Current through Register Vol. XLI, No. 38, September 20, 2024
3.1. All persons
identified in W. Va. Code §
33-41-5(a)
shall report in writing all suspected fraudulent insurance acts to the Insurance
Fraud Unit.
3.2. The report shall be
filed with the Insurance Fraud Unit within fourteen (14) days of the determination
by the reporter that a suspected fraudulent insurance act has been
committed.
3.3. When a suspected
fraudulent insurance act is reported, the following information, if known, shall be
reported to the Insurance Fraud Unit:
a. Date of
preparation of the report.
b. The
following information about the reporting insurance company:
1. Name of insurance company;
2. Telephone number and fax number of insurance
company;
3. Policy number or claim
number; and
4. Insurance policy
type.
c. The following
information about the reporting person if not an insurance company:
1. Complete name;
2. Occupation and title;
3. Complete address; and
4. Telephone number and fax number.
d. The following information about the
loss or occurrence:
1. Date of loss or
occurrence;
2. Location of loss
including the complete address;
3.
Estimated value of claim for loss; and
4. Whether claim was paid or not paid.
e. The following information concerning
the parties involved and their roles:
1. Complete
names of all parties;
2. Business and
alias names of parties;
3. Roles of each
party;
4. Complete address of each
party;
5. Phone number of each
party;
6. Date of birth or age of each
party;
7. Social Security number of each
party;
8. Tax identification number of
each party; and
9. Driver's license
number of each party.
f. A
detailed narrative of what fraudulent insurance act is suspected and the
circumstances leading to the suspicion of fraud.
g. A list of the type of documents in the
possession of the reporter, for example police reports, photographs, or falsified
documents, supporting the suspicion of fraud.
h. Any other agency or entity to which the
reporter has reported suspected fraud, including the name, address, and telephone
number of the other agency.
3.4. The report provided must be signed and dated
by the reporting party or an authorized representative of the reporting
party.
3.5. The required information
shall be submitted on a form prescribed by the commissioner.
