NOTE: The Following Section Is For Insurance Fraud Complaints Only
Please skip to the “Identify Other Agencies You Have Contacted Regarding This Referral” if your submission is not regarding insurance fraud.
Case Details and Claim/Incident Information for Insurance Fraud Complaints
In this section please provide additional information about the suspected insurance fraud including other investigations, litigation, claim, policy and financial information, etc.
If you are a consumer, please complete as much of this section as possible. If you are a memnber of the industry, please complete this section in its entirety.