CHAPTER 12. The Insurance Frauds Prevention Act [1871. - 1879.8.]

Chapter 12 added by Stats. 1989, Ch. 1119, Sec. 3.

§§ 1871–1879.8 · 87 sections

1. ARTICLE 1. False and Fraudulent Claims §§ 1871–1871.10 · 11 sections

   • § 1871 The Legislature finds and declares as follows: (a) The business of insurance involves many transactions that have the potential for abuse and illegal…
   • § 1871.1 Insurers and their agents, while they are investigating suspected fraud claims, shall have access to all relevant public records that are required to be open…
   • § 1871.2 (a) An insurer who, in connection with any insurance application, contract, or provision of contract, prints, reproduces, or furnishes a form to any person…
   • § 1871.3 (a) In the case of any claim arising from the theft of an insured vehicle, prior to the settlement of the claim, the insurer shall secure from the insured a…
   • § 1871.4 (a) It is unlawful to do any of the following: (1) Make or cause to be made a knowingly false or fraudulent material statement or material representation for…
   • § 1871.5 Any person convicted of workers’ compensation fraud pursuant to Section 1871.4 or Section 550 of the Penal Code shall be ineligible to receive or retain any…
   • § 1871.6 The provisions of Section 781 of the Penal Code are applicable to any prosecutions for violations of Section 1871.4. This section is declaratory of existing…
   • § 1871.7 (a) It is unlawful to knowingly employ runners, cappers, steerers, or other persons to procure clients or patients to perform or obtain services or benefits…
   • § 1871.8 An insurer or self-insured employer shall provide the following notice, in both English and Spanish, to an injured worker on or with a check for temporary…
   • § 1871.9 The department shall post all of the following information on its Internet Web site for each person, as defined in Section 19, convicted of a violation of this…
   • § 1871.10 It is unlawful to make or cause to be made a knowingly false or fraudulent material statement or material representation for the purpose of obtaining or…
2. ARTICLE 2. Bureau of Fraudulent Claims §§ 1872–1872.96 · 19 sections

   • § 1872 There is created within the department the Fraud Division to enforce the provisions of Sections 549, and 550 of the Penal Code, and to administer the…
   • § 1872.2 For purposes of this article, “insurer” means any person who undertakes to indemnify another against loss, damage, or liability arising from a contingent or…
   • § 1872.3 (a) If, by its own inquiries or as a result of complaints, the Fraud Division has reason to believe that a person has engaged in, or is engaging in, an act or…
   • § 1872.4 (a) Any company licensed to write insurance in this state that has determined, after the completion of the insurer’s special investigative unit investigation,…
   • § 1872.41 (a) An agent or broker who, before placing an insurance application with an insurer, reasonably suspects or knows that a fraudulent application is being made…
   • § 1872.45 A district attorney who files a criminal complaint pursuant to Section 549 or 550 of the Penal Code shall promptly do all of the following: (a) Notify each…
   • § 1872.5 No insurer, or the employees or agents of any insurer, shall be subject to civil liability for libel, slander, or any other relevant tort cause of action by…
   • § 1872.51 (a) An agent or broker who furnishes written or oral information pursuant to Section 1872.41, or an authorized governmental agency, or its employees, that…
   • § 1872.6 Nothing contained in this article shall: (a) Preempt the authority of other law enforcement or licensing agencies to investigate and prosecute suspected…
   • § 1872.8 (a) An insurer doing business in this state shall pay an annual special purpose assessment to be determined by the commissioner, but not to exceed one dollar…
   • § 1872.81 In addition to the special purpose assessment imposed pursuant to Section 1872.8, effective July 1, 2014, an insurer doing business in this state shall, until…
   • § 1872.83 (a) The commissioner shall ensure that the Fraud Division aggressively pursues all reported incidents of probable workers’ compensation fraud, as defined in…
   • § 1872.84 The commissioner shall ensure that the Fraud Division forwards to the appropriate disciplinary body, in addition to the names and supporting evidence of…
   • § 1872.85 (a) Every admitted disability insurer or other entity liable for any loss due to health insurance fraud doing business in this state shall pay an annual…
   • § 1872.86 (a) An insurer doing business in this state shall pay an annual special purpose assessment to be determined by the commissioner, not to exceed five thousand…
   • § 1872.87 (a) Each insurer required to pay special purpose assessments pursuant to Sections 1872.8, 1872.81, 1872.85, 1874.8, or subdivision (a) of Section 1872.86 may,…
   • § 1872.9 The Fraud Division shall annually compile and report, as a part of the commissioner’s annual report as required by Section 12922, the following information:…
   • § 1872.95 (a) Within existing resources, the Medical Board of California, the Board of Chiropractic Examiners, and the State Bar shall each designate employees to…
   • § 1872.96 The commissioner shall prepare an annual report, which shall be a public record, with respect to the receipts, expenditures, and activities of the Fraud…
3. ARTICLE 3. Insurance Fraud Reporting §§ 1873–1873.4 · 5 sections

   • § 1873 (a) Upon written request to an insurer by officers designated in subdivisions (a) and (b) of Section 830.1 and subdivision (a) of Section 830.2, and…
   • § 1873.1 Any information acquired pursuant to this article shall not be a part of any public record. Except as otherwise provided by law, any authorized governmental…
   • § 1873.2 In the absence of fraud or malice, no insurer, or any employee or agent authorized by an insurer to act on behalf of the insurer, and no authorized…
   • § 1873.3 (a) For purposes of this article and Article 2 (commencing with Section 1872), “insurance fraud” does not include motor vehicle theft and motor vehicle…
   • § 1873.4 Any or all information released or received by an authorized governmental entity pursuant to Section 1873 or 1873.1 shall be provided by that agency to the…
4. ARTICLE 4. Motor Vehicle Theft and Motor Vehicle Insurance Fraud Reporting §§ 1874–1874.8 · 7 sections

   • § 1874 This article shall be known and may be cited as the Motor Vehicle Theft and Motor Vehicle Insurance Fraud Reporting Act.
   • § 1874.1 The following definitions govern the construction of this article, unless the context requires otherwise: (a) “Authorized governmental agency” means the…
   • § 1874.2 (a) Upon written request to an insurer by an authorized governmental agency, an insurer or agent authorized by that insurer to act on behalf of the insurer,…
   • § 1874.3 (a) Any information acquired pursuant to this article shall not be a part of any public record. Except as otherwise provided by law, any authorized…
   • § 1874.4 In the absence of fraud or malice, no insurer, or agent authorized by an insurer to act on behalf of the insurer, and no authorized governmental agency or its…
   • § 1874.6 Every insurer shall report covered private passenger automobiles involved in theft and salvage total losses, including the vehicle identification number and…
   • § 1874.8 (a) Each insurer doing business in this state shall pay an annual special purpose assessment to be determined by the commissioner in an amount not to exceed…
5. ARTICLE 4.5. Insurer Inspections §§ 1874.85–1874.87 · 3 sections

   • § 1874.85 An insurer that issues automobile liability or collision policies shall inspect vehicles for which it has approved a claim for the cost of auto body repairs,…
   • § 1874.86 Each insurer subject to this article shall report, at the request of the commissioner, but not more than annually, to the department on the following: (a) The…
   • § 1874.87 (a) Each insurer subject to this article shall provide each insured with an Auto Body Repair Consumer Bill of Rights either at the time of application for an…
6. ARTICLE 4.6. Auto Insurance Fraud Crisis Areas § 1874.90 · 1 section

   • § 1874.90 The commissioner may declare any region of the state as an auto insurance fraud crisis area upon making a finding that auto insurance fraud is endemic to the…
7. ARTICLE 5. Arson Investigations §§ 1875–1875.8 · 8 sections

   • § 1875 As used in this chapter: (a) “Authorized agency” means any of the following officers or agencies, or their duly authorized representatives, when investigating…
   • § 1875.1 An authorized agency may, when there is evidence or suspicion that the crime of arson has been committed, request any insurer to release all information in its…
   • § 1875.2 If any insurer has reason to suspect that a fire loss was caused by incendiary means, the insurer shall furnish an authorized agency with all relevant…
   • § 1875.3 An authorized agency shall notify the insurer, if known, and at the expense of the insurer, whenever it has reason to believe that a fire loss was not…
   • § 1875.4 In the absence of fraud or malice, no insurer or person acting in its behalf who (a) furnishes information whether oral or written, pursuant to this article,…
   • § 1875.5 In any case in which an insurer willfully fails to comply with this article, the authorized agency may petition the superior court in an appropriate county for…
   • § 1875.6 Any authorized agency that receives any information furnished as required by this article shall not make the information public until the time that its release…
   • § 1875.8 (a) There is hereby created the Arson Information Reporting System to permit insurers, law enforcement agencies, fire investigative agencies, and district…
8. ARTICLE 5.5. Insurance Claims Analysis Bureaus §§ 1875.10–1875.18 · 9 sections

   • § 1875.10 The Legislature finds and declares as follows: (a) That the business of insurance involves many transactions which have potential for abuse and illegal…
   • § 1875.11 (a) No insurance claims analysis bureau shall conduct any operations in this state without first filing a written application with the commissioner and…
   • § 1875.12 (a) The commissioner may license an organization as an insurance claims analysis bureau if it meets the following qualifications: (1) Is a nonprofit…
   • § 1875.13 The commissioner shall license an insurance claims analysis bureau by class of claims, if an insurance claims analysis bureau makes application and is…
   • § 1875.14 An insurance claims analysis bureau shall perform the following functions: (a) Collect and compile information and data from members or subscribers concerning…
   • § 1875.15 (a) A licensed insurance claims analysis bureau shall develop rules governing the kind, quality, and frequency of data reporting, which shall be binding on all…
   • § 1875.16 Unless otherwise provided by law, any authorized entity which receives any information furnished pursuant to this article shall not release that information to…
   • § 1875.17 On or before May 1, 1992, and on or before May 1 of each year thereafter, any licensed insurance claims analysis bureau shall file with the department a report…
   • § 1875.18 (a) Every bodily injury, medical payment, or uninsured motorist claim made under a policy of automobile insurance shall be available, upon request, to law…
9. ARTICLE 5.6. Insurer Fraud Investigation §§ 1875.20–1875.24 · 5 sections

   • § 1875.20 Every insurer admitted to do business in this state, except those otherwise exempted in this code, shall provide for the continuous operation of a unit or…
   • § 1875.21 Insurers may maintain the unit or division required by this article using its employees or by contracting with others for that purpose.
   • § 1875.22 Insurers shall establish the unit or division required by this article no later than July 1, 1992.
   • § 1875.23 For purposes of this article, “unit or division” may include the assignment of fraud investigation to employees whose principal responsibilities are the…
   • § 1875.24 (a) If after examination, or upon the basis of other information, the commissioner has good cause to believe that an insurer to whom the provisions of this…
10. ARTICLE 6. Deposit of Automobile Insurance Claims Information §§ 1876–1876.5 · 4 sections

    • § 1876 Every insurer who receives a bodily injury, medical payment, or uninsured motorist claim made under a policy of automobile liability insurance defined in…
    • § 1876.3 Any information acquired pursuant to this article shall not be part of any public record except as follows: Except as otherwise provided by law, any authorized…
    • § 1876.4 No insurer, or the employees or agents of any insurer, shall be subject to civil liability for libel, slander, or any other tort cause of action arising from…
    • § 1876.5 As used in this article, “authorized governmental agency” and “insurer” have the same meaning as is given by Section 1874.1.
11. ARTICLE 7. Workers’ Compensation Insurance Fraud Reporting §§ 1877–1877.5 · 7 sections

    • § 1877 This article shall be known and may be cited as the Workers’ Compensation Insurance Fraud Reporting Act.
    • § 1877.1 The following definitions govern the construction of this article, unless the context requires otherwise: (a) “Authorized governmental agency” means the…
    • § 1877.2 For the purposes of this article, “authorized governmental agency” includes, in addition to the entities listed in subdivision (a) of Section 1877.1, any…
    • § 1877.3 (a) Upon written request to an insurer or a licensed rating organization by an authorized governmental agency, an insurer, an agent authorized by that insurer,…
    • § 1877.35 (a) The Public Employees’ Retirement System may request information from an insurer for any specific investigation of eligibility for, and unlawful application…
    • § 1877.4 (a) Any information acquired pursuant to this article shall not be a part of the public record. Except as otherwise provided by law, any authorized…
    • § 1877.5 No insurer, agent authorized by an insurer to act on its behalf, or licensed rating organization who furnishes information, written or oral, pursuant to this…
12. ARTICLE 8. Insurance Fraud Prevention §§ 1879–1879.8 · 8 sections

    • § 1879 The purpose of this article is to confront aggressively the problem of insurance fraud in this state by facilitating the detection of insurance fraud,…
    • § 1879.1 (a) The commissioner or their designated deputy commissioner may convene meetings with representatives of insurance companies or representatives of…
    • § 1879.3 The commissioner shall appoint supervisory and investigatory personnel within the bureau. In addition, the commissioner shall assign staff counsel who are…
    • § 1879.4 (a) The Chief of the Fraud Division and those investigators designated by him or her may expend funds to conduct undercover activities, employ civilian…
    • § 1879.5 (a) Any person who believes that a violation of this article has been or is being made may notify the department immediately after discovery of the alleged…
    • § 1879.6 The commissioner may adopt administrative regulations as he or she deems necessary for the effective implementation of this article.
    • § 1879.7 The commissioner shall report annually to the Legislature as to the activities of the department and the cost-effectiveness of the programs established…
    • § 1879.8 Nothing in this article shall be construed to preclude the applicability of any other provision of civil or criminal law that applies to any act committed or…