Two Sources of Insurance Crimes:
- Crimes committed by a regulated entity against a consumer, i.e. fraud, embezzlement, exploitation, etc.
- Crimes committed by a consumer against an insurance company, i.e. fraudulent insurance claims, insurance fraud
The Anti-Fraud Unit’s Primary Mission is:
The investigation of regulated entities accused of violating administrative and/or criminal law.
Mandatory Reporting Required (Title 36):
§ 363. Reporting Suspected Fraud
A. Any insurer, employee or agent of any insurer who has reason to believe that a person or entity has engaged in or is engaging in an act or practice that violates any statute or administrative rule of this state related to insurance fraud shall immediately notify the Anti-Fraud Unit of the Insurance Department and, in the case of an allegation of claimant fraud, the Workers’ Compensation and Insurance Fraud Unit of the Office of the Attorney General.
Grant of Immunity (Title 36):
§ 363. Reporting Suspected Fraud – Grant of Immunity
B. No insurer, employee or agent of an insurer, or any other person acting in the absence of fraud, bad faith, reckless disregard for the truth, or actual malice shall be subject to civil liability for libel, slander or any other relevant tort or subject to criminal prosecution by virtue of filing of reports or furnishing other information either orally or in writing, concerning suspected, anticipated or completed fraudulent insurance acts to the Anti-Fraud Division of the Insurance Department or the Workers’ Compensation and Insurance Fraud Unit of the Office of the Attorney General pursuant to subsection A of this section or to any other agency involved in the investigation or prosecution of suspected insurance fraud.
C. No civil or criminal cause of action of any nature shall exist against the person or entity by virtue of filing of reports or furnishing other information, either orally or in writing, concerning suspected, anticipated or completed fraudulent insurance acts to the Anti-Fraud Division of the Insurance Department pursuant to subsection A of this section or to any other agency involved in the investigation or prosecution of suspected insurance fraud. The immunity provided in this subsection shall extend to the act of providing or receiving information or reports to or from:
- Law enforcement officials, their agents and employees;
- The National Association of Insurance Commissioners, any state department of insurance, any federal or state agency or bureau established to detect and prevent fraudulent insurance activities, as well as any other organization established for the same purpose, their agents, employees or designees; and
- Any organization or person involved in the prevention and detection of fraudulent insurance activities or that organization or person’s employees, agents, or representatives.The immunity provided in this subsection shall not extend to any person, insurer, or agent of an insurer for communications or publications about suspected insurance fraud to any other person or entity.
Oklahoma Criminal Statute for “Insurance Fraud” (Title 21):
*Note: Claimant Fraud is most often investigated by the Attorney General’s Office
§ 1662. Fraudulent Claim Upon Insurance Contract for Payment of Loss
Oklahoma Criminal Statute for “Worker’s Compensation Fraud” (Title 21):
*Note: Workers Compensation Fraud is investigated by the Attorney General’s Office
§ 1663. Workers’ Compensation Fraud – Penalty – Definitions
Helpful Insurance Fraud Links:
The Anti-Fraud Unit maintains offices in OKC and Tulsa, but serves all 77 counties of Oklahoma. To report fraud, click the red button below or contact us in person, by mail, phone, or email at firstname.lastname@example.org.