California Code of Regulations
Title 10 - Investment
Chapter 5 - Insurance Commissioner
Subchapter 9 - Insurance Fraud
Article 5 - Organized Automobile Insurance Fraud Interdiction Program
Section 2698.74 - Strategic Plan

Universal Citation: 10 CA Code of Regs 2698.74

Current through Register 2024 Notice Reg. No. 38, September 20, 2024

A strategic plan shall include the following elements:

(a) Table of Contents.

(b) Problem Statement: Each application shall include for the applicable county:

(1) A narrative description of the organized automobile insurance fraud activity in the county, including any supporting data, evidence, or indicators of fraudulent related activity.

(2) A description of the general criminal activity, based upon the most recent California Crime Index Annual Report by the California Attorney General.

(3) Population density, based upon the most recent annual report compiled by the California Department of Finance, Demographic Research Unit.

(4) Automobile insurance claims frequency.

(5) Number of automobile fraud suspected fraudulent claims reported to the Division during a 36-month period immediately preceding the submission of the application.

(6) Evidence of prior and current organized automobile insurance fraud activity.

(c) Qualifications: A description of the applicant's experience in prosecuting automobile insurance fraud which for the purpose of this section shall include economic auto theft cases, for a three-year period preceding the application. The applicant shall include in this section:

(1) The number of automobile insurance fraud investigations initiated and/or coordinated with the Fraud Division, California Highway Patrol and other law enforcement agencies.

(2) The number of automobile insurance fraud related complaints and/or indictments.

(3) The number of automobile insurance fraud related arrests and convictions.

(4) A statement of the amount of charged fraud from the investigations and prosecutions identified in item (1)-(3).

(5) The complexity of the investigations and prosecutions, including the number of claims directly related to such automobile insurance fraud investigation and prosecution.

(d) Program Strategy: A statement of program strategy shall include:

(1) Outreach: Descriptions of the manner in which the grantee will develop its caseload referrals, whether directly from the Fraud Division, California Highway Patrol and from other law enforcement agencies and/or insurers.

(2) The number and ratio of the applicant's investigators to attorney to be funded by the grant award which reflect the most effective use of those resources under a coordinated investigation and prosecution program.

(3) List of personnel, by position title and function, that will be funded in full or in part through a grant award, including descriptions of the qualifications of personnel to be assigned to the program and an organization chart identifying those positions.

(e) Program Coordination: A description of the manner in which each grantee plans to coordinate its efforts and work with the Fraud Division, the California Highway Patrol and other participating agencies and interested insurers.

(f) Management Plan: A detailed plan and schedule of the steps the grantee will complete in achieving the objectives of the program and a discussion of how the program staff will be organized and what internal quality control and budget monitoring procedures will be employed. This part shall also include how this program will be integrated with any other anti-fraud program(s) maintained within the grantee's office.

(g) Staff development: The plan for ongoing training of personnel in the prosecution of organized automobile insurance fraud. Staff development may be addressed through coordination with the Fraud Division, insurers, or other entities.

(h) Objectives: An outline of the applicant's program goals for each funding cycle of the grant period. Applicants must state how these goals will be achieved in coordination with the Fraud Division, the California Highway Patrol and other law enforcement agencies.

1. New section filed 7-7-2000 as an emergency; operative 7-7-2000 (Register 2000, No. 27). A Certificate of Compliance must be transmitted to OAL by 11-6-2000 or emergency language will be repealed by operation of law on the following day.
2. Certificate of Compliance as to 7-7-2000 order transmitted to OAL 10-12-2000 and filed 11-21-2000 (Register 2000, No. 47).

Note: Authority cited: Sections 1874.8 and 1874.81, Insurance Code. Reference: Sections 1874.8(b) and (c) and 1874.81(a)(3) and (5), Insurance Code.

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