New York State Department of Financial Services

Insurance Frauds Bureau Annual SIU Report
Instructions on Submission of the Annual SIU Report and Company Management Signoff

Overview

The Annual SIU Report should contain data for New York business only

The due date of this report is March 15th.

Filers are not allowed to perform a "partial save" of the data. Once each filer accesses the blank form the filer must complete all applicable fields and then electronically submit the form. Upon submission the filer will receive a Submission ID. Filers may exit prior to submission but no data will be retained.

Previously filed Annual SIU Reports may be edited and resubmitted which will result in a new Submission ID. Edits will not be permitted after May 1.

Each insurer must have a minimum of 2 accounts to complete, submit and signoff on the e-form. Each insurer must have a Trusted Source, a Reviewer - SIU Manager and a Reviewer - Executive. A reviewer may also be a Trusted Source. See Directions for sign off of the e-form by the SIU Manager and Executive, below.

IMPORTANT: At sign-up for account creation, each individual must identify a "lead company". All individuals from a given company must use the same company (insurer name, NAIC No.) as the "lead company" in order to be able to access the e-submission.

 

Instructions for Annual SIU Report "Submitter"

Groups that have both P&C and A&H companies and meet the Section 409 threshold must file separate Annual SIU Reports for the P&C and A&H companies.

Each company that is a member of a group must identify all insurers included in the filing.

After logging into the Department's Portal, click the "My Applications" Tab, then select Frauds SIU -> Actions -> View (See below):

(Step 1): On Frauds SIU Form, select the appropriate form type: click the "Submit AH Form" Tab for Accident & Health Insurers, or the "Submit PC Form" Tab for Property/Casualty Insurers (see below):

Your Company Group(s) should be displayed on the screen (these are the Company(s)/Group(s) you requested during Application sign-up). A list of affiliated companies will appear once you click on a group name. Select all companies to be included in the current report (see below):

(Step 2): The first of 3 Annual SIU Report forms will appear. See below for the data requirements of the Annual Report.

 

Instructions on completion of the form grid:

1a. & 1b. - New York policy count, Premiums written

• 1a. & 1b.- Indicate policy count or individuals covered if policies are written on a group basis, and the corresponding premiums written. Assigned risk should be included. Do not include ASO business.

2a. & 2b - Number of claims processed, Dollar amount of claims paid

• 2a. - All claims that have been received and that are in the various stages of review for ultimate payment or denial. (These claims have been entered into the company claims system). Do not include ASO business.
• 2b. - Total value of claims incurred (including incurred but not reported) during the calendar year being reported. Do not include ASO business.

Include ASO business in columns 3a - 6b

3a. & 3b. Number of suspicious claims detected, Dollar amount of suspicious claims detected

• 3a. - Claims containing information that leads the reviewer to question the integrity/credibility of the information or that provides information indicating a pattern or trend of questionable organized activity within the calendar year being reported.
• 3b. - Report the corresponding dollar amount of the claims.

3c. & 3d. Number of claims reviewed by SIU, Number of referrals reviewed by SIU

• 3c. - Report the number of claims reviewed by the SIU resulting from audit, software analysis or other means of identifying suspicious claims other than via the claims payment process..
• 3d. - Total number of referrals reviewed by SIU. Column 3d could be a total of 3a +3c however, referrals may have come from other sources so 3d could be larger than the total of 3a and 3c.

3e. Number of cases opened by SIU

• 3e. - Number of cases opened for investigation during the calendar year being reported.

3f. Number of cases closed by SIU

• 3f. - Number of investigated cases closed during the calendar year being reported.

4a. & 4b. Dollar value of savings. Dollar value of restitution and recoveries.

• 4a. - Monies not paid due to investigation of suspicious claims submitted during the calendar year.
• 4b. - Monies collected/recovered from all sources including from court disposition during the calendar year being reported.

4c. & 4d. Number of investigated claims closed and not paid. Number of claims closed and partially paid.

• 4c. - Claims not paid as a direct result of SIU investigations during the calendar year being reported.
• 4d. - Number of claims that resulted in partial payments as a result of SIU investigations.

5. Number of referrals reported to the Insurance Frauds Bureau.

6a. & 6b. Total cost of SIU. Number of SIU investigators (These columns should be broken down by Insurer (I) and Contractor (C)). Report the total amount only in 6a and 6b.

• 6a. & 6b. - For national and regional SIU units, New York allocations must be determined using FTE activity for New York cases. FTE = one full time equivalent investigator.

After all 3 input forms have been completed and reviewed, click "Complete Submission" button to transmit the report. The e-Submission ID will now be displayed (see screen below). Please record this Submission number for future reference.

 

 

Instructions for Annual Report "Approvers": SIU Manager and Company Executive

A Reviewer - SIU Manager and Reviewer - Executive must sign off on the form.

After the form has been completed, the insurer may submit the form. Upon submission of the form, the insurer will receive a "Submission ID". This ID number will allow the insurer to access the form after submission. (If the Submission ID is not retained the filing can be retrieved via query.)

The SIU Manager and Executive responsible for the SIU must sign into the portal. After signing into the portal, click the "My Applications" Tab, then select Frauds SIU -> Actions -> Review Approve Submission (See below):

 

 

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