Introduction of CDI Fraud Division

My Organization:


The California Department of Insurance (CDI) regulates, investigates, audits, and trains members of the insurance industry to ensure that companies comply with applicable insurance law and regulations, remain solvent and meet their obligations to insurance policyholders.  The Department protects consumers by investigating and prosecuting individuals, employers, companies and licensees accused of insurance code violations, including fraud.


Branch Overview


The Enforcement Branch is the investigative body of the Department of Insurance. This branch consists of the Fraud Division and the Investigative Division. . The Enforcement Branch maintains its lead through the collaboration with allied law enforcement agencies and prosecutors throughout the state.  The Enforcement Branch investigates over 4,600 cases of misconduct and fraud by insurers, bail bond agents, employers, providers, insurance agents, brokers, and adjusters, and claimants annually.


Branch Mission


“To protect the public from economic loss and distress by actively investigating, arresting, and referring, for prosecution or other adjudication, those who commit insurance fraud and other violations of law; to reduce the overall incidence of insurance fraud and consumer abuse through anti-fraud outreach and training to the public, private, and governmental sectors.”

Fraud Division (FD)

The core mission of the Fraud Division is to protect the public and prevent economic loss through the detection, investigation, and arrest of insurance fraud offenders.  The Fraud Division acts as the primary law enforcement agency in the State of California for investigating different types of suspected insurance fraud.


Insurance fraud can involve claims, policy applications, and, in the case of workers' compensation insurance, premiums paid by employers. Claimant fraud may include the filing of an insurance claim based on a fictitious or fraudulently staged act such as an accident, injury, theft, arson or other loss, to collect money illegally from insurance companies. Application fraud includes misrepresentations or omissions of material information on the policy application. Premium fraud can occur when an employer fails to provide adequate workers' compensation coverage to employees, or underreports payroll which results in the employer paying a lower premium to the insurer. Crooks often act alone, but increasingly, organized crime rings stage extensive schemes resulting in the theft of millions of dollars. Unfortunately, sometimes even honest people feel that insurance fraud is a victimless crime and do not see the harm in committing this type of crime.


In addition to aggressively investigating suspected insurance fraud, the Fraud Division also conducts audits of grant funds awarded to district attorneys’ offices for the purposes of investigating and prosecuting suspected insurance fraud, and of insurers’ special investigative units to ensure compliance with anti-fraud regulations and statute.


http://cdiintranet.insurance.ca.gov/insidecdi/index.cfm


My Role:


As an intern I will be assisting the CDI's Fraud division in their case work during my time as an intern. My duties will typically include supporting detectives with office work and case management, such as creating case binders. Other duties will include field work such as assisting in the execution of search warrants as well as case review. For case reviews, the detectives will give me the opportunity to review a case that comes into the office and ask me too give my thought if there is a crime to investigate and who the likely suspects are and who should be interviewed. A lot of the work is primarily support work and as my time with the department goes on and my knowledge of the material grows, I will be given more duties to assist the department.