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
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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.
Zalma Opinion
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.
© 2021 – Barry Zalma Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders.
He also serves as an arbitrator or mediator for insurance related disputes. He practiced law in California for more than 44 years as an insurance coverage and claims handling lawyer and more than 54 years in the insurance business.
He is available at http://www.zalma.com and zalma@zalma.com. Mr. Zalma is the first recipient of the first annual Claims Magazine/ACE Legend Award. Over the last 53 years Barry Zalma has dedicated his life to insurance, insurance claims and the need to defeat insurance fraud. He has created the following library of books and other materials to make it possible for insurers and their claims staff to become insurance claims professionals.
Go to the podcast Zalma On Insurance at https://anchor.fm/barry-zalma;  Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library/ Read posts from Barry Zalma at https://parler.com/profile/Zalma/posts; and the last two issues of ZIFL at https://zalma.com/zalmas-insurance-fraud-letter-2/ podcast now available at https://podcasts.apple.com/us/podcast/zalma-on-insurance/id1509583809?uo=4