Annual Special Investigations Unit (SIU) Report
The Annual SIU Report is due by March 15 of each year. Failure to properly report may result in administrative action and/or fine.
The Annual SIU Report is submitted via the DFS Portal. Hard copies of the Annual SIU Report are not accepted.
DFS Portal
To access the Annual SIU Report application for the first time, your company must first designate a Trusted Source via the DFS Portal. The Trusted Source can then, in turn, authorize other staff to access to the application.
Use the DFS Portal button below to log into, or create, your Portal account or to designate a Trusted Source (choose the center option 'DFS Portal (Legacy)' as your Login Option):
Important Information Regarding Annual Submission
- The Annual SIU Report should contain data for New York business only and reflect only the previous calendar year activity.
- Insurers should file the Annual SIU Report if the insurer has an approved Fraud Prevention Plan on file with the Department. (Insurers must file a fraud prevention plan in accordance with Section 409(a) of the New York Insurance Law.)
- Filers may save a draft of the Report, log off, and then return to the form later. Upon submission, the filer will receive a Submission ID.
- Previously filed Annual SIU Reports may not be edited but may be resubmitted which will result in a new Submission ID. No submissions or resubmissions are permitted after May 1.
- Groups that have both Property and Casualty (P&C) and Accident and Health (A&H) affiliates that meet the Section 409 threshold must file separate Annual SIU Reports for the P&C and A&H companies.
- Each insurer's Annual SIU Report submission must be electronically approved by the SIU Manager and by an Executive Officer. The approval process is contained in the Annual SIU Report application.
- Each insurer must have a minimum of two (2) accounts to submit and signoff on the report. Each insurer must have a Trusted Source, a Reviewer - SIU Manager and a Reviewer - Executive. A reviewer may also be a Trusted Source. Insurers may create an additional "Submitter" account. The Trusted Source can approve additional users.
- At sign-up for account creation, each individual must identify a "Lead Company." All individuals (Trusted Source, Reviewer, and Submitter) from a given group must use the same company (insurer name, NAIC Number) as the Lead Company to be able to access the submission.
- The "Lead Company" is the insurer, selected by the filer, that serves as the common link among all users accessing the same submission. The Lead Company also provides the submitter of the Annual SIU Report with the option to include any and all affiliates in the filing via a dropdown list. If an insurer has no affiliates, then that insurer is the Lead Company. Companies that are members of a holding company or group may file on behalf of the entire group via one filing or may make multiple filings. If a group wants to make multiple filings, then multiple Lead Companies must be selected.
- After the Report form has been completed and submitted to the Department, the SIU Manager and an executive officer of the insurer responsible for the operations of the Special Investigations Unit must log in to the portal to access the sign-off feature of the Annual SIU Report application and then sign off on the Report.
Detailed Instructions for Submitters
1a & 1b: Policy Count & Premiums Written
Report policy count, or, for group policies, report the number of individuals insured. Report the corresponding written premium. Assigned risk should be included. Include only insured business.
2a & 2b: Number of Claims Processed & Dollar amount of Claims Paid - Only include insured business.
- 2a Report the number of all claims paid or in the process of payment or denial and include all claims received (entered into the claims system).
- 2b Report the dollar amount of claims paid.
3a & 3b, Number of Suspicious Claims Detected, Dollar amount of Suspicious Claims Detected
- 3a Report claims identified as suspicious in the claims settlement process
- 3b Report the corresponding dollar value of claims identified as suspicious in the claims settlement process
3c & 3d: Number of Investigated Claims Closed and Not Paid, Number of Investigated Claims Partially Paid
- 3c Report the number of claims reviewed by the SIU that have been denied or closed as a result of investigation
- 3d Report the number of claims reviewed by the SIU that were partially paid as a result of investigation
4a: Report the total number of referrals, reviewed by the SIU, received from all sources
4b & 4c: Number of Cases Opened by SIU, Number of Cases Closed by SIU
- 4b Report the number of cases opened by SIU
- 4c Report the number of cases closed by SIU
4d & 4e Dollar Value of Saving, Dollar Value of Recoveries and Restitution
- 4d Report the amount of monies not paid during the calendar year due to investigation of suspect claims (or other transactions)
- 4e Report the amount of monies collected or recovered during the previous calendar year from all sources, including court disposition, resulting from investigations
5 Number of IFBs filed with the Department’s Criminal Investigations Unit
6a & 6b Total Cost of SIU, Number of Investigators
- 6aI Report the total cost of New York’s portion of the SIU, on all lines of business, incurred from the insurer's internal investigations (Report in total column)
- 6aC Report the total cost of New York’s portion of the SIU, for all lines of business, incurred by SIU contractors (Report in total column)
- 6bI Report Investigator resources (as FTEs) dedicated to investigations related to all lines of business incurred by the Insurer’s employee investigators (I). Insurers using affiliated SIUs should report data in the Insurer (I) column.
- 6bC Report Investigator resources (as FTEs) incurred by third party contractor investigators for all lines of business
For national and regional SIUs: New York investigator personnel and SIU expenses must be apportioned and reported to reflect New York resources utilized during the previous calendar year. The amount apportioned must be determined using an allocation methodology detailed in service agreements, or by other reasonable expense allocation method using SIU activity. The number of investigators reported should reflect New York resources dedicated to New York cases and the total investigators must be reported as Full Time Equivalent Investigators (FTEs). Note that the amounts reported as investigator resources may be reported as a number including two (2) digits after the decimal place to account for the apportioned resources.
Please respond to eight questions below the grid:
- How many referrals were made to law enforcement agencies including prosecutors (other than the DFS Criminal Investigations Unit)?
- How many civil actions involving suspect transactions were initiated in the previous calendar year? Include lawsuits initiated to recover amounts paid on investigated cases.
- What were the total expenses (allocated and direct) of the public awareness program? Report direct expenses incurred and /or expenses allocated to the insurer for the public awareness program.
- What is the dollar amount of claims adjudicated for self-funded groups? Report the number of claims paid on behalf of self-funded groups.
- How many claims were paid on behalf of self-funded groups?
- How many IFBs were reported to the NYSDFS on all other lines of business not included above? Report the number of IFBs reported to NYSDFS on all other lines of business not shown in the grid above such as life, annuity, title, homeowners etc.
- Where is the SIU located? Provide the city and state of the primary location of the SIU.
- What is the percentage of investigators’ time spent in New York State working on New York State cases? Report the amount of time all investigators dedicated to New York cases while working in New York, as a percentage of the amount reported in 6b. If investigators are located in New York but, spent half of their time working on out of state cases, the percentage to report would be 50%. Enter the amount as a number followed by the percent symbol. Report the amount of time as a number followed by two (2) decimal places if the amount of time includes a fraction of a fulltime equivalent investigator.
Instructions for Approvers: SIU Manager and Company Executive
An SIU Manager and an Executive officer of the insurer responsible for the operations of the Special Investigations Unit must sign off on the Annual SIU Report after it has been submitted.
Each user with the Manager and Executive portal roles will receive an email notification alerting them that an Annual SIU Report has been submitted and is ready for their review. The SIU Manager and Executive must each sign into the portal, access the Annual SIU Report application and go to the Review/Approve tab. There, the user can click the Review button to view the data that was submitted, and the Approve button to approve the submission.