thereof, and may by rule establish the form and procedure for gathering and compiling such information. The rules may name any organization or agency designated by the Director to provide this service, and may in such case provide for a fee to be paid by the reporting insurers directly to the designated organization or agency to cover any of the costs associated with providing this service. After determination by the Director of substantial evidence of false or fraudulent claims, fraudulent applications, or premium fraud, the information shall be forwarded by the Director or the Director's designee to the proper law enforcement agency or prosecutor. Insurers shall have access to, and may use, the information compiled under the provisions of this Section. Insurers shall release information to, and shall cooperate with, any law enforcement agency requesting such information. In the absence of malice, no insurer, or person who furnishes information on its behalf, is liable for damages in a civil action or subject to criminal prosecution for any oral or written statement made or any other action taken that is necessary to supply information required pursuant to this Section.

Legislative History

(Source: P.A. 92-233, eff. 1-1-02.)