Fraud Frequently Asked Questions

  1. What does the Fraud Bureau DO?

    The duties of the Bureau are as follows:
    • To initiate inquiries and conduct investigations of insurance fraud;
    • To respond to notifications or complaints from all other agencies and persons;
    • To review notices of insurance fraud submitted by insurance companies and to conduct investigations if needed;
    • To conduct independent investigations and studies of insurance fraud and report on the results;
    • To report insurance fraud to any appropriate law enforcement agency and to prepare charges and otherwise assist any prosecutorial authority;
    • To assist any agency in the investigation of insurance fraud;
    • To maintain records and statistics and prepare an annual report;
    • To conduct, with the Attorney General and the Department of Public Safety, public outreach and awareness programs relating to insurance fraud.

  2. What does the Fraud Bureau NOT do?

    The Insurance Fraud Bureau does not investigate the following categories of fraud because they are the responsibility of other agencies:
    • Worker's Compensation Fraud
    • Medicare/Medicaid Fraud
    • Social Security Fraud

  3. How can you protect yourself?

    Remember these things:
    • If it sounds too good to be true, it is.
    • Deal only with licensed companies.
    • Go elsewhere if the agent becomes evasive about any terms of the policy.
    • Don't sign blank application or claims forms.
    • Never pay premiums in cash.

  4. Do I run a risk reporting fraud?

    No. Any person reporting insurance fraud in good faith is immune from civil liability. That means that no one can take any adverse action against you for reporting what you reasonably believe to be insurance fraud. A court must award attorney's fees and costs to any person winning a lawsuit arising out of such a report.

1120 Paseo de Peralta | Santa Fe NM 87501 | 1-855-4-ASK-OSI | Copyright © 2019 - All Rights Reserved - OSI