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§405
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§405 . Reports.
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§405(a)
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(a) Any person licensed pursuant to the provisions of this chapter, and any person engaged in the business of insurance in this state who is exempted from compliance with the licensing requirements of this chapter, including the state insurance fund of this state, who has reason to believe that an insurance transaction may be fraudulent, or has knowledge that a fraudulent insurance transaction is about to take place, or has taken place shall, within 30 days after determination by such person that the transaction appears to be fraudulent, send to the insurance frauds bureau on a form prescribed by the superintendent, the information requested by the form and such additional information relative to the factual circumstances of the transaction and the parties involved as the superintendent may require. The insurance frauds bureau shall accept reports of suspected fraudulent insurance transactions from any self insurer, including but not limited to self insurers providing health insurance coverage or those defined in §50 of the workers' compensation law, and shall treat such reports as any other received pursuant to (this §) .
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§405(b)
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(b) The insurance frauds bureau shall review each report and undertake such further investigation as it deems necessary and proper to determine the validity of the allegations.
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§405(c)
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(c) Whenever the superintendent is satisfied that a material fraud, deceit, or intentional misrepresentation has been committed in an insurance transaction or purported insurance transaction, he shall report any such violation of law to the appropriate licensing agency, the district attorney of the county in which such acts were committed, when authorized by law, to the attorney general, and where appropriate, to the person who submitted the report of fraudulent activity, as provided by the provisions of this article. Within 120 days of receipt of the superintendent's report, the attorney general or the district attorney concerned shall inform the superintendent as to the status of the reported violations.
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§405(d)
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(d) No later than March 15th of each year, beginning in 1994, the superintendent shall furnish to the governor, the speaker of the assembly and the president pro tem of the senate a report containing:
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§405(d)(1)
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(1) a comprehensive summary and assessment of the frauds bureau's efforts in discovering, investigating and halting fraudulent activities and assisting in the prosecution of persons who are parties to insurance fraud;
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§405(d)(2)
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(2) the number of reports received from any person or persons engaged in the business of insurance, the number of investigations undertaken by the bureau pursuant to any reports received, the number of investigations undertaken not as a result of reports received, the number of investigations that resulted in a referral to a licensing agency, a local prosecutor or the attorney general, the number of such referrals pursued by a licensing agency, a local prosecutor or the attorney general, and the disposition of such cases;
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§405(d)(3)
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(3) a delineation of the number of reported and investigated cases by line of insurance;
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§405(d)(4)
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(4) a comparison of the frauds bureau's experience, with regard to paragraphs this2 and this3 subdivision, to the bureau's experience of years past;
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§405(d)(5)
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(5) the total number of employees assigned to the frauds bureau delineated by title and location of bureau assigned;
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§405(d)(6)
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(6) an assessment of insurance company activities in regard to detecting, investigating and reporting fraudulent activities, including a list of companies which maintain special investigative units for the sole purpose of detecting, investigating and reporting fraudulent activities and the number of investigators assigned to such units per every 30000 policies in force with such company;
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§405(d)(7)
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(7) the amount of technical and monetary assistance requested and received by the frauds bureau from any insurance company or companies or any organization funded by insurance companies;
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§405(d)(8)
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(8) the amount of money returned by the frauds bureau to insurance companies pursuant to any fraudulent claims that were recouped by the bureau;
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§405(d)(9)
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(9) the number and amount of civil penalties levied by the frauds bureau pursuant to chapter 480 of the laws of 1992 ;
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§405(d)(10)
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(10) recommendations for further statutory or administrative changes designed to meet the objectives of this article; and
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§405(d)(11)
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(11) an assessment of law enforcement and insurance company activities to detect and curtail the incidence of operating a motor vehicle without proper insurance coverage as required by this chapter. Source Data downloaded: 2009-04-09 13: 15: 03; Processed: 2009-05-08 15: 35: 46
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