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The New York IFB 1 form serves as a critical tool within the operational framework of the New York State Department of Financial Services, particularly within the Insurance Frauds Bureau. Positioned at 25 Beaver Street, New York, NY 10004, this form is instrumental for insurance companies to report suspicious transactions that may indicate fraudulent activities. The IFB 1 form requires detailed information about the informant, including their name, address, and NAIC number, alongside whether the report has been previously submitted. Central to the form is a section for a brief statement describing the suspected fraudulent transaction, including the date of the loss, amount, and the specific nature of the suspected fraud, which might involve auto insurance, no-fault claims, medical insurance, workers compensation, fraudulent ID cards, among others. Additionally, the form seeks particulars about the parties involved in the suspicious transaction, policy or claim reference numbers, and contact information for a company representative who can provide further details. Importantly, it prompts the reporting entity to disclose if the matter has been reported to any other law agency, thereby facilitating a coordinated effort in tackling insurance fraud. By iteratively capturing and processing this information, the IFB 1 form plays a pivotal role in the state's efforts to combat and mitigate insurance fraud, enhancing the integrity of the insurance system for all stakeholders involved.

New York Ifb 1 Sample

NEW YORK STATE

DEPARTMENT OF FINANCIAL SERVICES INSURANCE FRAUDS BUREAU

25 BEAVER STREET

NEW YORK, NY 10004

DATE:

1). Information furnished by:__________________________

Address: _______________________________________

_______________________________________

NAIC # _______________________________________

Previously submitted? Yes ____ Log # ___________ No_____

PLEASE PRINT/TYPE INFORMATION

2)Brief statement of suspect transaction. Date of loss ___________ Amount of loss ____________ County_____

Type of loss: Auto___ No-Fault___ Medical___ Workers Comp. __ Fraudulent ID cards__ Other_____________

If Auto or No-Fault, was this policy application submitted via NYAIP? Y N

STATEMENT

3)Identify parties to suspect transaction: Name(s) Address(es)

Additional information on suspect(s)

If Auto or Fraudulent cards give VIN # _________________________ Plate or License # ____________________

4) Identify your policy, claim or reference number under which the above transaction is recorded:

Claim # __________________________ Claim status_____________________________________________

Reference #_____________________________ Policy # _________________________ SIU #_______________

5)Name, title, address & telephone number of individual in your company who can provide detailed information:

NAME__________________________________________ TITLE _________________________________

ADDRESS __________________________________________________ TELEPHONE # _____________

6)Have you reported this transaction to any other law enforcement agency? Yes ____________ No____________

If yes, please furnish: Agency _________________________________________________________________

Address ___________________________________________________________________________________

Person contacted _________________________ Telephone #____________________Date of report _________

Continue on reverse or attach additional sheets as necessary.

Signed: _______________________________

Title: ________________________________

http://www.dfs.ny.gov

IFB-1 REV 8/11

File Overview

Fact Name Description
Purpose The IFB-1 form is used for reporting suspected fraudulent insurance transactions to the New York State Department of Financial Services' Insurance Frauds Bureau.
Location of Bureau The form is submitted to the Insurance Frauds Bureau, located at 25 Beaver Street, New York, NY 10004.
Information Required Details such as the informer's contact information, a brief statement of the suspect transaction including the date and amount of loss, detailed identification of the parties involved, the policy or claim number, and contact information for a company representative with detailed knowledge of the case are required.
Categories of Fraud The form specifies different categories of fraud to be reported, including Auto, No-Fault, Medical, Workers Comp., Fraudulent ID cards, among others, to better classify the nature of the suspected fraudulent activity.
Reporting to Other Agencies It inquires whether the transaction has been reported to any other law enforcement agency, asking for details if applicable, to coordinate investigations between multiple authorities.
Governing Law The use of the IFB-1 form and the actions of the Insurance Frauds Bureau are governed by the insurance laws of the New York State, aiming to reduce fraudulent insurance activities through coordination between insurance companies and law enforcement.

New York Ifb 1: Usage Guidelines

When you're faced with the task of reporting a suspicious insurance transaction in New York, the IFB-1 form from the New York State Department of Financial Services' Insurance Frauds Bureau becomes your go-to document. This form is crucial for detailing transactions that may involve fraud across various insurance types, from auto to workers' compensation. As you prepare to fill out this form, remember that the accuracy and completeness of the information you provide can significantly aid in the investigation process. Here's a step-by-step guide to ensure you complete the IFB-1 form correctly.

  1. Start with the Date section at the top of the form, entering the current date.
  2. In the section labeled "Information furnished by," input your full name and address. If applicable, include your NAIC number. Answer “Yes” or “No” to whether this information has been previously submitted. If yes, provide the Log number.
  3. Under the heading "Brief statement of suspect transaction," specify the date of loss, amount of loss, and county. Check the corresponding box to indicate the type of loss (e.g., Auto, No-Fault, Medical, Workers Comp., Fraudulent ID cards, Other) and specify if applicable, particularly if it's an Auto or No-Fault case submitted via NYAIP.
  4. Identify all parties involved in the suspect transaction. Supply names, addresses, and any additional information that might assist in identifying the suspect(s). For Auto or Fraudulent cards, include the Vehicle Identification Number (VIN) and Plate or License Number.
  5. Indicate your policy, claim, or reference number associated with the transaction. Fill in the claim number, claim status, reference number, policy number, and SIU number as relevant.
  6. Provide the name, title, address, and telephone number of a contact within your company who can give more detailed information about the case.
  7. Answer whether this transaction has been reported to any other law enforcement agency. If the answer is "Yes," provide the name of the agency, address, name of the person contacted, their telephone number, and the date of report.
  8. If you need more space or have additional documents, mention that you will “Continue on reverse or attach additional sheets as necessary.”
  9. Conclude the form with your signature and title.

After completing the IFB-1 form, it's important to review all the details for accuracy before submission. This document assists authorities in the initial assessment and investigation of suspected insurance fraud, potentially leading to further action. Submitting inaccurate or incomplete information can hinder the process, so take the time to fill out each section with care. Once submitted, the information you've provided will contribute to the broader effort to combat insurance fraud in New York State.

FAQ

Welcome to the FAQ section for the New York IFB 1 form. Here, we'll cover common questions to help guide you through the process of completing and submitting this form.

  1. What is the purpose of the New York IFB 1 form?
  2. The New York IFB 1 form is designed for insurance companies to report suspicious transactions that may indicate insurance fraud. By providing detailed information about these transactions to the New York State Department of Financial Services' Insurance Frauds Bureau, companies play a crucial role in the fight against insurance fraud.

  3. Who needs to complete the IFB 1 form?
  4. Insurance providers operating within New York State are required to fill out and submit the IFB 1 form when they detect potentially fraudulent activities related to claims or policies.

  5. What information is required on the IFB 1 form?
    • Details about the reporter and insurance company, including the NAIC number and any previous submissions.
    • A brief statement of the suspect transaction, including the date and amount of loss, and type of insurance involved.
    • Identification of parties involved in the suspect transaction.
    • Policy, claim, or reference numbers pertinent to the transaction.
    • Contact information for an individual within the company who can provide further details.
    • Information regarding any law enforcement agencies that have been notified about the transaction.
  6. Where can I find the IFB 1 form?
  7. The IFB 1 form is available on the New York State Department of Financial Services website. You can download it directly by visiting http://www.dfs.ny.gov.

  8. How do I submit the completed IFB 1 form?
  9. Once completed, the IFB 1 form can be mailed to the Insurance Frauds Bureau at the address provided on the form. Ensure all information is accurate and the form is signed before submission.

  10. What happens after I submit the form?
  11. Upon receipt, the Insurance Frauds Bureau will review the information provided. If necessary, they may contact the individual listed in section 5 for further details. Investigations into the matter will then be conducted as deemed appropriate.

  12. Is it mandatory to report suspected insurance fraud?
  13. Yes, insurance companies are required by law to report any suspicions of insurance fraud. Failing to report such activities can result in penalties. The IFB 1 form facilitates this reporting process.

  14. Can the form be submitted anonymously?
  15. No, the IFB 1 form requires the contact information of the reporting entity and a designated individual within the company for follow-up. However, the information you provide is used strictly for investigating the reported activity.

  16. What should I do if I have additional information after submitting the form?
  17. If you have additional information related to a previously submitted IFB 1 form, you should contact the Insurance Frauds Bureau directly. Provide the original log number of your submission to help them efficiently locate your file.

If you have further questions not covered in this FAQ, feel free to contact the New York State Department of Financial Services' Insurance Frauds Bureau directly for assistance.

Common mistakes

Filling out the New York IFB-1 form, which is crucial for reporting suspect transactions to the Insurance Frauds Bureau, often involves detailed work that can be prone to mistakes. These errors can hinder the investigation process and even affect the outcome. Understanding and avoiding common mistakes can streamline the process and ensure the information provided is useful and accurately processed.

One of the most frequent mistakes is not fully completing every required section of the form. Essential information is sometimes left blank or filled out incompletely, especially in sections like:

  1. Information furnished by - where the contact information and details of the informant are crucial.
  2. Brief statement of suspect transaction - which requires specifics about the type of loss and other relevant details.
  3. Identification of parties to the suspect transaction, including names, addresses, and additional information that could be crucial to an investigation.

Such omissions can cause delays as further clarification or additional information may be necessary to proceed with an investigation.

Another common error involves incorrect or unclear information being provided. This might include:

  • Incorrect NAIC numbers, which are essential for identifying the insurance provider correctly.
  • Inaccurate policy, claim, or reference numbers, which are crucial for locating and reviewing the case in question.
  • Misidentified type of loss, such as miscategorizing a Workers Compensation claim as an Auto claim, which can send investigators down the wrong path.

Accuracy in these details is fundamental for the swift and effective handling of the case.

Additionally, individuals often neglect to use the additional sheets or reverse side of the form when more space is required. Important details are either cramped into the provided space or, worse, left out entirely. The instructions clearly allow for additional sheets to be attached as necessary, ensuring that the informant can provide a thorough description and all relevant information without the limitation of space.

Some users also fail to answer questions related to prior reporting of the incident to law enforcement agencies. This includes not only the question of whether it has been reported but also neglecting to provide details of the agency, the address, the contact person, their telephone number, and the date of report. This oversight can lead to duplication of efforts or, conversely, a lack of coordination that might impede the investigation.

Last, but not least, is the common mistake of not signing the form. A signature at the end of the form is mandatory as it validates the information given. Without a signature, the form may be considered incomplete, and necessary actions delayed.

Being diligent, attentive to details, and thorough when filling out the IFB-1 form can significantly contribute to the efficient handling and investigation of suspect insurance transactions. By avoiding these common mistakes, individuals can assist in the fight against insurance fraud more effectively.

Documents used along the form

When dealing with insurance fraud cases in New York, the IFB-1 form is an essential document submitted to the New York State Department of Financial Services Insurance Frauds Bureau. It serves as a primary means for insurance companies to report suspected insurance fraud. However, to thoroughly investigate and process such a case, other forms and documents are often required in addition to the IFB-1 form. These auxiliary documents play vital roles in providing comprehensive details and evidence to support the investigation.

  • Police Report: A detailed report from the local police department that documents the initial findings of an incident that led to an insurance claim. It is crucial for verifying the circumstances reported in a suspected fraudulent claim.
  • Insurance Policy Document: The original insurance policy under which the claim was filed. This document outlines the terms, conditions, and coverage specifics, which are critical for determining violations or inconsistencies with the claim in question.
  • Claim Form: The completed form submitted by the policyholder to file an insurance claim. It provides initial information regarding the loss or damage incurred, serving as the basis for fraud investigation.
  • Proof of Loss Document: A form submitted by the claimant that substantiates the amount of loss claimed. It typically requires detailed descriptions and may include receipts, invoices, or estimates that are scrutinized during fraud investigations.
  • Photographs or Video Evidence: Visual documentation of the damage or loss reported. These visuals are crucial for investigators to assess the extent and nature of the damage or loss claimed and to detect any discrepancies.
  • Witness Statements: Written or recorded accounts from individuals who have direct knowledge of the incident. These statements can provide additional insights or contradictions to the details provided by the claimant.
  • Expert Reports: Assessments or appraisals from specialists such as forensic analysts, medical professionals, or auto repair technicians, which provide expert opinions on the validity of the claimed loss or injury.

Each of these documents contributes valuable information that supports the thorough investigation of a suspected fraudulent insurance claim. By assembling a comprehensive dossier that includes the IFB-1 form along with these additional documents, investigators can better understand the circumstances of a case, identify discrepancies, and make informed decisions regarding the legitimacy of the claim in question.

Similar forms

The New York IFB 1 form, used for reporting insurance fraud, shares similarities with the California Department of Insurance Fraud Reporting Form. Both forms are designed to collect detailed information about suspected insurance fraud incidents, including details about the parties involved, the type of insurance policy, and the nature of the suspected fraud. They require the reporter to provide a brief statement of the suspected transaction, identify any involved parties, and note whether the incident has been reported to any other law enforcement agencies.

Analogous to the Workers' Compensation Fraud Reporting Form found in many states, the New York IFB 1 form requires information on the type of loss, which could include workers' compensation. Both forms gather details on the claim number, policy number, and the amount of loss, aiming to facilitate investigations into fraudulent claims that unjustly extract funds from workers' compensation insurance systems.

The National Insurance Crime Bureau (NICB) Fraud Reporting Form is another document paralleling the NY IFB 1 form in purpose and content. It allows the reporting of various types of insurance fraud, not limited to auto or workers' compensation fraud. Both documents collect comprehensive data on the fraud incident, including particulars about the claim and the entities involved, to support investigations carried out by their respective organizations.

The Auto Insurance Fraud Reporting Form also shares similarities with the NY IFB 1 form, focusing particularly on the automotive sector of insurance fraud. Like the IFB 1, it prompts for specific details related to auto insurance fraud, such as the Vehicle Identification Number (VIN) and license plate numbers, alongside other fraud types, enhancing the specificity and efficacy of fraud detection and prevention measures.

The Health Care Fraud Reporting Form, much like the NY IFB 1 form, targets a specific segment of insurance fraud. Both forms solicit detailed descriptions of the fraudulent act, information on the suspected parties, and the financial impact of the fraud. This specialization facilitates targeted investigations into fraudulent activities within the healthcare and medical insurance sectors.

A similar document is the Insurance Fraud Reporting Form used by various state departments and insurance companies. These forms are crucial in documenting suspected insurance fraud cases across a range of policies, including life, property, and casualty insurance. They record comprehensive details about the suspected fraud, echoing the structure and intent of the New York IFB 1 form in facilitating thorough investigations.

The Property Insurance Fraud Reporting Form mirrors the NY IFB 1 form by concentrating on fraud within the property insurance sector. It requires reporters to detail the suspected fraudulent incident, including the date, amount of loss, and specifics of the property involved, aiding in the specific investigation of fraud in property insurance claims.

Likewise, the Unemployment Insurance Fraud Report Form, while focusing on a different area of fraud, requires detailed submissions akin to those in the IFB 1 form. Both forms are vital for reporting fraudulent activity and provide spaces for outlining the fraudulent incident, perpetrator details, and monetary losses, thereby supporting the authorities in tracing and addressing fraudulent claims.

The Fire Insurance Fraud Reporting Form and the NY IFB 1 form both demand detailed information on incidents involving potential fraud, specifically with losses related to fires. Providing information such as the date of loss, amount, and any related policy or claim numbers, these forms are instrumental in investigating fire-related insurance fraud cases.

Lastly, the Life Insurance Fraud Reporting Form is another document with parallels to the NY IFB 1 form, focusing on fraud within the life insurance domain. Both forms gather significant details regarding the fraudulent activity, including information about the policies, claims, and individuals involved, serving a critical role in the detection and prevention of life insurance fraud.

Dos and Don'ts

When filling out the New York IFB-1 form, it's crucial to follow guidelines that ensure the submission is accurate and compliant. The following list outlines the do's and don'ts to keep in mind during the process.

  • Do:
    1. Thoroughly read the instructions before starting to fill out the form to avoid any mistakes.
    2. Use black or blue ink if filling out the form by hand to ensure all details are legible.
    3. Print or type the information clearly to prevent any misunderstandings or processing delays.
    4. Provide a detailed statement of the suspect transaction, including specific dates and amounts, to aid in the investigation.
    5. Include all relevant identifiers such as VIN numbers and license plate numbers if the case involves auto fraud.
    6. Make sure to list any law enforcement agencies you have already reported the transaction to, including contact details.
    7. Contact your company's representative who can provide more information if required.
    8. Check the form for any errors or omissions before submitting.
    9. Sign and date the form to validate the information you've provided.
    10. Keep a copy of the filled-out form for your records.
  • Don't:
    1. Leave any section blank; write 'N/A' if a question does not apply to your situation.
    2. Use abbreviations or acronyms without first providing the full term to ensure clarity.
    3. Ignore the requirement to attach additional sheets if necessary for providing complete information.
    4. Submit the form without first verifying the accuracy of all information.
    5. Forget to include the policy, claim, or reference number related to the suspect transaction.
    6. Neglect indicating whether you have previously submitted a report on the same incident, as this helps avoid duplication.
    7. Use pencil or any other non-permanent writing tool that may fade or be easily altered.
    8. Assume you don’t need to provide contact details for a company representative.
    9. Fail to report the transaction to law enforcement if advised to do so.
    10. Omit your signature and the date, which are necessary for the form to be processed.

Misconceptions

Understanding the complexities of insurance fraud reporting in New York can be daunting, especially when it involves the New York Insurance Frauds Bureau (IFB-1) form. There are several misconceptions around the use and requirements of this form, which need clarification.

  • Misconception 1: The IFB-1 form is only for reporting auto insurance fraud.

    Although the form mentions auto and no-fault fraud, it's not limited to these types. The form is designed for various types of fraud, including medical, workers comp, and fraudulent ID cards, among others. This broad scope is important for comprehensive fraud reporting.

  • Misconception 2: Only insurance companies can submit the IFB-1 form.

    The form's section "Information furnished by:" suggests that information can be provided by a range of reporters, not strictly insurance companies. This opens the door for various stakeholders in the fight against insurance fraud to participate.

  • Misconception 3: Reporting a fraud through the IFB-1 form automatically leads to law enforcement action.

    Submission of the form starts an investigative process by the Insurance Frauds Bureau, but it does not guarantee automatic law enforcement action. Investigations are comprehensive and consider various factors before proceeding with legal steps.

  • Misconception 4: The form requires conclusive evidence of fraud before submission.

    While detailed information is beneficial, the form is designed to flag suspect transactions. The expectation is not to provide conclusive evidence but rather to initiate an investigation based on reasonable suspicion.

  • Misconception 5: The transaction date and loss amount are optional details.

    Contrary to this belief, the transaction date and amount of loss are crucial details that must be filled in to provide context to the reported incident. These details assist in categorizing and prioritizing the case appropriately.

  • Misconception 6: Anonymous submissions are not allowed.

    While the form asks for detailed contact information of the individual reporting, it’s designed to gather as much useful information as possible. However, the integrity of the report is paramount, and anonymous tips can still play a valuable role in combating fraud.

  • Misconception 7: Once submitted, updates or additional information cannot be added to the IFB-1 report.

    A common misconception is that once the form is submitted, the case is closed for new information. In reality, the investigating body often relies on continued cooperation and additional information to aid their investigation. Reporting parties are encouraged to provide updates if new facts emerge.

Clearing up these misconceptions is crucial for effective collaboration between the insurance industry, stakeholders, and regulatory bodies in New York. Understanding the flexibility and requirements of the IFB-1 form ensures that suspicions of fraud are reported accurately, facilitating timely and efficient investigations.

Key takeaways

Filling out and using the New York IFB-1 form, provided by the New York State Department of Financial Services Insurance Frauds Bureau, is a structured process aimed at reporting insurance fraud. This form is instrumental in the fight against fraudulent activities involving insurance in New York. Here are seven key takeaways to ensure that its completion and use are done accurately and effectively:

  • Provide complete informant information: The section requesting information about the person furnishing the information is crucial. It is not only about who is submitting the report but also includes their address and the NAIC number, which is mandatory for insurers.
  • Clear articulation of the suspect transaction: A concise yet comprehensive statement about the suspect transaction is required. This includes the date of loss, amount of loss, and the type of loss incurred. Specification of the policy type, such as Auto, No-Fault, Medical, Workers Comp., or others, is essential for accurate categorization and investigation.
  • Detailed identification of parties involved: Identifying information for all parties involved in the suspect transaction is necessary. This information should include names and addresses, and if applicable, vehicle identification numbers (VIN) or license plate numbers, especially in cases of auto insurance or fraudulent identification cards.
  • Policy and claim identification: It is important to accurately identify the policy, claim, or reference number associated with the transaction. This assists the Insurance Frauds Bureau in locating and reviewing the specific case within their system.
  • Contact information for further details: One must provide the name, title, address, and telephone number of an individual within the company who can offer detailed information about the suspect transaction. This point of contact is critical for follow-up or additional inquiries by the bureau.
  • Reporting to other law enforcement agencies: Disclosing whether the transaction has been reported to any other law enforcement agency is required. If reported elsewhere, the form asks for the agency's name, address, the person contacted, their telephone number, and the date of the report. This helps in coordinating investigations between different agencies.
  • Form completion and submission: The form needs to be signed and the title of the signatory provided at the bottom. For cases requiring extensive detail that doesn't fit the provided space, one can continue on the reverse or attach additional sheets as necessary. Proper submission of the completed form, according to the guidelines provided, is fundamental for the report to be processed.

This form is a vital tool for insurance companies and individuals in New York to report suspected insurance fraud, aiding in the efforts to combat fraudulent activities. Accurate and thorough completion facilitates an efficient investigation process, contributing to the integrity of the insurance system.

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