Enforcement Overview / Fraud Division Overview / SIU Compliance Office

SIU Compliance Office

SIU Compliance Review Program

The primary responsibility of the California Department of Insurance (CDI) Special Investigative Unit (SIU) Compliance Review Program is to examine insurers and to evaluate regulatory and statutory compliance regarding the establishment, maintenance and operation of the insurer’s anti-fraud operations.

Insurers licensed to conduct business in California are required by California Insurance Code Sections 1875.20-24 and California Code of Regulations, Title 10, Sections 2698.30 - .43 to establish and maintain Special Investigative Units that identify and refer suspected insurance fraud to the CDI (and the California County District Attorney’s Office for workers’ compensation only).

The regulations also require each insurer to submit a SIU Annual Report to the CDI which provides important information regarding the insurer’s anti-fraud operations, procedures, and training materials. The SIU Compliance Review Program evaluates the accuracy, completeness, and timeliness of the report filed by approximately 1,100 insurers each year. For more information, please use the links below.

SIU Annual Report

SIU Annual Report

SIU Training Tools

SIU Information E-Blasts

California Insurance Code (CIC) / California Special Investigative Unit Regulations

Common Noncompliance Findings

FY 2020/2021 (Coming Soon)

The SIU Compliance Review Program evaluates the accuracy, completeness, and timeliness of the report. The reports are used to conduct a risk assessment to help determine which insurers are selected for SIU compliance review. Risk criteria includes, but is not limited to:

Prior SIU compliance review finding(s), as well as follow up on recommendations and corrective action compliance plans Discrepancies and/or non-compliance issues identified by analyzing the SIU Annual Report Quantity and/or quality of suspected insurance fraud referrals to CDI, known as eFD-1s, FD-1s, or SFCs and referrals to California County District Attorneys' Offices for workers' compensation only Lines of insurance that are relatively risky and susceptible to fraud

Nature and/or quantity of complaints received against a particular insurer Market share of the insurer Late or no response to written information demand letters from CDI or other authorized governmental agencies (e.g., district attorneys) CDI Executive Directive

For questions regarding California SIU compliance requirements, please contact:

SIU Compliance Review Program
California Department of Insurance, Fraud Division
2400 Del Paso Rd., Suite 250
Sacramento, CA 95834
Email: SIU-annualreport@insurance.ca.gov

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