A Video Explaining the SIU Compliance Office
Read the full article at https://www.linkedin.com/pulse/obligations-insurers-comply-siu-regulations-september-barry and see the full video at https://rumble.com/c/c-262921 and at https://youtu.be/izACIsATPQg and at https://zalma.com/blog plus more than 3850 posts.
Responsibility of Compliance Office
The primary responsibility of the Special Investigative Unit (SIU) Compliance Review Office is to inspect insurance companies to ensure regulatory compliance with regard to the establishment, staffing and operation of the insurer’s SIU. The Office also is responsible for updating, distributing, reviewing, monitoring and tracking the annual SIU compliance reports filed by over 1,100 insurance companies each year.
The SIU Regulations also requires each insurance company to submit an annual compliance report to the Fraud Division, SIU Compliance Review Office. The SIU annual reports must provide adequate information and documentation regarding the insurer’s anti-fraud operations, policies and procedures, and anti-fraud training. The SIU Compliance Review Office provides the format and instruction for submission of the reports and reviews, monitors and evaluates the completeness and timeliness of the reports filed annually. After completion of a review and evaluation of the insurers’ reports filed annually, the SIU Compliance Review Office considers various risk-based criteria for proper selection of insurers for SIU review.
Once an SIU compliance review is completed, a preliminary report (or Exit Review Report) is issued to the company identifying proposed findings and recommendations. The Insurer is given 30 days to respond and provide supporting documents and information, after which a Final Report of Findings (final report) is issued to the Insurer. The final report may show that all findings have been resolved and the company is in compliance with the SIU regulations, or that all or some of the findings still stand and the insurer is subject to legal action including fines/penalties.
The CDOI provides on its web site a video training program explaining the California Special Investigative Unit Requirements at http://www.insurance.ca.gov/0300-fraud/0100-fraud-division-overview/12-siu/SIU-video.cfm which can assist insurers and the integral anti-fraud personnel in understanding the SIU Regulations and its requirements.
The SIU Regulations require insurers to be actively involved in the work to defeat or deter insurance fraud. Failure to comply is expensive and can bring on the ire of the Department of Insurance. Remember, all integral anti-fraud personnel must be trained annually and all new hires must be trained within 90 days of hire. The book can accomplish the training so you don’t need a new class for every new hire.