Fraude en los seguros

[LOGO] ESTADO LIBRE ASOCIADO DE PUERTO RICO OFICINA DEL COMISIONADO DE SEGUROS 17 de junio de 1993 CARTA CIRCULAR NUM. C-4-1318-93 # A TODOS LOS ASEGURADORES DEL PAIS Y A LOS GERENTES DE LOS ASEGURADORES EXTRANJEROS AUTORIZADOS A LLEVAR A CABO NEGOCIOS DE SEGUROS EN PUERTO RICO Señores: El Departamento de Justicia Federal de los Estados Unidos ha instituido una forma conocida como Insurance Related Criminal Referral Form con el propósito de recibir la mayor cantidad posible de información relacionada con el fraude en el área de los seguros y la actividad criminal relacionada con éste. La información solicitada abarcará la actividad delictiva que se lleve a cabo en la esfera estatal al igual que aquella que afecte al ámbito federal. La Oficina del Comisionado de Seguros de Puerto Rico, en su afán de colaborar con todo aquel esfuerzo que sirva para erradicar o reducir aquella conducta o prácticas delictivas en la que se incurra dentro de la industria de seguros, emite las siguientes directrices en torno a la iniciativa del Departamento de Justicia Federal: 1. Cuando se tenga conocimiento o sospecha de alguna actividad o práctica delictiva que se relacione con la industria de seguros de Puerto Rico, o de los Estados Unidos, o información que sea de interés sobre ese particular, se deberá llenar la referida forma proveyendo la información solicitada en todos sus apartados. Luego de llenar la misma se deberá enviar al Departamento de Justicia Federal, a la siguiente dirección: U.S. Department of Justice Criminal Division, Fraud Section 10th Pennsylvania N.W. Washington, D.C. 20530 Attention: Karen Morrissette Deputy Chief Apartado 8330 — Estación Fdez. Juncos — Santurce, Puerto Rico 00910 - 8330 -2- 2. Se deberá remitir una copia de la forma a la Oficina del Comisionado de Seguros, Apartado 8330, Estación Fernández Juncos, Santurce, Puerto Rico 00910-8330. 3. Si la actividad delictiva que se ha llevado a cabo, o de la que se tiene sospecha, ocurriese en Puerto Rico, se deberá remitir también una copia de la forma al Negociado de Investigaciones Federales (FBI) de Puerto Rico a la siguiente dirección: U.S. Department of Justice Federal Bureau of Investigation G.P.O. Box 366269 San Juan, Puerto Rico 00936 De ocurrir ésta en los Estados Unidos, la copia de la forma deberá ser enviada a la oficina del Negociado de Investigaciones Federales más cercana a la jurisdicción en donde se esté llevando a cabo la referida actividad. Además, si el caso fuere de la competencia de alguna de las agencias federales mencionadas en el apartado número once (11) de la referida forma, se deberá remitir una copia fiel y exacta de ésta a esas agencias. De manera que podamos contribuir a este esfuerzo conjunto del Gobierno Federal y los gobiernos estatales para reducir la incidencia de aquella actividad delictiva que afecta directamente a la industria de seguros, se les requiere a todos los aseguradores del país autorizados a hacer negocios de seguros de todas clases en Puerto Rico el estricto cumplimiento con todo lo que esta carta circular requiere. Se acompaña una copia del Insurance Related Criminal Referral Form con el propósito de que la reproduzcan para su uso futuro. Cordialmente, Juan Antonio García Comisionado de Seguros Anejo # UNITED STATES DEPARTMENT OF JUSTICE INSURANCE RELATED CRIMINAL REFERRAL FORM To Be Used for Criminal Referrals in Suspected Cases of Major Insurance Fraud or Corruption.* Please provide as much of the requested information as possible, but if any information is unavailable leave the answer blank. 1. Name and Location of Insurance Company/Agency/Entity Name Location street city state zip Location of Suspected Offense: 2. Asset Size of Insurance Company/Agency/Entity 3. Approximate date and dollar amount of loss due to suspected violation. Date Month Year Amount 4. Summary characterization of the suspected violation. Check appropriate item(s). | ☐ Defalcation/embezzlement | ☐ Employee Benefit Plans (ERISA) | | --- | --- | | ☐ False Statement by insurance company (e.g. assets/liabilities; ownership; reserves) | ☐ METS & MEWAS | | ☐ Misuse of Position or Self Dealing; other abuses by insurance company insiders | ☐ Reinsurance | | ☐ Check Kiting | ☐ Tax Violations | | ☐ Bank Fraud | ☐ Public Corruption/Bribery | | ☐ Bank Secrecy Act/Money Laundering | ☐ Securities Fraud | | | ☐ Other (Describe) | * Major insurance fraud or corruption is defined as: (1) a scheme which resulted in a loss to the state, company, policyholders, a multiple employer trust (MET), a multiple employer welfare arrangement (MEWA), or participants in METS or MEWAs of more than $100,000 or a gain to the perpetrator of more than $100,000; or (2) insurance-related public corruption, such as bribery of a public official, regardless of the amount. Please exclude all arson cases or matters. In the event a fraud is uncovered which involves less than $100,000, this form may still be submitted or a referral may be made by letter. FORM OMB-1105-0054 EXP. AUG. 95 5. Person(s) Suspected of Criminal Violation (If more than one, use Continuation Sheet.) a. Name first middle last b. Address street city state zip c. Date of Birth Social Security No. (if known) mo/day/yr (if known) d. Relationship to the insurance entity. Check all applicable item(s) ☐ Officer ☐ Managing General Agent ☐ Stockholder ☐ Director ☐ Agent/Broker ☐ Policyholder ☐ Employee ☐ Appraiser ☐ Other(specify) ☐ Accountant ☐ Lawyer ☐ Consultant ☐ Employee Benefit ☐ Third Party ☐ Plan Service Provider ☐ Administrator e. Is person still affiliated with the insurance entity? ☐ yes ☐ no If no, ☐ Terminated ☐ Resigned f. Is person affiliated with any other insurance entities? If yes, please identify 6. Explanation/Description of Suspect Activity (You may use a separate sheet) Give an account of the suspected criminal activity. 21 01 2 # 7. Witnesses If known, list any witnesses who might have information about the suspected violation and describe their position or employment. Indicate if they have been interviewed. (Use continuation sheet if necessary.) | | Name | Position | Address | Tele. | Interviewed | | | --- | --- | --- | --- | --- | --- | --- | | | | | | | Yes | No | | (1) | | | | | — | — | | (2) | | | | | — | — | 9. Is this matter the subject of any civil law suit or regulatory action including liquidation or insolvency proceedings? If so, please describe. 10. Has a referral or complaint been made about this or a related matter or individual to a state insurance regulatory agency, law enforcement, a U.S. Attorney's Office, State Attorney General's Office or other prosecutor's office. If so, please describe. # 11. Distribution Information a. Send one copy to the office of the Federal Bureau of Investigation (FBI) nearest to where the suspected offense took place. FBI office to which form was sent: city/state b. If the allegations are false claims or mail fraud, please send one copy to the Postal Inspection Service nearest to where the suspected offense took place. 3 Postal Inspection Service office to which form was sent: city/state c. Send one copy to: U.S. Department of Justice, Criminal Division, Fraud Section, 10th & Pennsylvania N.W., Washington, D.C. 20530, Attention: Karen Morrissette, Deputy Chief. d. In addition, if the allegations in this referral involve any of the categories as listed below, please send a copy to the corresponding agency listed below and indicate that the referral was sent. 1. Employee Benefit Plans (ERISA); Multiple Employer Trusts or Welfare arrangements. Send to: Office of Labor Racketeering U.S. Department of Labor Room S-5012 200 Constitution Avenue Washington, D.C. 20210 Referral sent Yes No Pension & Welfare Benefits Administration Enforcement Section U.S. Department of Labor Room N - 5702 200 Constitution Avenue Washington, D.C. 20210 Referral sent Yes No 2. Tax Violations; Bank Secrecy Act/Money Laundering Send to: Internal Revenue Service Criminal Investigation Division 1111 Constitution Avenue, Room 2143 Washington, D.C. 20224 Attn: Director of Operations Referral sent Yes No 12. Person to contact for further information about referral Name Position Organization Phone No. Date of referral 4 Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing this burden to Fraud Section, Criminal Division, U.S. Department of Justice, Washington, DC. 20530; and to The Office of Management and Budget, Washington, DC. 20503 # ADDENDUM Insurance companies and any other insurance industry representatives should provide a copy of the completed form to the insurance department in every jurisdiction where the suspect activities took place. Insurance departments should provide a copy of all referral forms received or completed to: SAD Coordinator National Association of Insurance Commissioners 120 West 12th Street Kansas City, Missouri 64105