Md. Code Regs. 31.04.15.06

Current through Register Vol. 51, No. 26, December 27, 2024

Section 31.04.15.06 - Reporting of Fraud-Related Data

A. An insurer shall maintain appropriate records for the Commissioner to determine the effectiveness of its antifraud plan.

B. A report shall be developed and provided to the Administration on an annual basis regarding the plan's effectiveness and the effectiveness of the investigative and prosecutorial efforts.

C. The report shall be filed with the Administration by March 31 of each year, reporting the previous year's statistics. The report shall be limited to Maryland data. The following information shall be reported:

(1) Number of policies in force;

(2) Number of claims;

(3) Number of suspected fraud cases;

(4) Number of suspected fraud cases in which a claim was denied;

(5) Number of suspected fraud cases reported to the authorities;

(6) Number of suspected fraud cases by product line;

(7) Number of suspected fraud cases in which a claim was denied, by product line;

(8) Number of cases prosecuted by criminal authorities; and

(9) Breakdown by perpetrator, as follows:

(a) Insured,

(b) Claimant,

(c) Insurance producer/employee,

(d) Noninsurance professional, by category, and

(e) Other.

Md. Code Regs. 31.04.15.06

Regulations .06 adopted as an emergency provision effective October 1, 1996 (23:21 Md. R. 1465); adopted permanently effective December 30, 1996 (23:26 Md. R. 1859)
Regulation .06C amended effective January 15, 2007 (34:1 Md. R. 33)