Insurance Fraud Enforcement Department: Referral Form

Insurance Fraud Enforcement Department: Referral Form

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Insurance Fraud Enforcement Department: Referral Form

INSTRUCTIONS

This form is to be used by designated IFED insurer Single Point of Contacts (SPOCs) for referral of insurance fraud cases to IFED. Completion of this form will facilitate a prompt decision by IFED on whether the case meets the referral criteria.

Please ensure that all details are completed in full, irrespective of the presence of additional documentation and emailed to . If all required information is not submitted, IFED will return the form to the SPOC to complete and re-send.

IFED will send an e-receipt within two working days of receiving a referral. If a referred case meets the IFED acceptance criteria, the SPOC will be notified within 14 days.

Advice concerning any prospective referral can be obtained from the IFED Hub, by calling 0207 164 8200, between the hours of 8:00 am to 6:00 pm. Any referral requiring urgent (same day action), should be reported to the City of London Police switchboard on 020 7601 2222.

INTERNAL USE ONLY

IFED Referral Number:
Matrix Score:
Case Decision: / ACCEPTED / REJECTED / OTHER
Comments:
Date of Response:
Potential OCG: / YES / NO

FOR COMPLETION BY THE INSURER SPOC ONLY

REFERRER DETAILS

Referring organisation:
ABI or Lloyds Syndicate:
Name of SPOC:
SPOC’s details: / Tel: / Email:
Referrer’s reference:
Name of investigator:
Investigator’s details: / Tel: / Email:
Date of referral to IFED: / //
Action Fraud reference: / NFRC

CASE INFORMATION

1 / Crime committed date: / If offences have been ongoing, please indicate between dates.
// - //
2 / Priority Area: / Application Fraud / After the Event Policy InceptionFalse No Claims DiscountFronting (Person)Illegal Insurance IntermediaryMisrepresentation of Material FactsOther
Claims Fraud / Contrived AccidentInduced AccidentStaged AccidentEmployee Liability & Public LiabilityExaggeration of LossesFabrication of LossesOther
Data Theft / External FraudTheft by EmployeeTheft by Service ProviderOther
Internal Fraud / Broker FraudCriminal InfiltrationFalse Claim PaymentOther
Other Fraud / Mandate FraudPension / Investment Fund Fraud
Other (please specify)
3 / Is there evidence of the involvement of a Professional Enabler: / YES / NO / DON’T KNOW
If Yes, please provide a summary.
4 / Insurance Product Line: / Personal Insurance / Please select from listCreditorExtended WarrantyMobile PhoneMotorPersonal Accident SicknessPet & BloodstockPropertyTravelYacht / Leisure CraftOther (please specify)
Commercial Insurance / Please select from listContractors PlantEmployers LiabilityMarineMotorPrivate Medical InsurancePropertyPublic & Products LiabilityOther (please specify)
Other Insurance / Please select from listRegular Premium Investment & Savings ProductsSingle Premium Investment & Savings ProductsIndividual Pensions (Regular Premium & Single PremOccupational PensionsLifeRetirement IncomeOffshore BusinessOther Single Premium Policies
If Other Insurance Please Specify Product Line
5 / Estimated value of the fraud: / £
6 / Geographical location of fraud: / County / City / Region
7 / Is this referral part of a series of offences: / YES / NO
8 / Summary of the fraud: / Please provide a short synopsis of the offence, including sufficient detail to allow the reader to fully understand the case.
9 / Suspect details (if known): / Name
DOB
Address
Telephone Number
Email Address
Other Information
Suspect details (if known): / Name
DOB
Address
Telephone Number
Email Address
Other Information
There is space provided for further suspect details at the end of this form, if required

OTHER INFORMATION

10 / Investigations undertaken: / What steps have been taken to investigate, including any civil litigation, and what evidence is available i.e. document, statement, CCTV.
11 / Payments: / Details of any payments made, including amount, payee and dates.
12 / Outstanding reserves: / Details of any outstanding reserves or funds / property at imminent risk if the fraud continues.
13 / Linked intelligence: / Details of any confirmed linked intelligence to not only insurance fraud but also any other criminal act.
14 / IFB involvement: / YES / NO
15 / Law enforcement involvement: / YES / NO
If yes, please detail the Police Force involved and any crime reference number.
16 / 3rd Party material: / Insurer / Solicitor / Other
Do we have authority to contact the solicitor or investigator directly?
YES / NO
If yes, please provide contact details
17 / Any other relevant information:

ADDITIONAL SUSPECT DETAILS

Suspect details (if known): / Name
DOB
Address
Telephone Number
Email Address
Other Information
Suspect details (if known): / Name
DOB
Address
Telephone Number
Email Address
Other Information
Suspect details (if known): / Name
DOB
Address
Telephone Number
Email Address
Other Information
Suspect details (if known): / Name
DOB
Address
Telephone Number
Email Address
Other Information
Suspect details (if known): / Name
DOB
Address
Telephone Number
Email Address
Other Information
Suspect details (if known): / Name
DOB
Address
Telephone Number
Email Address
Other Information

NOT PROTECTIVELY MARKED

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