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Can you summarize 11 NYCRR 86.5?
Reports of Suspected Insurance Frauds to Criminal Investigations Unit; Required Warning Statements > Reports of fraudulent acts.
Short Summary
This legal document, part of the New York Codes, Rules and Regulations, pertains to the reporting of suspected insurance frauds to the Criminal Investigations Unit. It applies to any person licensed under the Insurance Law who determines that an insurance transaction or purported insurance transaction appears to be fraudulent or suspect. The document requires the submission of a report on the prescribed reporting form issued by the Criminal Investigations Unit or any other approved form. Reporting can also be done through approved electronic mediums or systems. The document provides a reporting form with fields to be filled out, including information about the suspect transaction, parties involved, policy or claim number, and contact details of an individual in the reporting company. It also inquires about reporting to other law enforcement agencies. The document also includes a separate form for criminal referrals in suspected cases of major insurance fraud or corruption, to be used for providing detailed information about the suspected violation, persons involved, witnesses, and any civil law suits or regulatory actions related to the matter. The document provides distribution information for sending copies to relevant agencies. No specific exemptions or penalties are mentioned in this document.
Whom does it apply to?
Any person licensed pursuant to the provisions of the Insurance Law
What does it govern?
Reports of Suspected Insurance Frauds to Criminal Investigations Unit; Required Warning Statements
What are exemptions?
No exemptions are mentioned.
What are the Penalties?
No penalties are mentioned.
Jurisdiction
New York