California Code of Regulations
Title 10 - Investment
Chapter 5 - Insurance Commissioner
Subchapter 9 - Insurance Fraud
Article 2 - Special Investigative Unit
Section 2698.32 - SIU Staffing
Current through Register 2024 Notice Reg. No. 38, September 20, 2024
(a) Adequacy. The adequacy of an insurer's SIU staffing shall be determined by its demonstrated ability to establish, operate and maintain an SIU that is in compliance with these regulations. Factors that may be considered in staffing the SIU include, but not limited to, the number of policies written and individuals insured in California, number of claims received with respect to California insureds on an annual basis, volume of suspected fraudulent California claims currently being detected and other factors relating to the vulnerability of the insurer to insurance fraud.
(b) Knowledge. An SIU shall be composed of employees who have knowledge and/or experience in general claims practices, the analysis of claims for patterns of fraud, and current trends in insurance fraud, education and training in specific red flags, red flag events, and other criteria indicating possible fraud. They shall have the ability to conduct effective investigations of suspected insurance fraud and be familiar with insurance and related law and the use of available insurer related database resources.
1. New section
filed 9-4-2003 as an emergency; operative 9-4-2003 (Register 2003, No. 36). A
Certificate of Compliance must be transmitted to OAL by 1-2-2004 or emergency
language will be repealed by operation of law on the following day.
2.
New section refiled 1-2-2004 as an emergency; operative 1-3-2004. (Register 2004,
No. 1). A Certificate of Compliance must be transmitted to OAL by 5-3-2004 or
emergency language will be repealed by operation of law on the following
day.
3. New section refiled 5-4-2004 as an emergency; operative 5-4-2004
(Register 2004, No. 19). A Certificate of Compliance must be transmitted to OAL by
9-1-2004 or emergency language will be repealed by operation of law on the following
day.
4. Editorial correction of HISTORY 3 (Register 2004, No.
36).
5. New section refiled 9-1-2004 as an emergency; operative 9-1-2004
(Register 2004, No. 36). A Certificate of Compliance must be transmitted to OAL by
12-30-2004 or emergency language will be repealed by operation of law on the
following day.
6. New section refiled 12-28-2004 as an emergency;
operative 12-30-2004 (Register 2004, No. 53). A Certificate of Compliance must be
transmitted to OAL by 4-29-2005 or emergency language will be repealed by operation
of law on the following day.
7. New section refiled 4-29-2005 as an
emergency; operative 4-29-2005 (Register 2005, No. 17). A Certificate of Compliance
must be transmitted to OAL by 8-29-2005 or emergency language will be repealed by
operation of law on the following day.
8. Certificate of Compliance as
4-29-2005 order, including repealer and new section, transmitted to OAL 8-26-2005
and filed 10-7-2005 (Register 2005, No. 40).
Note: Authority cited: Sections 1875.24, 1879.5 and 1879.6, Insurance Code; Calfarm Ins. Co. v. Deukmejian (1989) 48 Cal.3d. 805, 824, 258 Cal. Rptr. 161, 771 P.2d 1247; Credit Ins. Gen. Agents Assn. v. Payne (1976) 16 Cal.3d 651, 656, 128 Cal. Rptr. 881, 547 P.2d 993; and Garris v. Carpenter (1939) 33 Cal. App. 2d. 649, 653, 92 P.2d 688. Reference: Sections 1875.20, 1875.21, 1875.24, 1879.5, 12921(a) and 12926, Insurance Code.
